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[EsoTODAY 027 - Anatomy of hiatal hernia]

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[2017-6-8. ¾Öµ¶ÀÚ Áú¹®]

EG junction¿¡ ´ëÇÑ ÀÌÇØ°¡ ºÎÁ·ÇÏ¿© Áú¹®µå¸³´Ï´Ù. ½Äµµ ¸»´ÜºÎÀ§ ÇغÎÇÐÀ» ã¾Æº¸´Ï ±¸±Û¿¡¼­ ´ÙÀ½°ú °°Àº ±×¸²À» ã¾Ò½À´Ï´Ù.

LES°¡ ½Äµµ distal ºÎÀ§ ȾÃà¿¡ ±æ°Ô ¼±»óÀ¸·Î °ÉÃÄÀÖÀ¸¸ç ±× ¹üÀ§¾È¿¡ A,B,C ¸µÀÌ Àִµ¥ A¸µÀº ±¸Ã¼ÀûÀ¸·Î muscularis ring(=inf.esophageal sphincter), B¸µÀº mucosal ring(=SC junction), C¸µÀº diaphragmatic orifice·Î ÀÌÇØÇÏ¸é µÉ±î¿ä?

±¸Ã¼ÀûÀ¸·Î EG junctionÀÌ ¾î´À ºÎÀ§ÀÎÁö ±×¸®°í SC jungtion °ü°è´Â ¾î¶»°ÔµÇ´ÂÁö È¥¶õ½º·´½À´Ï´Ù.

[2017-6-8. ÀÌÁØÇà ´äº¯]

º¸³»ÁֽŠ±×¸² Áß Ã¹¹ø° ±×¸²Àº Âü°íÇÒ¸¸ ÇÏÁö¸¸, µÎ¹ø° ±×¸²Àº ¸Å¿ì ¾ûÅ͸®ÀÔ´Ï´Ù. Àؾî¹ö¸®½Ã±â ¹Ù¶ø´Ï´Ù. Â÷¶ó¸® Á¦°¡ ±×¸° ±×¸²À» º¸½Ã¸é ÁÁ°Ú½À´Ï´Ù.

LES´Â ½Äµµ circular muscleÀÌ ÇϺνĵµ¿¡¼­ 3cm ±æÀÌ Á¤µµ µÎ²¨¿öÁø °ÍÀÔ´Ï´Ù. Á¤»óÀûÀÎ °æ¿ì LES ¸»´Ü°ú, squamocolumnar junction°ú EG junctionÀº °ÅÀÇ ÀÏÄ¡ÇÕ´Ï´Ù.

Sliding hiatal hernia°¡ ÀÖÀ¸¸é LES ÇÏ´ÜÀÇ squamous columnar junction ºÎÀ§°¡ web ºñ½ÁÇÏ°Ô inward indentationÀ» º¸À̴µ¥ À̸¦ mucosal ring ȤÀº B ringÀ̶ó°í ºÎ¸£¸ç, ÀÌ ºÎÀ§°¡ fixedµÇ¾î Á¼¾ÆÁö¸é Shatzki ringÀ̶ó°í ÇÕ´Ï´Ù. LES »ó´ÜÀÌ ¾à°£ ¹¶ÅüÇÏ°Ô ¼öÃàµÇ¾î º¸À̴µ¥ À̸¦ muscular ring ȤÀº A ringÀ̶ó°í ºÎ¸¨´Ï´Ù. ½ÇÁ¦·Î ÀÌ ºÎÀ§°¡ anatomicalÇÏ°Ô Á¼¾ÆÁöÁö´Â ¾Ê½À´Ï´Ù. ³»½Ã°æÀ» ÇÒ ¶§ ³»½Ã°æ »ðÀԺθ¦ ¾à°£ Á¶ÀÌ°í ÀÖ´Â µíÇÏ°Ô º¸ÀÏ »ÓÀÔ´Ï´Ù. Sliding hiatal hernia°¡ ÀÖÀ» ¶§ musclar ring°ú mucosal ringÀÇ »çÀÌ(±×·¯´Ï±î LES ºÎÀ§¿Í ÀÏÄ¡ÇÕ´Ï´Ù)°¡ ¹èÈ긲±âµÕó·³ ¾à°£ ¹Ù±ùÀ¸·Î ºÒ·èÇѵ¥ ÀÌ ºÎÀ§¸¦ ampulla ȤÀº vestibuleÀ̶ó°í ºÎ¸¨´Ï´Ù. Sliding hiatal hernia°¡ ÀÖÀ» ¶§ mucosal ring (= squamocolumnar junction = EG junction) ¾Æ·¡ºÎÅÍ diaphragmatic orfice »çÀ̵µ ¹èÈ긲±âµÕó·³ ¾à°£ ¹Ù±ùÀ¸·Î ºÒ·èÇѵ¥ ÀÌ ºÎÀ§¸¦ hernia sacÀ̶ó°í ºÎ¸¨´Ï´Ù.

C ringÀº Àß ¾²´Â ¸»ÀÌ ¾Æ´Ñµ¥¿ä... ¼±»ý´ÔÀÌ º¸³»ÁֽŠù¹ø° ±×¸²À» º¸´Ï diaphragmatic orfice¸¦ ÁöĪÇÏ´Â °Í °°½À´Ï´Ù. "LES°¡ ½Äµµ distal ºÎÀ§ ȾÃà¿¡ ±æ°Ô ¼±»óÀ¸·Î °ÉÃÄÀÖÀ¸¸ç ±× ¹üÀ§¾È¿¡ A,B,C ¸µÀÌ Àִµ¥" ºÎºÐÀº Áú¹®ÇϽŠ¼±»ý´Ô²²¼­ ¿ÏÀüÈ÷ Àß ¸ø ¾Ë°í °è½Å °ÍÀÌ´Ï Àؾî¹ö¸®¼¼¿ä. LES´Â A ring°ú B ring »çÀÌÀÌ°í C ring°ú´Â ÀüÇô ¹«°üÇÕ´Ï´Ù.

º¸´Ù »ó¼¼ÇÑ ³»¿ëÀº Á¦°¡ YouTube¿¡ ¿Ã¸° °­ÀÇ µ¿¿µ»óÀ» Âü°íÇϽñ⠹ٶø´Ï´Ù. 17:00 ºÎÅÍ 27:30 »çÀÌÀÔ´Ï´Ù.

2017-5-19 one point lesson (°­ÀÇ PPT PDF)


[References]

1) EsoTODAY - Esophageal diseases

2) SmallTODAY - Small bowel diseases

3) ColonTODAY - Colorectal diseases

4) Dr. Sinn's LiverTODAY - Liver diseases

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