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양성 식도 수술 문합부 협착에 대한 확장 치료의 임상 결과
최철웅 ( Cheol Woong Choi ),강대환 ( Dae Hwan Kang ),김형욱 ( Hyung Wook Kim ),박수범 ( Su Bum Park ),김수진 ( Su Jin Kim ),남형석 ( Hyeong Seok Nam ),유대곤 ( Dae Gon Ryu ) 대한소화기학회 2017 대한소화기학회지 Vol.69 No.2
목적: 식도 절제술 후 발생하는 양성 식도 협착은 드물지 않은 합병증이다. 양성 식도 문합부 협착은 여러 번의 확장 치료가 필요하다고 알려져 있다. 본 연구에서는, 수술 후 발행한 식도 문합부 협착 환자에서 확장 치료(내시경 풍선 확장 또는 부우지 확장)의 임상 결과를 분석하고, 불응성 협착과 관련된 위험인자를 알아보고자 하였다. 대상과 방법: 2009년 1월부터 2016년 5월까지, 식도 수술 문합부 협착으로 진단되어 확장 치료를 시행 받은 환자의 의무기록을 후향적으로 분석하였다. 결과: 연구 기간 동안에 21명의 양성 식도 문합부 협착 환자에 대해서 확장시술을 시행하였다. 환자의 성별은 남자가 17명(80.1%), 환자의 평균나이는 68.2±7.2세였다. 첫 진단 때, 협착의 직경은 협착 정도가 5 mm 미만인 경우가 10명(47.6%), 6-10 mm가 8명(38.1%), 11 mm 이상인 경우가 3명(14.3%)이었다. 협착의 길이는 평균 6.4 mm(표준편차 8.1mm)였다. 확장 치료 후 발생하는 중요 합병증은 없었다. 불응성 식도 협착은 7명(33.3%)이었고, 관련된 인자는 협착의 길이(>10 mm)와 당뇨였다. 결론: 양성 식도 수술 문합부 협착 환자에서 확장 치료는 안전한 치료법이며, 협착의 길이가 10 mm보다 작은 경우에 효과적이었다. Background/Aims: Benign esophageal stricture after esophagectomy is not an infrequent complication. Anastomotic esophageal stricture requires frequent multiple dilations. We aimed to evaluate the clinical outcomes of dilation therapies using an endoscopic balloon or bougie dilator and analyzed the risk factors associated with refractory stricture. Methods: Between January 2009 and May 2016, the medical records of 21 patients treated with endoscopic balloon dilation or bougie dilation for esophageal anastomotic strictures were retrospectively reviewed. Results: During the study periods, a total of 21 patients were diagnosed with esophageal anastomotic stricture and included for analysis (17 male; mean age, 68.2±7.2 years at the first procedure). The mean stricture length was 6.4±8.1 mm. The refractory stricture was found in 28.6% of patients, and successful relief of dysphagia was achieved in 71.4% of patients. The major complication associated with dilations was absent. Factors associated with refractory stricture were stricture length (> 10 mm, p<0.049) and diabetes mellitus (p=0.035). Additive bougie dilations achieved clinical success in 4 out of 7 patients. Conclusions: Dilation with endoscopic balloon or bougie dilator was an effective and safe procedure for benign anastomotic esophageal strictures of less than 10 mm in length. (Korean J Gastroenterol 2017;69:102-108)
대장 측방 발육형 종양의 임상 병리학적 특성 및 내시경 치료
최철웅 ( Cheol Woong Choi ),이선미 ( Sun Mi Lee ),김태오 ( Tae Oh Kim ),김광하 ( Gwang Ha Kim ),허정 ( Jung Heo ),강대환 ( Dae Hwan Kang ),송근암 ( Geun Am Song ),조몽 ( Mong Cho ) 대한장연구학회 2007 Intestinal Research Vol.5 No.1
Background/Aims: Laterally spreading tumors (LSTs) of the colorectum are defined as lesions greater than 10 mm in diameter with a low vertical axis that extend laterally along the luminal wall. We analyzed the clinicopathologic characteristics and endoscopic treatment of LSTs on the colorectum. Methods: The 127 colorectal LSTs were collected from January 2005 through February 2007. Those lesions were analysed according to their endoscopic and pathologic findings. Results: 67 LSTs (52.8%) were more than 20 mm in size. Most common involved sites of LSTs were rectum (32.4%) and ascending colon (25.9%). Mostcommon subtype of LSTs were granular-homogeneous type (G-H) (37%). Histologic types were 76 tubular adenomas (59.8%), 24 tubulovillous adenomas (18.8%), 6 villous adenomas (4.8%) and 21 adenocarcinoma (16.6%). Both nodular mixed type (G-NM) and pseudo-depressed type (NG-PD) contained a carcinomatous component with high frequency as compared with the G-H type. Carcinoma invaded into the submucosa were present in 3 lesions of G-NM type and 6 lesions of NG-PD type. Conclusions: LSTs showed different clinicopathologic characteristics depending on the morphologic classification. G-NM type or NG-PD type had more malignant potential than other types. Endoscopists should select an adequate therapeutic strategy for large LST with careful consideration. (Intest Res 2007;5:33-37)