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EndoTODAY ³»½Ã°æ ±³½Ç


[Áߺνĵµ°Ô½Ç. Mid-esophageal diverticulum] - ðû

2020-4-25. ¼øõ¸¸³»½Ã°æ¼¼¹Ì³ª µ¿¿µ»ó °­ÀÇ


1. ³»½Ã°æ ¼Ò°ß

Pentax Imagina·Î ÃÔ¿µÇÑ Áߺνĵµ °Ô½Ç


2. Áߺνĵµ°Ô½Ç ³»½Ã°æÄ¡·á

Áߺνĵµ°Ô½ÇÀÌ Å©¸é Áõ»óÀÌ ¹ß»ýÇÒ ¼ö ÀÖ½À´Ï´Ù. ÃÊ°í·É ȯÀÚ¿´½À´Ï´Ù. ¼ö¼ú ÀÌ¿ÜÀÇ ´Ù¸¥ ¹æ¹ýÀÌ ¾ø´Âµ¥, ¼ö¼úÀº ³Ê¹« À§ÇèÇÏ´Ï À½½ÄÀ» Á¶±Ý¾¿ µå½Ã°í ¹°À» ¸¹À̵å½Ã¶ó´Â À̾߱⸸ µé¾ú´Ù°í ÇÕ´Ï´Ù. 2Â÷ ÀÇ°ßÀ» À§ÇÏ¿© ¹æ¹®ÇÏ¿´½À´Ï´Ù.

Endoscopic septal dissectionÀ» ½ÃµµÇϱâ·Î ÇÏ°í Zenker diverticulum ³»½Ã°æÄ¡·á ÇÏ´Â °Í°ú ºñ½ÁÇÏ°Ô knife¸¦ ÀÌ¿ëÇÏ¿© septumÀ» Àý°³ÇÏ¿´½À´Ï´Ù. Áõ»óÀº Áï½Ã ÁÁ¾ÆÁ³½À´Ï´Ù. õ°øÀÌ °ÆÁ¤ÀÌÁö¸¸ ½Ã¼úÀº ±×¸® ¾î·ÆÁö ¾Ê¾Ò½À´Ï´Ù.

½Ã¼úÀå¸é µ¿¿µ»ó


3. Midesophageal traction diverticulum with anthracotic pigmentation

[2018-6-26. ¾Öµ¶ÀÚ Áú¹®]

ÀÌÁØÇà±³¼ö´Ô²²

¾È³çÇϼ¼¿ä? ´Ê¾úÁö¸¸ À۳⿡ À§³»½Ã°æ hands on ±³À°À» ¹ÞÀ» ¼ö ÀÖ°Ô ÇØÁּż­ ´Ù½Ã Çѹø °¨»çµå¸³´Ï´Ù. Àúµµ ¸ð¸£°Ô Àͼ÷ÇØÁø ³»½Ã°æ ½À°üµéÀ» °´°üÀûÀ¸·Î ºÁÁÖ½Ã°í ¹Ù·ÎÀâ¾Æ Áּż­ ÀÌÀüº¸´Ù ÈξÀ ¾ÈÁ¤ÀûÀ¸·Î °Ë»çÇÒ ¼ö ÀÖ°Ô µÈ °Í °°½À´Ï´Ù. ¹°·Ð ½ºÅ³º¸´Ù´Â º´º¯À» ¾Ë¾Æº¸´Â ³»°øÀÌ Áß¿äÇÏ°ÚÁö¿ä? ¾ÕÀ¸·Îµµ EndoTODAY¸¦ ÅëÇØ ´õ ¿­½ÉÈ÷ °øºÎÇÏ°Ú½À´Ï´Ù.

ÃÖ±Ù ºñ½ÁÇÑ µÎ ½Äµµº´º¯À» Á¢ÇÏ°Ô µÇ¾î ¹®Àǵ帮°íÀÚ ÇÕ´Ï´Ù. Áߺνĵµ °Ô½Ç ±âÀú¸é¿¡ °ËǪ¸¥ »öÀÌ ºñÃç º¸ÀÌ´Â °ÍÀ¸·Î Ȥ½Ã ºÎ½Ä¼º ½Äµµ¿°ÀÇ scar tissueÀΰ¡ ½Í¾î¼­ º´·ÂÀ» ûÃëÇÏ¿´À¸³ª Ưº°ÇÑ Á¡Àº ¾ø¾ú½À´Ï´Ù.

Áõ·Ê 1

Áõ·Ê 2

±³¼ö´ÔÀÇ ÀÇ°ßÀº ¾î¶°½ÅÁö¿ä?

[2018-6-26. ÀÌÁØÇà ´äº¯]

Traction diverticulum ¹Ù´ÚÀÇ anthracotic pigmentationÀÔ´Ï´Ù. ¿ì¸®³ª¶ó¿¡¼­ Áߺνĵµ traction diverticulumÀÇ ÈçÇÑ ¿øÀÎÀº °áÇÙ¼º mediastinal lymphadenopathyÀÔ´Ï´Ù. °áÇÙÀÌ ÁÁ¾ÆÁö¸é¼­ ½Äµµ º®ÀÌ ´ç°ÜÁ®¼­ traction diverticulumÀÌ ¸¸µé¾îÁö´Â °ÍÀÔ´Ï´Ù.

°áÇ٠ȯÀÚÀÇ ±â°üÁö ³»½Ã°æ¿¡¼­ anthracotic pigmentationÀÌ ÀÚÁÖ °üÂûµÇ´Â °ÍÀº Àß ¾Ë°í °è½Ç °ÍÀÔ´Ï´Ù. ¸¶Âù°¡Áö·Î °áÇÙ¼º ¸²ÇÁÀý¿°¿¡¼­µµ anthracotic pigmentationÀÌ ¹ß»ýÇÕ´Ï´Ù. °áÇÙ¼º ¸²ÇÁÀý¿°ÀÌ ½Äµµº®À¸·Î ÆıÞÇÏ°í ¶Ç ¾Æ¹°¸é¼­ ½Äµµº®ÀÌ ´ç°ÜÁ® traction diverticulumÀÌ µÇ´Â °ÍÀε¥, ÀÌ °úÁ¤¿¡¼­ °Ô½Ç ¹Ù´Ú¿¡ anthracotic pigmentationÀÌ ³²°Ô µË´Ï´Ù.

Pathology International 2002

¾Æ·¡´Â Á¦°¡ °æÇèÇÑ Áõ·ÊÀÔ´Ï´Ù.

Pathology International 2002¿¡ ¸Å¿ì ÀλóÀûÀÎ ÀϺ» Áõ·Ê º¸°í°¡ À־ ÃÊ·Ï°ú »çÁøÀ» ¼Ò°³ÇÕ´Ï´Ù.

"A case of anthracosis of the esophagus is reported. The patient was a previously healthy 69-year-old Japanese woman. A black and slightly elevated lesion was detected in her esophagus by upper gastroesophageal fiberoscopic examination. Endoscopically, the lesion looked like malignant melanoma. Thoracic esophagotomy was then performed. Histological examination revealed a pigmented lesion beneath the mucosal epithelial layer. The lesion consisted of an aggregation of histiocytes containing an abundance of tiny black pigments. A few mature lymphocytes and plasma cells were also evident in the periphery of the lesion. Histologically, these findings looked like lymph nodes in the pulmonary hilus; however, no lymph nodal structure was evident in the esophageal wall. Traction diverticula were also noted in the pigmented lesion. The patient has remained well without disease for 9 months since the surgery. Although anthracosis is a rare condition in the esophagus, the present case gave warning to pathologists and clinicians that it does indeed occur. Endoscopists and pathologists should differentiate anthracosis from malignant melanoma because the treatment and outcome are quite different for each."

½ÄµµÀÇ melanocytosis/melanosis¿Í °¨º°ÇØ¾ß ÇÒ °Í Áß Çϳª°¡ anthracosisÀÔ´Ï´Ù.


[2022-2-3. ¾Öµ¶ÀÚ Áú¹®]

¿¬ÈÞ µ¿¾È Esophageal diverticulum°ú °ü·ÃÇÑ ½Ã¼úÀ» EndoToday¿¡¼­ ã¾Æº¸°Ô µÇ¾ú½À´Ï´Ù. ÀÌ Áß, ÁߺΰԽǿ¡¼­ septotomy (FESD)¸¦ ½ÃÇàÇÑ µ¿¿µ»ó°ú »çÁøÀ» ¸Å¿ì Èï¹Ì·Ó°Ô º¸¾Ò½À´Ï´Ù.

½Ã¼ú Àå¸é µ¿¿µ»ó

ƯÈ÷, ½Ã¼ú°ú °ü·ÃÇÑ ¼³¸í¿¡¼­, septumÀ» °ÅÀÇ '»§±¸'°¡ ³¯ Á¤µµ·Î ±í°Ô ÃÄ¾ß ÇÏ°í, ½Ã¼ú ½Ã°£Àº 15ºÐ ³²ÁþÀ¸·Î ª¾ÒÀ¸¸ç, õ°øÀÇ À§Ç輺ÀÌ ³ô´Ù´Â ³»¿ëÀÌ ÀλóÀûÀ̾ú½À´Ï´Ù. ½Ã¼ú µ¿¿µ»óÀÇ »çÁø¿¡¼­ ÃÊ·Ï»ö ¿ø ºÎºÐÀÌ Á» ¾Æ½½¾Æ½½ÇØ º¸¿´½À´Ï´Ù¸¸, º°µµÀÇ clippingÀ» ÇÏÁö ¾Ê°í Á¾·áÇÑ °Í °°¾Ò½À´Ï´Ù. ÃÊ·Ï»ö ¿ø ºÎºÐÀº serosa°¡ ³ëÃâµÈ°ÍÀº ¾Æ´ÑÁö ±Ã±ÝÇÏ¿© ¿©Âã½À´Ï´Ù.

¾Æ¿ï·¯, '¾î´À Á¤µµ'±îÁö septumÀ» ÃÄ¾ß ÇÏ´ÂÁö Ȥ½Ã ±³¼ö´Ô¸¸ÀÇ ±âÁØÀ̳ª landmark°¡ ÀÖÀ¸½ÇÁö ¿©Âã½À´Ï´Ù.

[2022-2-6. ÀÌÁØÇà ´äº¯]

´äÀÌ ´Ê¾ú½À´Ï´Ù. Á˼ÛÇÕ´Ï´Ù. »õÇØ º¹ ¸¹ÀÌ ¹ÞÀ¸¼¼¿ä.

±×·¸½À´Ï´Ù. ÁöÀûÇϽŠ¹Ù¿Í °°ÀÌ ½Ã¼úÇϸ鼭 ÃÊ·Ï»ý µ¿±×¶ó¹Ì ºÎÀ§¸¦ º¸°í "Ȥ½Ã õ°øÀΰ¡?" °ÆÁ¤Çߴµ¥ ½Ã¼ú ÈÄ ÈäºÎ »çÁø¿¡¼­ º° ¹®Á¦°¡ ¾ø°í ȯÀÚµµ Ưº°ÇÑ ºÒÆí°¨ ¾øÀÌ Àß È¸º¹Çϼ̽À´Ï´Ù. Á¦ÁÖµµ ȯÀÚ¿´´Âµ¥ Áõ»óÀÌ ÁÁ¾ÆÁ³´Ù°í ±â»µÇϸ鼭 Àú¿¡°Ô õ¸®Çâ ÇÑ ¹Ú½º¸¦ º¸³»Á̴ּø ±â¾ïÀÌ ³³´Ï´Ù. ±è¿µ¶õ¹ý ÀÌÀüÀÇ ¹Ì´ãÀÌÁö¸¸...

¾Æ½Ã´Â ¹Ù¿Í °°ÀÌ ½Ã¼ú°ú °ü·ÃµÈ õ°øÀº ´ëºÎºÐ ±Ý½Ä°ú Ç×»ýÁ¦·Î ÇØ°áÇÒ ¼ö ÀÖ½À´Ï´Ù. õ°øÀ» ¸ð¸£°í ½Ä»ç¸¦ ÇÏ¿© Á¾°Ýµ¿¿°ÀÌ ¹ß»ýÇÑ °æ¿ì°¡ ¹®Á¦ÀÌÁö ½Ã¼ú ÈÄ ÀûÀýÈ÷ »ìÇÇ°í ÃæºÐÈ÷ ±Ý½ÄÇϸé ÇØ°áÀÌ µË´Ï´Ù. ±×·¡¼­ ±×¸® °ÆÁ¤ÇÒ °ÍÀº ¾ø½À´Ï´Ù. Áõ»óÀÌ Àç¹ßµÇÁö ¾Êµµ·Ï ±ÙÀ° fiber¸¦ ³¡±îÁö ²÷¾îÁÖ´Â °ÍÀÌ Áß¿äÇÒ °Í °°½À´Ï´Ù. »ç½Ç ÃÊ·Ï»ö µ¿±×¶ó´Ï ÇÏ´ÜÀÇ transverseÇÑ ±ÙÀ°ÃþÀ» Á¶±Ý ´õ cutting Çұ±î ¸î ¹ø ¸Á¼³¿´´ø ±â¾ïÀÌ ³³´Ï´Ù. Ç×»ó °¡´ÉÇÑ °ÍÀº ¾Æ´ÏÁö¸¸ º¸ÀÌ´Â transverseÇÑ ±ÙÀ°ÃþÀ» ¸ðµÎ cutting ÇÏ´Â °ÍÀÌ ÀÏÂ÷ÀûÀÎ ¸ñÇ¥ÀÔ´Ï´Ù.

Àú´Â ¾ÆÁ÷ ½ÃµµÇÑ ÀûÀÌ ¾øÁö¸¸ POEM ¹æ¹ýÀ» Àû¿ëÇÏ¸é º¸´Ù ¾ÈÀüÇÒ °Í °°±â´Â ÇÕ´Ï´Ù. ¾ÕÀ¸·Î´Â ºñ½ÁÇÑ È¯ÀÚ°¡ ¿À½Ã¸é ¹Î¾ç¿ø ±³¼ö´ÔÀ̳ª ÀÌÇõ ±³¼ö´Ô²² ÀÇ·ÚÇÏ·Á°í ÇÕ´Ï´Ù.


[References]

1) ½Äµµ °Ô½Ç: Zenker diverticulum, Killian-Jamieson °Ô½Ç, Áߺνĵµ °Ô½Ç, ÇϺνĵµ °Ô½Ç, 2022³â ½Åö¹Î ±³¼ö´Ô Á¾¼³

2) À§ °Ô½Ç

3) ½ÊÀÌÁöÀå °Ô½Ç

4) Meckel °Ô½Ç

5) ´ëÀå °Ô½Ç°ú °Ô½Ç¿°

© ÀÏ¿ø³»½Ã°æ±³½Ç ¹Ù¸¥³»½Ã°æ¿¬±¸¼Ò ÀÌÁØÇà. EndoTODAY Endoscopy Learning Center.