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EndoTODAY ³»½Ã°æ ±³½Ç


[Prepyloric erosion and (shallow) ulcers - ÀϺδ Helicobacter ¶§¹®, ÀϺδ ±â°èÀû ÀÚ±Ø, ÀϺδ µÑ ´Ù¿¡ ÀÇÇÑ °ÍÀ¸·Î ÃßÁ¤µË´Ï´Ù] - ðû

¿ì¿¬È÷ ½ÃÇàÇÑ ³»½Ã°æ¿¡¼­ healing stage ulcer·Î ÀÇ·ÚµÈ ºÐÀÔ´Ï´Ù. ±×·±µ¥ Helicobacter µµ ¾ø°í, NSAIDµµ µå½ÃÁö ¾Ê´Â ºÐÀ̾ú½À´Ï´Ù. Áõ»óµµ ¾ø°í...

ÀÌ´Â ±Ë¾çÀÌ ¾Æ´Ï°í ¹Ì¶õÀÔ´Ï´Ù. Prepyloric areaÀÇ ¼Ò¸¸ÃøÀÇ À§ ÁÖ¸§¿¡ ¹Ì¶õ(°æ¿ì¿¡ µû¶ó¼­´Â ¾èÀº ‚ʾß)ÀÌ °üÂûµÇ´Â °æ¿ì°¡ ¸¹Àºµ¥ overtÇÑ ±Ë¾çÀ¸·Î ¹ßÀüÇÏ´Â °æ¿ì´Â °ÅÀÇ ¾ø´Â °Í °°½À´Ï´Ù. ¾Æ¸¶µµ À§Á¡¸· ÀϺΰ¡ ³¯¹®À¸·Î ÀϽÃÀûÀ¸·Î herniation µÇ´Â µîÀÇ ±â°èÀû ÀÚ±ØÀ¸·Î ÀÎÇÑ ÀÛÀº ¹Ì¶õÀÎ °ÍÀ¸·Î »ý°¢ÇÕ´Ï´Ù. Ä¡·áµµ ÇÊ¿äÇÏÁö ¾Ê½À´Ï´Ù. ÀÇ·ÚÁֽŠºÐÀÌ Áø´ÜÀº ±Ë¾çÀ̶ó´Â À̸§À» ºÙ¿©Áּ̱⠶§¹®¿¡ H2RA¸¦ 2ÁÖ Ã³¹æÇßÁö¸¸ »ç½Ç ²À ÇÊ¿äÇß´ÂÁö´Â Àǹ®ÀÔ´Ï´Ù. ÀÌ È¯ÀÚ´Â °ú°Å¿¡µµ ÀÌ ºÎÀ§¿¡ ±Ë¾çÀÌ ÀÖ´Ù°í ÇÏ¿© ±Ë¾ç¾à ó¹æÀ» ¹Þ°í ÃßÀû°Ë»ç¸¦ Çϼ̴ø º´·ÂÀÌ ÀÖ¾ú½À´Ï´Ù. 13³â Àü »çÁøÀÔ´Ï´Ù.

Prepyloric antrum LC sideÀÇ fold ȤÀº fold À§¿¡ ³õÀÎ ¹Ì¶õ ¶§¹®¿¡ ȯÀÚ¿¡°Ô ºÒÇÊ¿äÇÑ °í»ý½ÃÅ°Áö ¸¿½Ã´Ù. ¾Æ·¡´Â ºñ½ÁÇÑ °æ¿ìµéÀÔ´Ï´Ù. ¸ðµÎ ¾Æ¹« ¹®Á¦ ¾ø¾ú½À´Ï´Ù. Helicobacter°¡ Àִ ȯÀÚ´Â Á¦±Õ Ä¡·á ÈÄ ÁÁ¾ÆÁö±âµµ ÇÕ´Ï´Ù.

Ưº°ÇÑ Ä¡·á¸¦ ÇÏÁö ¾Ê¾Ò´Âµ¥ 1³â ÈÄ °Ë»ç¿¡¼­´Â ¾Æ¹«·± ÀÌ»óÀÌ ¾ø¾ú½À´Ï´Ù.

Ưº°ÇÑ Ä¡·á¸¦ ÇÏÁö ¾Ê¾Ò´Âµ¥ 1³â ÈÄ °Ë»ç¿¡¼­´Â ¾Æ¹«·± ÀÌ»óÀÌ ¾ø¾ú½À´Ï´Ù.

Á÷Àå °ËÁø¿¡¼­ '±Ë¾ç'À̶ó´Â Áø´ÜÀ¸·Î ÀÇ·ÚµÈ ºÐÀÔ´Ï´Ù. Áõ»óÀÌ ÀüÇô ¾ø¾ú°í, ³»½Ã°æ ¼Ò°ßµµ ±Ë¾ç°ú´Â °Å¸®°¡ ¸Ö¾ú½À´Ï´Ù. Prepyloric areaÀÇ fold º¯È­°¡ ÀÌ¿Í °ü·ÃµÈ erosionÀ» ulcer·Î ¿ÀÀÎÇÑ °æ¿ì¶ó°í ÆǴܵǾú½À´Ï´Ù.

¼±Á¾ ÀǽÉÀ¸·Î Á¶Á÷°Ë»ç¸¦ ÇÏ¿´´Âµ¥ ¼±Á¾ÀÌ ³ª¿ÀÁö ¾Ê¾Ò´Ù°í ÀÇ·ÚµÈ È¯ÀÚÀÔ´Ï´Ù. ¿ÜºÎ ½½¶óÀ̵å ÀçÆǵ¶°ú ÀÇ·Ú ÈÄ ³»½Ã°æ Á¶Á÷°Ë»ç Àç°Ë ¸ðµÎ ¼±Á¾ÀÌ ¾Æ´Ï¾ú½À´Ï´Ù.

°ËÁø ³»½Ã°æ¿¡¼­ ´Ù¹ß¼º ±Ë¾çÀ̶ó°í Á¶Á÷°Ë»ç ¹× Hp °Ë»ç ÈÄ ÀǷڵǾú´Âµ¥.... ±Ë¾çº¸´Ù´Â ¹Ì¶õÀ̾úÀ½. Hp°¡ ³ª¿À¸é Ä¡·á¸¦ ÇÒ±î ÇÔ.

¾Æ·¡´Â °ËÁø ³»½Ã°æÀ» ÇÒ ¶§¸¶´Ù À§±Ë¾çÀ¸·Î ÀǷڵǾú´ø ºÐÀÔ´Ï´Ù. »ç½Ç ±Ë¾çÀÌ ¾Æ´Ï¶ó ¹Ì¶õÀÔ´Ï´Ù. ±Ë¾çÀ̶ó´Â Áø´ÜÀ» ºÙ¿©¼­ ÀÏÀÌ º¹ÀâÇÏ°Ô ²¿¿´Áö, °ËÁø ³»½Ã°æ ´ç½Ã ¹Ì¶õÀ̶ó°í ºÙ¿´À¸¸é ¿Ü·¡·Î ÀǷڵǴ ¹ø°Å·Î¿òÀÌ ¾ø¾úÀ» ȯÀÚÀÔ´Ï´Ù. ±Ë¾çÀº ±Ë¾çÀ¸·Î, ¹Ì¶õÀº ¹Ì¶õÀ¸·Î ºÒ·¯ÁݽôÙ.


[Ç︮ÄÚ¹ÚÅÍ Á¦±ÕÄ¡·á ÈÄ ÇöÀúÈ÷ ÁÁ¾ÆÁø °æ¿ì]

¾Æ·¡ Áõ·ÊµéÀº Ç︮ÄÚ¹ÚÅÍ Á¦±ÕÄ¡·á ÈÄ ÇöÀúÈ÷ ÁÁ¾ÆÁø °æ¿ìÀÔ´Ï´Ù. Àú´Â prepyloric erosion/ulcerÀÇ ¹ß»ý¿¡´Â ±â°èÀûÀÎ Àڱذú ¿°Áõ ¸ðµÎ °ü¿©ÇÑ´Ù°í »ý°¢ÇÏ°í ÀÖ½À´Ï´Ù.

ÀüÁ¤ºÎ¿Í À§Ã¼ºÎÀÇ ´Ù¸¥ erosionµéµµ °ÅÀÇ ´Ù ÁÁ¾ÆÁ³½À´Ï´Ù.


[Gastric cancer at prepyloric area]

À§¾Ï°ú ±¸ºÐÀÌ ¾î·Á¿î °æ¿ìµµ ÀÖ½À´Ï´Ù. ´Ã ÁÖÀÇÇØ¾ß ÇÕ´Ï´Ù. ¾Æ·¡ Áõ·Ê´Â ¾ÏÀ̾ú½À´Ï´Ù. ÀÇ·Ú Àü ù ³»½Ã°æ¿¡¼­´Â Á» ´õ ¾Ï °°¾Æ º¸¿´À¸³ª ÀÇ·Ú ÈÄ Àç°Ë¿¡¼­´Â ù °Ë»ç¸¸Å­ ¸íÈ®ÇÏÁö ¾Ê¾Ò½À´Ï´Ù. ¾Æ¸¶µµ À§»êºÐºñ¾ïÁ¦Á¦¸¦ µå½Å ¿µÇâ °°½À´Ï´Ù. Á¡¸·¿¡ ±¹ÇÑµÈ 2.5cm M/D adenocarcinoma¿´½À´Ï´Ù.

Á¡¸·¾Ï

¾Æ·¡ Áõ·Êµµ À§¾ÏÀ̾ú½À´Ï´Ù. ÇÔ¹°ºÎÀÇ edge°¡ ºÒ±ÔÄ¢ÇÏ°í ¹Ù´Úµµ flat ÇÏÁö ¾ÊÀº µî ¾Ï ¼Ò°ßÀÌ ¶Ñ·ÇÇß´ø °æ¿ìÀÔ´Ï´Ù.


Stomach, radical subtotal gastrectomy: Early gastric carcinoma
1. Location : lower third, Center at pylorus and lesser curvature
2. Gross type : EGC type IIc + IIb
3. Histologic type : tubular adenocarcinoma, moderately differentiated
4. Histologic type by Lauren : intestinal
5. Size : 2.0x1.8 cm
6. Depth of invasion : invades mucosa (muscularis mucosae) (pT1a)
7. Resection margin: free from carcinoma
8. Lymph node metastasis : no metastasis in 20 regional lymph nodes (pN0)
9. Lymphatic invasion : not identified
10. Venous invasion : not identified
11. Perineural invasion : not identified


[References]

1) EndoTODAY À§¿°

2) EndoTODAY ±Ë¾çÀº ±Ë¾çÀÌ°í ¹Ì¶õÀº ¹Ì¶õÀÔ´Ï´Ù



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