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[¹«´äÅä·Ð - À§½Äµµ¿ª·ùÁúȯ 008. ¿ª·ù¼º ½Äµµ¿° LA-B]

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³»½Ã°æ ¼Ò°ßÀ» ¾î¶»°Ô ±â¼úÇØ¾ß ÁÁÀ»Áö ¸ð¸£°Ú´Ù´Â Áú¹®À» ¹Þ¾Ò½À´Ï´Ù. ±¸Ã¼ÀûÀ¸·Î´Â LA-B¶ó ºÒ·¯¾ß ÁÁÀ»Áö LA-C¶ó ºÒ·¯¾ß ÁÁÀ»Áö ±Ã±ÝÇØÇÏ°í ÀÖ¾ú½À´Ï´Ù.

ÀÏ´Ü 12½Ã, 3½Ã, 6½Ã ¹æÇâ¿¡ °æ°è°¡ È帰 longitudinal hyperemia°¡ º¸ÀÔ´Ï´Ù. ±× ÁÖº¯ Á¡¸·Àº Á¤»óº¸´Ù ÇϾé°Ô º¸ÀÌ°í Á¡¸·ÇÏ Ç÷°üµéÀÌ º¸ÀÌÁö ¾Ê½À´Ï´Ù. Mucosal break°¡ ÀÖ°í ÁÖº¯ Á¡¸·ÀÌ dirty white squamous hyperplasia¸¦ º¸ÀÌ´Â °ÍÀÔ´Ï´Ù.

¹®Á¦´Â 'mucosal break ÇϹæÀÌ À¶ÇյǾú´Â°¡?'ÀÔ´Ï´Ù. À¶ÇÕÀ̸é LA-C, À¶ÇÕÀÌ ¾Æ´Ï¸é LA-BÀÏ °ÍÀ̴ϱî¿ä. ±×·±µ¥ °£´ÜÇÏÁö ¾Ê½À´Ï´Ù. À§½ÄµµÁ¢Çպο¡ 2 cm ¹Ì¸¸ÀÇ hiatal hernia°¡ ÀÖÀ¸¸é¼­ squamocolumnar junctionÀÌ blurring µÇ¾î Àֱ⠶§¹®ÀÔ´Ï´Ù. Àú´Â À¶ÇÕÀ̶ó°í ÆÇ´ÜÇÏÁö ¸»°í LA-B·Î ºÎ¸¦ °ÍÀ» ±ÇÇß½À´Ï´Ù. »ç½Ç 1³â Àü »çÁø(¾Æ·¡)À» º¸¸é Á» ´õ ¸íÈ®ÇÕ´Ï´Ù. ±Ùº»ÀûÀ¸·Î ¿ÃÇØ¿Í °°Àº ¼Ò°ßÀÔ´Ï´Ù.

¿ÃÇØ »çÁø 3½Ã ¹æÇâ mucosal break ¾Æ·¡ À§Á¡¸·ÀÌ ¾à°£ ºÎÇ®¾î º¸ÀÔ´Ï´Ù. °úÀåÇϸé sentinel polypÀÔ´Ï´Ù. ±×·¯³ª ¹«½ÃÇϽʽÿÀ. ÀÓ»óÀû ÀÇÀÇ°¡ ¾ø´Â »ç¼ÒÇÑ ¼Ò°ßÀº ¹«½ÃÇÏ´Â °ÍÀÌ ³»½Ã°æÀÇ ¹Ì´öÀÔ´Ï´Ù.

¿ÃÇØ »çÁø ÁÂÃø(7½Ã-11½Ã)´Â ¿ìÃø°ú ´Þ¸® ¾à°£ acute angleÀ» ÀÌ·ç°í ÀÖ½À´Ï´Ù. ÀÌ°÷Àº His angle Á÷»ó¹æÀÔ´Ï´Ù. ªÀº hiatal hernia°¡ ÀÖ´Â »ç¶÷¿¡¼­ His angle Á¶±Ý À§ÂÊ¿¡ ÀÌ¿Í °°Àº acute angulationÀ» º¸ÀÌ´Â °æ¿ì´Â ¸¹½À´Ï´Ù. ÀÌÀ¯´Â Àúµµ ¸ð¸¨´Ï´Ù.

¿äÄÁµ¥ ÀÌ·¸°Ô ¾²½Ã¸é µÇ°Ú½À´Ï´Ù. ÇϺνĵµ¿¡ °æ°è°¡ ºÒºÐ¸íÇÑ ±ä longitudinal hyperemia ¾ç»óÀÇ mucosal break°¡ ¿©·µ °üÂûµÇ¸é¼­ ÁÖº¯ ½Äµµ Á¡¸·Àº dirty white squamous hyperplasia¸¦ º¸ÀÔ´Ï´Ù. 2 cm ¹Ì¸¸ÀÇ hiatal hernia°¡ ÀÖ°í Z-lineÀÌ blurring µÇ¾î ÀÖÁö¸¸ mucosal breakÀÇ convergence´Â ¶Ñ·ÇÇÏÁö ¾Ê½À´Ï´Ù. Impression: reflux esophagitis, LA-B

Sentinel polypÀº ¸íÈ®ÇÏÁö ¾ÊÀ¸¹Ç·Î ¾ð±ÞÇÏÁö ¾Ê´Â °ÍÀÌ ÁÁ°Ú½À´Ï´Ù. ±¦È÷ ³î¶ø´Ï´Ù.


[References]

1) EndoTODAY ¹«´äÅä·Ð - À§½Äµµ¿ª·ùÁúȯ

© ÀÏ¿ø³»½Ã°æ±³½Ç ¹Ù¸¥³»½Ã°æ¿¬±¸¼Ò ÀÌÁØÇà. EndoTODAY Endoscopy Learning Center. Lee Jun Haeng. (2016-4-5)