[Description exercise 9 Çؼ³]

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À̹ø ÁÖ¿¡´Â À§¿°°ú À¯»ç ÁúȯµéÀ» »ìÆ캸¾Ò½À´Ï´Ù. ÀúÀÇ description ´ë½Å ³»°ú º¸µå½ÃÇè Áغñ¿¡ µé¾î°£ ¾î´À Àü°øÀÇ 4³âÂ÷ÀÇ ´äº¯ (2016-12-7 2:30am)À» ¼Ò°³ÇÕ´Ï´Ù. »õº®±îÁö °øºÎÇÏ°í ³»½Ã°æ ¹®Á¦ Ǫ´À¶ó °í»ýÀÌ ¸¹¾ÒÀ¸´Ï±î^^ 7¹®Á¦ ´Ù ¸ÂÃ߼̽À´Ï´Ù. ³»½Ã°æ ½ÃÀÛÇÑÁö 1³âµµ ¾È µÇ¾ú´Âµ¥... ³î¶ø½À´Ï´Ù. ÀÌ Á¤µµ ½Ç·ÂÀÌ¸é º¸µå½ÃÇèÀº ½±°Ô ÇÕ°ÝÇÒ °Í °°½À´Ï´Ù. ±×·¯³ª ¹æ½ÉÀº ±Ý¹°. °è¼Ó ³ë·ÂÇϽðí... ÇÕ°ÝÀ» ±â¿øÇÕ´Ï´Ù.

¾Æ·¡ À§¿° µ¿¿µ»óÀ» ÃßõÇÕ´Ï´Ù. ²À º¸¼¼¿ä.

°¥¼ö·Ï ¾î·Á¿öÁø´Ù´Â ÆòÀÔ´Ï´Ù. Èû ³»¼¼¿ä.

ÇÑ ½Ç½ÀÇлýÀÇ commentÀÔ´Ï´Ù.

2022-1-14.


Case 57.

[³»°ú º¸µå½ÃÇè Áغñ¿¡ µé¾î°£ ¾î´À Àü°øÀÇ 4³âÂ÷ÀÇ ´äº¯ (2016-12-7 2:30am)] ¼Ò°ß: À§Ã¼ºÎ(¿ÞÂÊ»çÁø)¿Í fundus·Î ÃßÁ¤µÇ´Â ºÎÀ§(¿À¸¥ÂÊ»çÁø)¿¡ °ÉÃÄ 1cm ¹Ì¸¸ Å©±âÀÇ ´Ù¹ß¼ºÀÇ ¹Ì¶õÀÌ °üÂûµË´Ï´Ù. ¹Ì¶õµéÀÇ ÇüÅ´ ¸ðµÎ À¯»çÇÏ¸ç ¹Ì¶õ ÁÖº¯ÀÌ ¾à°£ À¶±âµÇ¾î ÀÖ°í, hemorrhage´Â µ¿¹ÝµÇÁö ¾ÊÀº ¾ç»óÀÔ´Ï´Ù. Áø´Ü: Erosive gastritis

Áø´Ü: ¹Ì¶õ¼º À§¿°


[ÀÌÁØÇà comment]

½ÉÇÑ ÆíÀÌÁö¸¸ ÀüÇüÀû ¹Ì¶õ¼º À§¿°ÀÔ´Ï´Ù. Flat erosionµµ ÀϺΠº¸ÀÌÁö¸¸ ´ëºÎºÐ raised erosion (= verruca)À̳׿ä. µû¶ó¼­ verrucous gastritis¶ó°í ºÎ¸¦ ¼ö ÀÖÁö¸¸, ÃÖ±Ù¿¡´Â classicÇÑ ´À³¦ÀÎ verrucous gastritisº¸´Ù´Â ±×³É erosive gastritis¶ó°í ºÎ¸£´Â °æÇâÀÎ °Í °°½À´Ï´Ù. ¹Ì¶õ¼º À§¿°Àº ¸ðµÎ chronicÀ̶ó°í º¸¸é µË´Ï´Ù. ±×·¡¼­ ±¸Å¿© chronicÀ̶ó´Â ¸»À» ºÙÀÌÁö ¾Ê°í ÀÖ´Â °ÍÀÔ´Ï´Ù.


À§¿°Àº Æ÷ÀÎÆ®°¡ Áß¿äÇÕ´Ï´Ù. ÀÌ Áõ·Ê´Â ¹°·Ð edematousÇÑ ºÎÀ§µµ ÀÖ°í hyperemicÇÑ ºÎÀ§µµ ÀÖÁö¸¸ ÁÖ ¼Ò°ßÀÌ multiple elevated erosionµéÀÔ´Ï´Ù. Áï erosive gastritisÀÎ °ÍÀÌÁö¿ä. FragileÀ̶ó´Â Ç¥ÇöÀº ºÎÀûÀýÇÕ´Ï´Ù. ³»½Ã°æ °Ë»ç´Â °ø±â¸¦ ³Ö¾î¼­ À§¸¦ ÆØâ½ÃÅ°´Â °ÍÀÌ°í °Ë»ç¸¦ ÇÏ´Ùº¸¸é Á¶±Ý¾¿ Á¡¸·À» touchÇÏ°Ô µË´Ï´Ù. À̶§ ÇÇ°¡ ³ª´Â °ÍÀ» fragileÇÏ´Ù°í ÇÕ´Ï´Ù. Fragilibity´Â easy touch bleeding°ú °ÅÀÇ °°Àº ¸»À̶ó°í º¸¸é µÇ°Ú½À´Ï´Ù. Erosive gastritis, atrophic gastritis, metaplastic gastritisÀÇ ÁÖ ¿øÀεµ Ç︮ÄÚ¹ÚÅÍÀÌ°ÚÁö¸¸ ¸¸¼º±â¿¡¼­ º¸ÀÌ´Â ¼Ò°ßÀÌ°í °ü·Ê»ó Helicobacter-associated¶ó´Â ¸»À» ¾²Áö´Â ¾Ê°í ÀÖ½À´Ï´Ù. ºñ±³Àû ±Þ¼º±â¿¡¸¸ Helicobacter-associated¶ó´Â °ÍÀ» ºÙÀÔ´Ï´Ù. ÀÌ»óÇÑ °ü·ÊÀÌÁö¿ä? °ú°Å¿¡´Â °¨¿° Ãʱ⿡ Ä¡·áÇؾ߸¸ ÀǹÌÀÖ´Â °á°ú°¡ ÀÖ´Ù°í »ý°¢Ç߱⠶§¹®¿¡ ±×·± °Í °°½À´Ï´Ù. Áö±ÝÀº À§Ã༺ È­»ý¼º À§¿°¶§µµ Ä¡·áÇÏ´Â °ÍÀÌ ÁÁ´Ù°í ÁÖÀåÇÏ´Â ºÐµéÀÌ ¸¹½À´Ï´Ù.

°ú°Å¿¡ ¹Ì¶õ¼º À§¿° ȯÀÚ¿¡¼­ Á¶±Ý µµµå¶óÁø ºÎÀ§°¡ ÀÖ¾î Á¶Á÷°Ë»ç¸¦ ÇÏ¿© À§¾ÏÀ¸·Î È®ÀεǾú´ø °æ¿ì°¡ ÀÖ¾ú½À´Ï´Ù. ´Ù¸¥ ¹Ì¶õµé°ú ¾à°£ ¶³¾îÁø °÷¿¡ À§Ä¡ÇÏ°í ÀÖ¾ú½À´Ï´Ù. ¹Ì¶õ¼º À§¿°¿¡¼­´Â Ȥ½Ã ¼û¾î ÀÖ´Â ¾ÏÀº ¾ø´ÂÁö ã¾Æº¸´Â sense¸¦ °®µµ·Ï ÇսôÙ.


Stomach, subtotal gastrectomy:
Early gastric carcinoma
1. Location : lower third, center at antrum and anterior wall
2. Gross type : EGC type IIc
3. Histologic type : signet-ring cell carcinoma
4. Histologic type by Lauren : diffuse
5. Size : 0.7x0.3x0.1 cm
6. Depth of invasion : extension to mucosa (muscularis mucosa) (pT1a)
7. Resection margin: free from carcinoma, safety margin: proximal, 9 cm; distal, 2.3 cm
8. Lymph node metastasis : no metastasis in 40 regional lymph nodes (pN0)
9. Lymphatic invasion : not identified
10.Venous invasion : not identified
11.Perineural invasion : not identified


Case 58. Two separate locations (left: high body, right: antrum)

[³»°ú º¸µå½ÃÇè Áغñ¿¡ µé¾î°£ ¾î´À Àü°øÀÇ 4³âÂ÷ÀÇ ´äº¯ (2016-12-7 2:30am)] ¼Ò°ß: À§Ã¼ºÎ ¼Ò¸¸¿¡ 3.5x5cm Á¤µµ¿Í ÀüÁ¤ºÎ ´ë¸¸¿¡ 3x2cm Á¤µµ¿¡ °ÉÃÄ diffuse erythema with whitish discoloration, focal exudate, spontaneous bleeding spots and several erosions º´º¯ÀÌ °üÂûµË´Ï´Ù. Áø´Ü: R/O EGC type IIb, R/O lymphoma

Áø´Ü: MALT ¸²ÇÁÁ¾


[ÀÌÁØÇà comment]

º´¼Ò°¡ (1) ´Ù¹ß¼ºÀÌ°í, (2) geographic ÇÏ°í, (3) ³ÐÁö¸¸ ±íÁö ¾Ê°í, (4) ÀÏ°ß ÁöÀúºÐÇÑ À§¿° °°´Ù´Â Á¡ µîÀ» °í·ÁÇØ º¸¼¼¿ä.

³»½Ã°æ ¼±ÇàÇнÀ ÁßÀÎ ÇÑ ¼±»ý´ÔÀÇ ¸Å¿ì ÀÚ¼¼ÇÑ ´ä¾ÈÀ» ¼Ò°³ÇÕ´Ï´Ù. ³»½Ã°æÀ» ÇÑ ¹øµµ Çغ¸Áö ¾Ê°í ¿ÀÁ÷ simulator training°ú °øºÎ ±×¸®°í description exercise¸¸À¸·Î ÀÌ Á¤µµ ÀÚ¼¼È÷ ±â¼úÇÒ ¼ö ÀÖ´Â ´É·ÂÀ» ¾ò¾ú´Ù´Â Á¡¿¡¼­ ³î¶ó¿î ¼º°ú°¡ ¾Æ´Ò ¼ö ¾ø½À´Ï´Ù.

µ¿¹® ¼º°á ±³¼ö´ÔÀÇ ¸ÚÁø °­ÀǸ¦ ¼Ò°³ÇÕ´Ï´Ù.

Á¦15ȸ SMC ³»½Ã°æ¼¼¹Ì³ª - Single topic symposium on gastric MALToma

* Âü°í: EndoTODAY À§ MALT ¸²ÇÁÁ¾


Case 59

[³»°ú º¸µå½ÃÇè Áغñ¿¡ µé¾î°£ ¾î´À Àü°øÀÇ 4³âÂ÷ÀÇ ´äº¯ (2016-12-7 2:30am)] ¼Ò°ß: À§ ÀüÁ¤ºÎ¿¡ multiple whitish nodular elevated lesionµéÀÌ °üÂûµÇ¸ç background mucosa´Â atrophic change¸¦ º¸ÀÌ°í ÀÖ½À´Ï´Ù. Áø´Ü: Metaplastic gastritis

Áø´Ü: È­»ý¼º À§¿°


[ÀÌÁØÇà comment]


Case 60

[³»°ú º¸µå½ÃÇè Áغñ¿¡ µé¾î°£ ¾î´À Àü°øÀÇ 4³âÂ÷ÀÇ ´äº¯ (2016-12-7 2:30am)] ¼Ò°ß: À§ÀüÁ¤ºÎ¿Í À§Ã¼ºÎ ¼Ò¸¸¿¡¼­ ºÒ±ÔÄ¢ÇÑ ¸ð¾çÀÇ ulcer¿Í shallow depressed mucosal lesionÀÌ °üÂûµË´Ï´Ù. ulcer´Â °æ°è°¡ irrerularÇÏ°í base´Â unevenÇϸ鼭 spontaneous bleedingÀÌ ±ºµ¥±ºµ¥ µ¿¹ÝµÇ°í ÀÖ½À´Ï´Ù. º´º¯ÀÌ ÀüÁ¤ºÎ ´ëºÐÀ» µ¤¾î ƯÈ÷ pylorus ÁÖº¯ ¸ðµÎ ħ¹üÇϸ鼭 pyloric stenosis¸¦ µ¿¹ÝÇÏ°í ÀÖ´Â °ÍÀ¸·Î º¸ÀÔ´Ï´Ù. Áø´Ü: Gastric syphilis

Áø´Ü: À§ ¸Åµ¶


[ÀÌÁØÇà comment]

¸Å¿ì ¾î·Á¿î ¹®Á¦ÀÔ´Ï´Ù. ÇÑ °¡Áö È®½ÇÇÑ °ÍÀº ´Ü¼øÇÑ erosive gastritis´Â ¾Æ´Ï¶ó´Â °ÍÀÔ´Ï´Ù. Impression¿¡ Å¿¬ÇÏ°Ô 'erosive gastritis'¶ó°í¸¸ ¾²¸é ¾È µÉ °Í °°¾Æ¿ä. ¹º°¡ ´Ù¸¥ Áúº´ÀÎ °Í °°´Ù´Â ´À³¦ÀÌ Àü´ÞµÇµµ·Ï impressionÀ» ºÙ¿©º¸¼¼¿ä.

»ç½Ç ¾ÆÁÖ ¿À·¡ Àü¿¡ clinicopathology conference (CPC)¿¡ ³ª¿Ô´ø Áõ·ÊÀÔ´Ï´Ù. »ï¼ºº´¿ø °³¿ø Ãʱ⿡´Â ¹Ì±¹¿¡¼­ ÀÇ»ç»ýÈ°À» ÇÏ´Ù ±Í±¹ÇϽŠºÐµéÀÌ ¸¹¾Ò±â ¶§¹®¿¡ conferenceµµ ¾à°£ ¹Ì±¹½ÄÀ̾ú½À´Ï´Ù. CPC°¡ ´ëÇ¥ÀûÀÎ ¹Ì±¹½Ä conference¿´Áö¿ä. ÀÌÁ¦´Â ´Ù ¾ø¾îÁ³½À´Ï´Ù. ÀÌÁ¦´Â ¿ÏÀüÈ÷ Çѱ¹½ÄÀ¸·Î ¿î¿µÇÏ°í ÀÖ½À´Ï´Ù. ³Ê¹« ÁÁ½À´Ï´Ù. (¿ì¸®³ª¶ó ȯÀÚÀÇ ÀÓ»ó»óÀ» ¿µ¾î·Î ¾²°í À̸¦ ´Ù½Ã Çؼ®ÇÏ¿© ÀÌÇØÇÑ´Ù´Â °ÍÀÌ ¸»À̳ª µË´Ï±î? ¿ì¸® ȯÀÚ´Â ¿ì¸®¸»·Î ÆľÇÇÏ´Â °ÍÀÌ ¿Ã¹Ù¸¥ ±æÀÔ´Ï´Ù.) ¿©ÇÏÆ° °ú°Å CPC ÀڷḦ ¿Å±é´Ï´Ù.

History: A 25-year-old, apparently healthy man presented with one month history of epigastric tenderness and vomiting. The patient visited a local clinic where he underwent an endoscopic examination and the endoscopic diagnosis was benign gastric ulcer. But gastric ulcer symptom was not improved on ulcer medication. He was transferred to our hospital for further evaluation. His family history and past medical history were negative for any gastrointestinal disease, abdominal surgery or significant medical illness. Physical examinations were normal except minimal epigastric tenderness only. A laboratory evaluation revealed hemoglobin of 16.4 g/dL and hematocrit 47.9%. White blood cell count and differential count were within normal ranges. Total serum protein level was 7.3 g/dL and albumin level 4.3 g/dL. Serum bilirubin and liver enzymes were within normal ranges. A computed tomographic scan of the abdomen with contrast revealed diffuse layered thickening of the wall of the gastric antrum, pylorus, duodenal bulb, and second portion of duodenal loop without definite perigastric and periduodenal fatty infiltration (Fig. 1). Multiple small and enlarged lymph nodes were identified along both common femoral vessel and inguinal area. Gastric endoscopy showed geographic irregular ulcer and shallow depressed mucosal lesions in almost all aspect of antrum. The ulcer revealed an irregular edge and uneven nodular base (Fig. 2). Endoscope was failed to advance to duodenal bulb due to luminal obstruction. A diagnostic procedure was done.

Layered wall thickening involving gastric antrum, pylorus, duodenal bulb,and 2nd duodenal loop

Biopsy: Chronic gastritis, active, with intestinal metaplasia (incomplete type), large lymphoid follicle and dense lymphoplasma cell infiltration (Note: Based on histology, syphilitic gastritis could be considered)

Automated Quantitative RPR Test: Reactive(5.00)

Automated Quantitative TPLA Test: Reactive(282.9)

A: foveolar pit ¿¡¼­ H.pylori °¡ °üÂûµÇÁö ¾Ê´Â´Ù. B: ½ÉÇÑ À§¿°¼Ò°ßÀ¸·Î neutrophilic infiltration ÀÌ °üÂûµÈ´Ù. C: lamina propria ¿¡ ½ÉÇÑ lymphoplasma cell infiltration ÀÌ °üÂûµÈ´Ù. D: lagre irregular lymphoid follicular hyperplasia with geographic feature

Large irregular lymphoid follicle : H.pylori °¨¿°°ú´Â ´Þ¸® marginal zone Àº »ó´ëÀûÀ¸·Î À§ÃàµÇ¾î ÀÖÀ¸³ª follicular center °¡ ½ÉÇÏ°Ô ´Ã¾î³ª¸é¼­ Áöµµ¸ð¾ç(geographic feature) À¸·Î Ä¿Á®ÀÖ´Ù.


Case 61

[³»°ú º¸µå½ÃÇè Áغñ¿¡ µé¾î°£ ¾î´À Àü°øÀÇ 4³âÂ÷ÀÇ ´äº¯ (2016-12-7 2:30am)] ¼Ò°ß: À§ ÀüÁ¤ºÎ anteroLC¿¡ 0.8cm Å©±âÀÇ geographic ÇÑ shallow depressed mucosal lesionÀÌ °üÂûµË´Ï´Ù. ÀÌ º´º¯Àº whitish discoloration º¸À̸ç ÁÖÀ§·Î ¾à°£ÀÇ erythema°¡ µ¿¹ÝµÇ°í ÀÖ½À´Ï´Ù. background gastric mucosa´Â Àü¹ÝÀûÀ¸·Î chronic atrophic change¸¦ µ¿¹ÝÇÏ°í ÀÖ½À´Ï´Ù. Áø´Ü: Chronic atrophic gastritis with single erosion, R/O EGC IIc

Áø´Ü: EGC IIc


[ÀÌÁØÇà comment]

Á¶Á÷°Ë»ç °á°ú´Â 'tiny atypical glandular lesion with fused architecture and atypical cytology, suggestive of adenocarcinoma, well-differentiated'¿´½À´Ï´Ù. Á¶±âÀ§¾Ï ÃßÁ¤À¸·Î ³»½Ã°æÀýÁ¦¼úÀ» ½ÃÇàÇÏ¿´°í ÁÁÀº °á°ú¿´½À´Ï´Ù.


Endoscopic submucosal dissection:
Early gastric carcinoma
1. Location : proximal antrum, lesser curvature
2. Gross type : EGC type IIb+IIc
3. Histologic type :tubular adenocarcinoma, moderately differentiated
4. Histologic type by Lauren : intestinal
5. Size of carcinoma : (1) longest diameter, 14 mm (2) vertical diameter, 10 mm
6. Depth of invasion : invades mucosa (muscularis mucosa) (pT1a)
7. Resection margin : free from carcinoma(N), safety margin : distal 12 mm, proximal 5 mm, anterior 12 mm, posterior 10 mm
8. Lymphatic invasion : not identified(N)
9. Venous invasion : not identified(N)
10. Perineural invasion : not identified(N)
11. Microscopic ulcer : absent
12. Histologic heterogeneity: absent


Case 62

[³»°ú º¸µå½ÃÇè Áغñ¿¡ µé¾î°£ ¾î´À Àü°øÀÇ 4³âÂ÷ÀÇ ´äº¯ (2016-12-7 2:30am)] ¼Ò°ß: À§º® ÁÖ¸§ÀÌ ºñÈÄµÇ¾î º¸À̸ç 6°³¿ù ÈÄ »çÁø¿¡¼­ ¾ÇÈ­µÇ°Å³ª »õ·ÎÀÌ ulcer°¡ ¹ß»ýÇÑ ¼Ò°ß µî ¾ø½À´Ï´Ù. ÁÖ¸§ ºñÈÄ ¾ç»óÀ» º¼ ¶§ ²¿ºÒ²¿ºÒÇϸ鼭 ÁÖ¸§»çÀÌÀÇ °ñÀº Àß À¯ÁöµÇ°í ÀÖ´Â ¼Ò°ßÀÔ´Ï´Ù. Áø´Ü: Hypertrophic gastritis

Áø´Ü: ºñÈļº À§¿° (°æÇÑ ÆíÀÔ´Ï´Ù. º¸¸¸ 4Çü ÁøÇ༺ À§¾Ï ÀǽÉÀ¸·Î ÀǷڵǼ̴ø ºÐÀÔ´Ï´Ù.)

* Âü°í: EndoTODAY ºñÈļº À§¿°


Case 63

[³»°ú º¸µå½ÃÇè Áغñ¿¡ µé¾î°£ ¾î´À Àü°øÀÇ 4³âÂ÷ÀÇ ´äº¯ (2016-12-7 2:30am)] ¼Ò°ß: À§Ã¼ºÎ ¹× fundus¿¡¼­ À§º®ÀÇ mosaic-like pattern°ú ´Ù¹ß¼º vascular ectasia, ÀϺΠclotÀ» °üÂûÇÒ ¼ö ÀÖ½À´Ï´Ù.

Áø´Ü: Portal hypertensive gastropathy, mild (Baveno classification)


[ÀÌÁØÇà comment]

Portal hypertensive gastropathyÀÇ ³»½Ã°æ ¼Ò°ßÀ» Àß Á¤¸®ÇÑ Ç¥¸¦ ¼Ò°³ÇÕ´Ï´Ù. ¸î °³ÀÇ Áõ·Ê¿Í ÇÔ²².

ºÐ·ù´Â 2´Ü°è ºÐ·ù¿Í 3´Ü°è ºÐ·ù°¡ Àִµ¥, ÀúÈñ´Â Baveno ºÐ·ù(2 ´Ü°è)¸¦ »ç¿ëÇÏ°í ÀÖ½À´Ï´Ù.

Baveno classification

* Âü°í: EndoTODAY Portal hypertensive gastropathy. ¹®¸Æ¾ÐÇ×Áø À§º´Áõ


[2016-12-9. ÀÌÁØÇà comment]

"À̹ø ÁÖ ¼÷Á¦´Â ±²ÀåÈ÷... ¾î·Á¿ü½À´Ï´Ù¤Ð¤Ð"¶ó´Â ÀÇ°ßÀÌ ÀÖ¾ú½À´Ï´Ù. Á¦°¡ ³­À̵µ Á¶Àý¿¡ ½ÇÆÐÇÑ ¸ð¾çÀÔ´Ï´Ù.^^ Á˼ÛÇÕ´Ï´Ù.

°¡Àå ¸ÕÀú ´ä¾ÈÀ» º¸³»ÁֽŠºÐ²²¼­ Ʋ·È´ø ¹®Á¦¿¡ ´ëÇÏ¿© ¾à°£ÀÇ hint¸¦ µå¸° ÈÄ ´Ù½Ã ´äº¯À» ¹Þ¾Ò½À´Ï´Ù.

¹®Á¦Ã³À½ ´äº¯Hint ÈÄ ´äº¯
57Verrucous gastritis (Á¤´ä)
58EGC IIcMALT lymphoma (Á¤´ä)
59Metaplastic gastritis (Á¤´ä)
60NSAID-related ulcersLymphoma
r/o viral gastritis
r/o gastric syphilis (Á¤´ä)
61BGU H2EGC (Á¤´ä)
62Hyperplastic gastritis (Á¤´ä. Hypertrophic gastritis°¡ ´õ ÁÁÀº ¿ë¾îÀÓ)
63AGC B-IVPortal hypertensive gastropathy (Á¤´ä)

±×·¸½À´Ï´Ù. ³»½Ã°æ »çÁø¸¸ º¸°í Áø´ÜÀ» ¸ÂÃ߱⺸´Ù´Â ÀÓ»ó»óÀ» ¾Ë°í ³»½Ã°æ »çÁøÀ» º¸´Â ÂÊÀÌ ÈξÀ Á¤È®ÇÕ´Ï´Ù. °ËÁø ³»½Ã°æ¿¡¼­ ȤÀº ÁøÁ¤ ³»½Ã°æÀ» ÇÒ ¶§ ȯÀÚ¿¡°Ô ÇÑ ¸¶µðµµ ¹°¾îº¸Áö ¾Ê°í °Ë»çÇÏ´Â °æ¿ì°¡ ÀÖ½À´Ï´Ù. ¸Å¿ì ³ª»Û °ü·ÊÀÔ´Ï´Ù. °ËÁø ³»½Ã°æÀ» Æ÷ÇÔÇÏ¿© ¸ðµç °Ë»ç Àü ¹Ýµå½Ã ȯÀÚÀÇ Áõ»óÀ» È®ÀÎÇϽñ⠹ٶø´Ï´Ù. °ú°Å Àǹ«±â·Ï È®Àεµ ÇʼöÀÎ °ÍÀº ´ç¿¬ÇÕ´Ï´Ù.


[¸¸¼º À§¿°ÀÇ ºÐ·ù]

¾ÆÁ÷±îÁö ¸¸¼º À§¿°ÀÇ ÅëÀÏµÈ ºÐ·ù¹ýÀº ¾ø½À´Ï´Ù. ¾î´À Çϳª ¸¸Á·½º·´Áö´Â ¸øÇÏÁö¸¸ (1) ¿øÀκ° ºÐ·ù, (2) ÀÓ»ó»ó¿¡ ÀÇÇÑ ºÐ·ù, (3) ¹ß»ý±âÀü¿¡ ÀÇÇÑ ºÐ·ù, (4) ÇüÅÂÇÐÀû ºÐ·ù µîÀÌ °¡´ÉÇÕ´Ï´Ù.

¿øÀκ° ºÐ·ù´Â ¹®Ç庰·Î ´Ù¾çÇÑ ¹æ¹ýÀ× Á¦½ÃµÇ°í ÀÖÁö¸¸ (Dixon 1996), Àú´Â Harrison ±³°ú¼­ÀÇ ´ã¹éÇÑ ºÐ·ù¸¦ °¡Àå ÁÁ¾ÆÇÕ´Ï´Ù. ±³°ú¼­¸¦ ¾à°£ ¹Ù²ã Ç¥ÇöÇϸé (1) ±Þ¼º À§¿°, (2) ¸¸¼º (ºñƯÀ̼º) À§¿°, (3) µå¹® ÇüÅÂÀÇ À§¿°À¸·Î ³ª´©´Â °ÍÀÌÁö¿ä.

³»½Ã°æ ºÐ·ù´Â º´¸®¼Ò°ß Áß½ÉÀÇ Sydney ü°è°¡ ¸¹ÀÌ ¾²ÀÌ°í ÀÖÀ¸³ª ±×´ÙÁö ¸¸Á·½º·´Áö ¸øÇÕ´Ï´Ù. ÀϺ»¿¡¼­´Â Kyoto ºÐ·ù¶ó´Â ÀڽŸ¸ÀÇ °íÀ¯ÇÑ ¹æ¹ýÀÌ ¾²ÀÌ°í ÀÖ½À´Ï´Ù. ÇÊÀÚ´Â À§¿°ÀÇ ³»½Ã°æ ºÐ·ù·Î¼­ Schindler ¹ýÀ» ÁÁ¾ÆÇÕ´Ï´Ù.

1947³â À§³»½Ã°æÀÇ ¾Æ¹öÁö¶ó°í ºÒ¸®´Â Dr. Schindler(À¯ÅÂ°è µ¶ÀÏÀÎÀ¸·Î ¹Ì±¹À¸·Î ¸Á¸íÇÏ¿´½À´Ï´Ù. Schindler´Â À¯ÅÂÀÎ ¼ºÀÔ´Ï´Ù. Schindler list¶ó´Â ¿µÈ­¸¦ »ý°¢Çغ¸¸é ±Ý¹æ ÀÌÇØ°¡ µË´Ï´Ù)°¡ ³»½Ã°æ ¼Ò°ßÀ» Åä´ë·Î ¸¸¼º À§¿°À» Ç¥À缺 À§¿°, À§Ã༺ À§¿°, ºñÈļº À§¿°À¸·Î ±¸ºÐÇÏ¿´½À´Ï´Ù. ¿ì¸®°¡ ¸ÅÀÏ »ç¿ëÇÏ´Â ¿ë¾îÀÎ chronic superficial gastritis(CSG)°¡ ¿©±â¼­ ³ª¿Â ¸»ÀÔ´Ï´Ù.

Schindler ºÐ·ù´Â °£´ÜÇÏ´Ù´Â °ÍÀÌ ´ÜÁ¡ÀÌÀÚ ÀåÁ¡ÀÔ´Ï´Ù. Sydney classificationÀÌ ³Ê¹« º¹ÀâÇÏ¿© ÀÓ»óÀû ÀÇÀÇ¿Í correlationÇϱ⠾î·Á¿î ¹Ý¸é, Schindler ºÐ·ù´Â °£´ÜÇϱ⠶§¹®¿¡ ÀÓ»óÀû Àǹ̰¡ ºñ±³Àû ¸íÈ®ÇÕ´Ï´Ù. Ç¥Ãþ¼º À§¿°Àº º° Àǹ̸¦ ºÎ¿©Çϱ⠾î·Æ°í À§Ã༺ À§¿°Àº ¾Ï¹ß»ý À§ÇèÀÌ ´Ù¼Ò ³ôÀº ±ºÀ¸·Î º¸¸é µÇ°í, ºñÈļº À§¿°Àº Borrmann type IVµî°ú °¨º°À» ¿äÇÏ´Â »óȲÀ¸·Î ÀÌÇØÇÏ¸é µÇ±â ¶§¹®ÀÔ´Ï´Ù.

Schindler ºÐ·ùÀÇ °¡Àå Å« ´ÜÁ¡Àº ÀÇÇבּ¸ ºÐ¾ß¿¡¼­ Àß »ç¿ëµÇÁö ¾Ê´Â´Ù´Â °ÍÀÔ´Ï´Ù. Sydney classification¿¡ ¹Ð¸®°í Àֱ⠶§¹®ÀÔ´Ï´Ù. ±×·¯³ª À§¿°ÀÇ À°¾È¼Ò°ß¿¡ µû¸¥ ¿¬±¸¸¦ ÇÑ´Ù´Â °ÍÀº ±× ºÐ·ùÀÚü°¡ ¸ðÈ£Çϱ⠶§¹®¿¡ ¾îÂ÷ÇÇ º°·Î Àǹ̴ ¾ø½À´Ï´Ù. Àڽſ¡°Ô ÆíÇÏ°í ȯÀÚ¿¡°Ô ¼³¸íÇϱ⵵ ÁÁÀº ºÐ·ù¹ýÀ» ½º½º·Î °ñ¶ó¼­ »ç¿ëÇÏ´Â °ÍÀÌ ÃÖ¼±ÀÏ °ÍÀ¸·Î »ý°¢ÇÕ´Ï´Ù. ÀÌ·± °üÁ¡¿¡¼­ Àú´Â Àú¸¸ÀÇ ¹æ¹ýÀ¸·Î ³»½Ã°æ À§¿°À» ºÐ·ùÇÏ°í ÀÖ½À´Ï´Ù (EndoTODAY ÀÌÁØÇàÀÇ À§¿° ³»½Ã°æ ºÐ·ù). ½Ç¿ëÀûÀÎ Á¢±Ù¹ýÀ̶ó°í »ý°¢ÇÕ´Ï´Ù.

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À§¿°ÀÇ ³»½Ã°æ ºÐ·ù¹ýÀº Schindler ¹ý, Sydney ¹ý ±×¸®°í ÀϺ» À§¿° ºÐ·ù µîÀÌ ÀÖ½À´Ï´Ù. ¾î´À Çϳª ¿ì¸®³ª¶ó Çö½Ç¿¡ ¸ÂÁö ¾Ê½À´Ï´Ù. ¿ì¸® °íÀ¯ÀÇ ºÐ·ù¹ýÀÌ ÇÊ¿äÇѵ¥ ¾ÆÁ÷ ÀÌ ºÐ¾ß¿¡ ´ëÇÑ ³íÀÇ´Â ºÎÁ·ÇÕ´Ï´Ù. °á±¹ Á¦ ½ºÅ¸ÀÏ·Î ½º½º·Î ¸¸µé¾î ¾²´Â ¼ö¹Û¿¡ ¾ø¾ú½À´Ï´Ù. 'ÀÌÁØÇà À§¿° ³»½Ã°æ ºÐ·ù'¸¦ »ý°¢Çغ¾´Ï´Ù.

1) 'ºñƯÀÌÀû À§¿° (nonspecific gastritis)'Àº °¡Àå ÇöÀúÇÑ ¼Ò°ßÀ» ¹ÙÅÁÀ¸·Î Áø´Ü¸íÀ» ¾´´Ù. ºÎÁ·ÇÏ´Ù°í ´À²¸Áö´Â °æ¿ì¿¡´Â µü ÇÑ °¡Áö Áø´Ü¸íÀ» µ¡ºÙÀδÙ. ¿¹¸¦ µé¸é '¸¸¼º À§Ã༺ À§¿°'Àε¥ È­»ý¼º º¯È­µµ ¹«½ÃÇϱ⠾î·Á¿î Á¤µµ¶ó¸é '¸¸¼º À§Ã༺ È­»ý¼º À§¿° (chronic atrophic (and) metaplastic gastritis)'À̶ó°í ¾´´Ù.

³»½Ã°æ ¼Ò°ß³»½Ã°æ Áø´Ü
Erythema (hyperemia)Chronic superficial gastritis
Erosions (flat or raised)Chronic erosive gastritis
Atrophic changesChronic atrophic gastritis
Metaplastic changesChronic metaplastic gastritis
Hypertrophic changesChronic hypertrophic gastritis
HematinsChronic superficial gastritis

2) 'ƯÀÌÀû À§¿° (specific gastritis)'Àº °¢ÀÚÀÇ ±â¼ú¹ý¿¡ µû¸¥´Ù.

3) Single erosionÀº ¾ÏÀ» ¹èÁ¦ÇØ¾ß Çϱ⠶§¹®¿¡ µû·Î °ü¸®ÇÑ´Ù.

4) ±âŸ

- ¾²Áö ¸»¾Æ¾ß ÇÒ Áø´Ü¸í: ÃâÇ÷¼º À§¿°, ´ãÁó ¿ª·ù¼º À§¿°

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