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EndoTODAY ³»½Ã°æ ±³½Ç


[Ampullary adenoma and adenocarcinoma. À¯µÎºÎ ¼±Á¾°ú À¯µÎºÎ ¾Ï] - ðû

1. À§³»½Ã°æ¿¡¼­ À¯µÎºÎ¸¦ ²À °üÂûÇØ¾ß Çϴ°¡?

2. Ampullary neoplasmÀÇ ³»½Ã°æ ºÐ·ù

3. Ampullary adenomas À¯µÎºÎ ¼±Á¾

4. Ampullary cancers À¯µÎºÎ ¾Ï

5. Neuroendocrine carcinoma

6. PPPD ÈÄ ³»½Ã°æ ¼Ò°ß

7. FAQs

8. References

2018³â ¼ÒÈ­±âº´½ÉÆ÷Áö¾ö. ¹ÚÁÖ°æ ±³¼ö´Ô °­ÀÇ·Ï¿¡¼­

2022-8-24. Á÷½Ã°æ °Ë»ç¿¡¼­ ³õÄ¡±â ½¬¿î ½ÊÀÌÁöÀå ¹× À¯µÎºÎ Áúȯ (Á¶ÀçÈñ ±³¼ö´Ô)


1. À§³»½Ã°æ¿¡¼­ À¯µÎºÎ¸¦ ²À °üÂûÇØ¾ß Çϴ°¡?

Pentax IMAGINA·Î °üÂûÇÑ Á¤»ó À¯µÎºÎ


Á÷½Ã°æ°ú Ãø½Ã°æÀ» ¸ðµÎ ´Ù·ê ¼ö ÀÖÀ¸¸é ÁÁ½À´Ï´Ù. »óºÎ³»½Ã°æ¿¡¼­ ampullary lesionÀÌ ÀǽɵǾî Áï½Ã Ãø½Ã°æÀ¸·Î ³»½Ã°æÀ» ¹Ù²ã Á¶Á÷°Ë»çÇÏ¿© ampullary cancer¸¦ ¹ß°ßÇÏ¿© ÀÇ·ÚÁֽŠȯÀÚÀÔ´Ï´Ù. ´ë´ÜÇÕ´Ï´Ù. ERCP Àǻ簡 ¾Æ´Ï´õ¶óµµ Ãø½Ã°æ¿¡ Á» ´õ °ü½ÉÀ» °®±â ¹Ù¶ø´Ï´Ù.


[2016-8-2. Web-seminar Áú¹®]

Áø´Ü ³»½Ã°æ¿¡¼­ ½ÊÀÌÁöÀå À¯µÎºÎ¸¦ ¸ðµç ȯÀÚ¿¡¼­ È®ÀÎÇϽôÂÁö¿ä?

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»óºÎÀ§Àå°ü ³»½Ã°æ °Ë»çÀÇ ¹üÀ§´Â ½ÊÀÌÁöÀå Á¦2ºÎ±îÁö°¡ ¸Â½À´Ï´Ù.

2Áֱ⠰ËÁø±â°üÆò°¡ ±âÁØ 1.2 °úÁ¤Æò°¡(À§³»½Ã°æ) Ç׸ñ¿¡ "1.2.6 Ç×»ó ½ÊÀÌÁöÀå±îÁö »ðÀÔÇÏ°í ¿µ»ó±â·Ï(È­»ó 8¹ø; ½ÊÀÌÁöÀå 2ºÎ)À» ³²±â´Â°¡?"¶ó´Â ¾ð±Þµµ ÀÖ½À´Ï´Ù (Âü°íÀÚ·á).

¹®Á¦´Â ½ÊÀÌÁöÀå 2ºÎ¿¡ µé¾î°¡´Â ÀÏ, À¯µÎºÎ¸¦ ã°í °üÂûÇÏ´Â ÀÏÀÌ ´Ã ½¬¿î °ÍÀº ¾Æ´Ï¶ó´Â Á¡ÀÔ´Ï´Ù. 10¸í¿¡ 9¸í Á¤µµ´Â ½±°í ºü¸£°í ÀÚ¿¬½º·´°Ô ½ÊÀÌÁöÀå 2ºÎ¿¡ µé¾î°¥ ¼ö ÀÖÁö¸¸, °£È¤ Á¶±Ý º¹ÀâÇÑ Á¶ÀÛÀ» Çؾ߸¸ µé¾î°¥ ¼ö ÀÖ´Â °æ¿ìµµ ÀÖ°í, ¾ÆÁÖ ¾î·Á¿î °æ¿ìµµ ÀÖ½À´Ï´Ù. ½ÊÀÌÁöÀå 2ºÎ¿¡ µé¾î°¬À¸³ª À¯µÎºÎ¸¦ Á¤È®È÷ ã°í »ó¼¼È÷ °üÂûÇϱ⠾î·Á¿î °æ¿ìµµ ¸¹½À´Ï´Ù.

Àú´Â ¹«Áõ»ó ¼ºÀÎÀÇ °ËÁø ³»½Ã°æ¿¡¼­ ½ÊÀÌÁöÀå 2ºÎ¿Í À¯µÎºÎ´Â '°¡´ÉÇÏ¸é º¸µÇ ¹«¸®ÇÏÁö´Â ¾Ê´Â´Ù' Á¤µµ·Î »ý°¢ÇÏ°í ÀÖ½À´Ï´Ù. ½ÊÀÌÁöÀå 2ºÎ¿Í À¯µÎºÎ¸¦ º¸·Á°í ³Ê¹« ¸¹Àº ½Ã°£À» »ç¿ëÇÑ ÈÄ ¸·»ó Áß¿äÇÑ À§¸¦ ÀÚ¼¼È÷ °üÂûÇÏÁö ¸øÇÑ´Ù¸é ¹«½¼ ¼Ò¿ëÀÌ ÀÖ°Ú½À´Ï±î?

¹º°¡ÀÇ Áõ»óÀÌ ÀÖ¾î ½ÃÇàÇÏ´Â ³»½Ã°æÀº ÀüÇô ´Ù¸¨´Ï´Ù. ºóÇ÷, Ȳ´Þ, º¹Åë µî¿¡¼­´Â ½ÊÀÌÁöÀå 2ºÎ¿Í À¯µÎºÎ¸¦ ¸é¹ÐÈ÷ °üÂûÇØ¾ß ÇÕ´Ï´Ù.

ºóÇ÷·Î ½ÃÇàÇÑ ³»½Ã°æ °Ë»ç¿¡¼­ ¹ß°ßµÈ AoV cancer (¸¶Áö¸· ³»½Ã°æ: 6°³¿ù Àü)

ÀÏ¹Ý ³»½Ã°æ ³¡¿¡ capÀ» ÀåÂøÇÏ¸é ½ÊÀÌÁöÀå À¯µÎºÎ¸¦ Á¶±Ý ´õ Àß °üÂûÇÒ ¼ö ÀÖ½À´Ï´Ù (Abdelhafez M. Am J Gastroenterol 2017). ¸ðµç ȯÀÚ¿¡°Ô ÇÊ¿äÇÒ °Í °°Áö´Â ¾Ê°í, À¯µÎºÎ¸¦ ÀÚ¼¼È÷ °üÂûÇØ¾ß ÇÒ ÇÊ¿ä°¡ Àִ ȯÀÚ¿¡¼­ Àû¿ëÇØ º¼ ¼ö ÀÖÀ» °Í °°±âµµ ÇÕ´Ï´Ù. ¾Æ¿¹ óÀ½ºÎÅÍ Ãø½Ã°æÀ» »ç¿ëÇÏ´Â °Íµµ ÇÑ ¹æ¹ýÀ̱â´Â ÇÕ´Ï´Ù¸¸.



[2021-3-28. ¾Öµ¶ÀÚ Áú¹®]

53¼¼ ³²¼ºÀÔ´Ï´Ù. ¹«¾ùº¸´Ù µîÀÌ ¾ÆÆļ­ ÀáÀ» ÀڱⰡ ¾î·Æ´Ù°í ³»¿øÇß½À´Ï´Ù. ³»½Ã°æÀ» º¸¸é ½ÊÀÌÁöÀå ±¸ºÎ ÀÌÇÏ·Î ÁøÀÔÀÚü°¡ ºÒ°¡´ÉÇÕ´Ï´Ù. ÀÌ È¯ÀÚ´Â 2³â¸¶´Ù Á¤±âÀûÀÎ °ø´ÜÀ§¾Ï°ËÁøÀ» Âø½ÇÈ÷ ¹Þ¾Æ¿À´ø ºÐÀ̾ú½À´Ï´Ù. ÇÏÁö¸¸ ¾ÈŸ±õ°Ôµµ Á÷Àü 2³âÀü »çÁøÀ» º¸¸é ±¸ºÎ¸¸ ÃÔ¿µµÇ¾î ÀÖ°í Á¦2ºÎ¿¡ ÁøÀÔÇÏÁö ¾Ê¾Ò½À´Ï´Ù. ´ç½Ã ÀÌ È¯ÀÚÀÇ °Ë»ç¸¦ ½ÃÇàÇÏ¿´´ø ¼±»ý´ÔÀº ¿ø³»¿¡¼­ "fast hand"·Î À¯¸íÇϽŠºÐÀ̾ú½À´Ï´Ù. À§³»½Ã°æÀÇ Ã¹ »çÁøºÎÅÍ ³¡ »çÁø±îÁö 60ÃÊ°¡ °É¸®Áö ¾Ê°í, ´ëÀå³»½Ã°æ¿¡¼­µµ ¸ÍÀåÀÇ êÀÌØ»çÁøºÎÅÍ ³¡»çÁø±îÁö Àý´ë 5ºÐÀ» ³Ñ±âÁö ¾Ê½À´Ï´Ù. º´¿ø °æ¿µÁøÀ̳ª °£È£»çµéÀÌ ÁÁ¾ÆÇß´ø ÀÌ»óÀûÀÎ ³»½Ã°æ ÀÇ»ç»óÀ̾ú½À´Ï´Ù.

ÀÌ È¯ÀÚÀÇ 4³â, 6³âÀü »çÁøµéÀ» º¸¸é ´Ù¸¥ ¼±»ý´ÔµéÀº AOV¸¦ ÃÔ¿µÀº ÇßÁö¸¸ Á¤¸é»óÀ» º¸Áö´Â ¸øÇß½À´Ï´Ù. Àú ¿ª½Ã À̺¸´Ù ´õ ÀßÂïÀ» ÀÚ½ÅÀº ¾ø½À´Ï´Ù. ¾î¶»°Ô Çϸé AOV¸¦ Àß º¼ ¼ö ÀÖÀ»±î¿ä? º¹ºÎ¸¦ ´­·¯ º¸´Â ¹æ¹ýÀº ¾î¶²°¡¿ä? AOV¸¦ º¸Áö ¸øÇ߰ųª ³»°¡ º»°Ô major ÀÎÁö minor papillaÀÎÁö ±¸ºÐÀÌ ¾ÈµÈ´Ù¸é ±× »ç½ÇÀ» ¼ö°ËÀÚ¿¡°Ô ¾Ë·ÁÁ༭ 3Â÷±â°ü¿¡¼­ side scopeÀ¸·Î Àç°Ë»ç¸¦ ¹Þµµ·Ï ±Ç°íÇØ¾ß µÉ±î¿ä? ½ÊÀÌÁöÀåÀÇ ±¼°îÀÌ ½ÉÇÑ ¼ö°ËÀڵ鿡¼­ Á¤¸é»óÀÇ AOV¸¦ º¸·Á ³ë·ÂÇÏ´Ùº¸¸é ½ºÄßÀ¸·Î ÀÎÇÑ Æ®¶ó¿ì¸¶·Î Á¡¸·ÃâÇ÷ÀÌ »ý±â°í, °Ë»çÈÄ º¹ÅëÀÇ ¿øÀÎÀÌ µÇ´Â°Í °°½À´Ï´Ù.

ÀÌ È¯ÀÚ´Â ÀÌÈÄ ´ëÇк´¿ø¿¡¼­ ½ÊÀÌÁöÀå¾Ï°ú ±¹¼ÒÀüÀÌ·Î ¼ö¼ú, ´ãÁó´©Ãâ·Î Àç¼ö¼ú, 9Â÷¿¡ °ÉÄ£ Ç×¾ÏÄ¡·á¸¦ ¹ÞÀ¸¸é¼­ ¾ÆÁ÷ º´¸¶ÀÇ ¼Õ¾Æ±Í¿¡¼­ Èûµé°Ô Áö³»°í ÀÖ½À´Ï´Ù.

[2021-3-28. ÀÌÁØÇà ´äº¯]

1

'Fast hand'´Â ¹Ù¸¥ ³»½Ã°æÀÌ ¾Æ´Õ´Ï´Ù. °ËÁø À§³»½Ã°æ °Ë»çÀÇ ÀûÀýÇÑ °Ë»ç ½Ã°£Àº 5ºÐÀÔ´Ï´Ù. À߸øµÈ °Ë»ç¿¡ ´ëÇÏ¿© Àú´Â ÇÒ ¸»ÀÌ ¾ø½À´Ï´Ù. Á¤µµ¸¦ Áöŵ½Ã´Ù.

2

¹«Áõ»ó ¼ºÀÎÀÇ °ËÁø À§³»½Ã°æ¿¡¼­ ½ÊÀÌÁöÀå Á¦2ºÎ, ƯÈ÷ À¯µÎºÎ¸¦ ²À º¸¾Æ¾ß ÇÏ´ÂÁö´Â ³í¶õÀÇ ¿©Áö°¡ ÀÖ½À´Ï´Ù (EndoTODAY À§³»½Ã°æ¿¡¼­ À¯µÎºÎ¸¦ ²À °üÂûÇØ¾ß Çϴ°¡?). Àú´Â ¹«Áõ»ó ¼ºÀÎÀÇ °ËÁø ³»½Ã°æ¿¡¼­ ½ÊÀÌÁöÀå 2ºÎ¿Í À¯µÎºÎ´Â '°¡´ÉÇÏ¸é º¸µÇ ¹«¸®ÇÏÁö´Â ¾Ê´Â´Ù' Á¤µµ·Î »ý°¢ÇÏ°í ÀÖ½À´Ï´Ù.

°ËÁø À§³»½Ã°æÀÇ ¸ñÀûÀº À§¾ÏÀÇ Á¶±â Áø´ÜÀÔ´Ï´Ù. °ËÁø À§³»½Ã°æ¿¡¼­ ¾ÆÁÖ ÀÛÀº ½Äµµ¾Ï°ú ¾ÆÁÖ ÀÛÀº ½ÊÀÌÁöÀå ¾Ï±îÁö ¸ðµÎ ¹ß°ßÇØ¾ß ÇÑ´Ù´Â °ÍÀº Áö³ªÄ£ ±â´ëÀÔ´Ï´Ù. »ç½Ç ÀÇÇÐÀûÀÎ ±Ù°Åµµ ¾ø½À´Ï´Ù. ScreeningÀÌ ÇÊ¿äÇÑ ¾Ïµµ ÀÖ°í screeningÀÇ È¿°ú°¡ ÀÔÁõµÇÁö ¾ÊÀº ¾Ïµµ ÀÖ½À´Ï´Ù. Àú´Â ¹«Áõ»ó ¼ºÀβ²¼­ °ËÁø À©³»½Ã°æ¿¡¼­ ½ÄµµÀÇ ¾Ç¼º ÁúȯÀÌ ¹ß°ßµÇ¾î ½Äµµ ¼ö¼úÀ» ¹Þ°í ÇÕº´ÁõÀ¸·Î °ð »ç¸ÁÇÑ ¿¹µµ º¸¾Ò½À´Ï´Ù. ±× ºÐ¿¡¼­ °ËÁø ³»½Ã°æÀ̶õ ¹«½¼ Àǹ̰¡ ÀÖ¾ú´ø °ÍÀϱî¿ä?

¸ðµç °Ë»ç´Â specificity¿Í sensitivity°¡ ÀÖ½À´Ï´Ù. ½ÊÀÌÁöÀå Áúȯ¿¡ ´ëÇÑ »óºÎ³»½Ã°æÀÇ sensitivity´Â »ó´çÈ÷ ³·½À´Ï´Ù. 2³â Àü °Ë»ç¿¡¼­ ½ÊÀÌÁöÀå Á¦2ºÎ¸¦ º¸Áö ¸øÇÑ °ÍÀº ¾ÈŸ±î¿î ÀÏÀ̳ª ÀÌ È¯ÀÚ¿¡¼­ ½ÊÀÌÁöÀå Á¦2ºÎ¸¦ º¸Áö ¾Ê¾Ò´Ù°í °Ë»çÇϼ̴ø ¼±»ý´ÔÀ» Å¿Çϱâ´Â ¾î·Á¿ï °Í °°½À´Ï´Ù. 2³â Àü¿¡´Â ÀüÇô º´ÀÌ ¾ø¾úÀ» ¼öµµ ÀÖ½À´Ï´Ù. ´Ù¸¸ ¸ðµç ȯÀÚ¿¡¼­ ½ÊÀÌÁöÀå Á¦2ºÎ¸¦ °üÂûÇÏÁö ¾Ê´Â ½À°üÀÌ ÀÖ´Ù¸é Á¶½É½º·´°Ô °Ë»ç patternÀ» ¹Ù²Ù½Ãµµ·Ï ±ÇÇÏ´Â °ÍÀÌ ¾î¶»°Ú½À´Ï±î? À§³»½Ã°æÀÇ ¹Ù¶÷Á÷ÇÑ °Ë»ç ½Ã°£ÀÌ 5ºÐÀ̶ó´Â °Íµµ ÁÖÁö½ÃÄÑ Áֽøé ÁÁ°Ú½À´Ï´Ù. ¼­·Î ÁÁÀº ¹æÇâÀ¸·Î °£¼·ÇÏ´Â °ÍÀÌ ¹Ù¶÷Á÷ÇÑ Àü¹®°¡ »çȸÀÇ ¸ð½ÀÀÏ °ÍÀÔ´Ï´Ù.


[2017-5-13. ÀÌÁØÇà Ãß°¡] Ampulla of Vater ±Ùó¿¡¼­ Á¶Á÷°Ë»ç ÇÒ ¶§¿¡´Â ´Ã pancreatitis¸¦ ÁÖÀÇÇØ¾ß ÇÕ´Ï´Ù. ¾î´À Ã¥¿¡¼­ Èï¹Ì·Î¿î ±×¸²À» º¸¾Ò±â¿¡ ¾Æ·¡¿¡ ¿Å±é´Ï´Ù.



2. Ampullary neoplasmÀÇ ³»½Ã°æ ºÐ·ù (ÀÚ·áÁ¦°ø: ºÎ»ê´ëÇб³ °­´ëȯ ±³¼ö´Ô)




3. Ampullary adenomas

°ÇÁø ³»½Ã°æÀÇ º»ÁúÀº À§¾ÏÀÇ Á¶±âÁø´ÜÀÔ´Ï´Ù. °ÇÁø°³³äÀ¸·Î ½ÃÇàÇÑ »óºÎÀ§Àå°ü ³»½Ã°æ¿¡¼­ À¯µÎºÎ ¼±Á¾ÀÌ °£È¤ ¹ß°ßµË´Ï´Ù. ¹«Áõ»ó À¯µÎºÎ ¼±Á¾À» ¸ðµÎ Ä¡·áÇØ¾ß ÇÏ´ÂÁö Àú´Â ¾ËÁö ¸øÇÕ´Ï´Ù. Ä¡·á¿¡ µû¸¥ ÇÕº´Áõ À§ÇèÀÌ »ó´çÇϱ⠶§¹®¿¡ ¹«Áõ»ó ¼ºÀÎÀÇ À¯µÎºÎ ¼±Á¾À» Ä¡·áÇØ¾ß ÇÏ´ÂÁö ¸é¹ÐÇÑ °ËÅä°¡ ÇÊ¿äÇÕ´Ï´Ù. 2010³â ÇöÀç À¯µÎºÎ ¼±Á¾ÀÌ ¹ß°ßµÇ¸é Ä¡·áÇÏ´Â °ÍÀÌ Åë·ÊÀÔ´Ï´Ù. (EndoTODAY 20101002)

ampullary adenoma

ampullary adenoma

minor papilla adenoma

ampullary adenoma in FAP

ampullary adenoma in FAP

Ampulla of Vater adenoma. Á÷½Ã°æÀ¸·Î °Ë»çÇÒ ¹«·Æ diverticulumÀ» º¸Áö ¸øÇßÀ¸³ª, ERCP ÆÀ¿¡¼­ papillectomy¸¦ ÇÒ ¶§ AoV¿·¿¡ diverticulumÀÌ ÀÖÀ½À» È®ÀÎÇÏ¿´À½.

Transduodenal ampullectomy, Tubulovillous adenoma, high grade dysplasia, 1) tumor size: 2.8x2.5 cm, 2) negative resection margin

Ampullary hyperplastic polypÀ¸·Î ÀǷڵǾúÀ¸¸ç, outside slide review¿¡¼­ villous adenoma·Î ³ª¿Í endoscopic papillectomy ½ÃÇàÇÏ¿´°í ÃÖÁ¾ º´¸®°á°ú´Â tubulovillous adenoma with focal high-grade dysplasia¿´À½.

2020³â 9¿ù 10ÀÏ ³»½Ã°æÁý´ãȸ¿¡¼­ ³ªÁöÀº ¼±»ý´Ô²²¼­ ¸®ºäÇϽŠ³»¿ëÀÔ´Ï´Ù.


4. Ampullary cancers. À¯µÎºÎ¾Ï

F/70 (2018)
Histopathologic Diagnosis: Ampullary Carcinoma
-Type of surgery: pylorus preserving pancreaticoduodenectomy (PPPD)
(1) Histologic type: Adenocarcinoma
(2) Histologic Grade: G2 (moderately differentiated)
(3) Tumor extent
- tumor size: greatest dimension: 2.6x2 cm
- epicenter: papilla of Vater
- Intra-ampullary adenoma (IAPN): absent
- involvement of pancreatic duct: present (intraductal spread of adenoma)
(4) T3a: Tumor invades pancreas (up to 0.5 cm) with pancreato-duodenal groove soft tissue
(5) N0: No regional lymph node metastasis ( 0 / 17 : "LN #12", 0/6 ; "LN #6", 0/1 ; "LN #8", 0/2 ; "LN #7", 0/3 ; peripancreatic, 0/5 )
(6) Margin status
- Retroperitoneal surface: negative
- Duodenal margin: negative
(7) Perineural and neural invasion: absent
(8) Lymphovascular invasion: not identified
(9) Tumor necrosis: absent
(10) ICD code: M8500AoVca


Pylorus preserving pancreaticoduodenectomy (PPPD): Ampullary Carcinoma
(1) Histologic type: Adenocarcinoma
(2) Histologic Grade: G2 (moderately differentiated)
(3) Tumor extent
- tumor size: greatest dimension: 1.8x1.5 cm
- epicenter: intra-ampullary
- Intra-ampullary adenoma (IAPN): absent
- involvement of pancreatic duct: absent
(4) T3b: Tumor invades pancreas (up to 0.5 cm), duodenum, and pancreatoduodenal groove soft tissue
(5) N2: Regional lymph node metastasis (¡Ã4) with extranodal extension (largest one: 6 mm)
( 4/24 : LN12, 0/1 ; LN8, 0/4 ; LN7,9, 0/7 ; LN16, 0/6 ; peripancreatic, 4/6 )
(6) Margin status
- Retroperitoneal surface: negative
- Duodenal margin: negative
(7) Perineural and neural invasion: present
(8) Lymphovascular invasion: present
(9) Tumor necrosis: absent
(10) ICD code: M8500AoVca
R0: complete resection with grossly and microscopically negative resection margins
AJCC stage (2018, 8th ed) Stage IIIB T3 N2 M0

30´ë ³²ÀÚ¿¡°Ô Ȳ´ÞÀÌ ¿À¸é °£¿°ºÎÅÍ »ý°¢ÇÏ°Ô µË´Ï´Ù. ±×·¯³ª µå¹°°Ô ¾Ç¼ºÁúȯÀÎ °æ¿ìµµ ÀÖ½À´Ï´Ù. ÀÌ È¯ÀÚ´Â Ampulla of Vater cancer¿´À¸¸ç PPPD ¼ö¼úÀ» ÇÏ¿´°í ¾Æ·¡¿Í °°Àº °á°ú¿´½À´Ï´Ù. 3³â ÈÄ multiple hepatic metastasis¸¦ º¸¿´½À´Ï´Ù.
Adenocarcinoma, moderately differentiated
(1) T1 : Tumor limited to AoV or sphincter of Oddi (extension to submucosa)
(2) Involvement of pancreas and duodenum : absent
(3) Extension to distal common bile duct : absent
(4) N0 : No regional lymph node metastasis (0/28: pericholedochal, 0/21; peripancreatic, 0/7)
(5) M0 : No distant metastasis
(6) Negative (pancreas, common bile duct, retropancreatic) resection margins

³»½Ã°æ Á¶Á÷°Ë»ç¿¡¼­ adenoma with HGD and suspicious carcinomatous transformationÀ¸·Î ³ª¿Í papillectomy¸¦ ½ÃµµÇÏ¿´À¸³ª non-lifting signÀ» º¸¿© PPPD ¼ö¼úÀ» ÇÏ¿´½À´Ï´Ù.
Ampullary Carcinoma arising from IAPN
(1) Histologic type: Adenocarcinoma
(2) Histologic Grade: G2 (moderately differentiated)
(3) Precursor lesion: Adenoma
(4) Invasive tumor size: greatest dimension (0.5cm) (S/N)
(5) T1b Tumor invades into perisphincteric and duodenal submucosa
(6) N0: No regional lymph node metastasis (0/13: LN8, 0/5; LN12, 0/3; periductal, 0/5)
(7) cM0: Clinically No distant metastasis
(8) Involvement of portal vein: absent
(9) Margin status; Bile duct margin : negative; Retroperitoneal margin: negative; Duodenal margin: negative (safety margin: 4cm)
(10) Perineural and neural invasion: absent
(11) Lymphovascular invasion: not identified

Ãø½Ã°æ ¼Ò°ß. Fever/chill·Î CT¸¦ ¸ÕÀú Âï°í ampullary cancer ÀǽÉÇÏ¿¡ ÀǷڵǾî ERBD ÈÄ ¼ö¼ú. ¸²ÇÁÀý ÀüÀÌ À־ adjuvant chemotherapy
Histopathologic Diagnosis: Ampullary Carcinoma
-Type of surgery: pylorus preserving pancreaticoduodenectomy (PPPD)
(1) Histologic type: Adenocarcinoma
(2) Histologic Grade: G2 (moderately differentiated)
(3) Tumor extent
- tumor size: greatest dimension: 1.2 cm
- epicenter: intra-ampullary
- Intra-ampullary adenoma (IAPN): present (arising from IAPN)
- involvement of pancreatic duct: absent
(4) T1b: Tumor invades into perisphincteric and duodenal submucosa
(5) N1: Regional lymph node metastasis (1-3) with / without extranodal extension (largest one: 4 mm) ( 1 / 11 : LN7,9, 1/4 ; LN8, 0/1 ; LN12, 0/1 ; peripancreatic, 0/5 )
(6) Margin status
- Retroperitoneal surface: negative
- Duodenal margin: negative
(7) Perineural and neural invasion: absent
(8) Lymphovascular invasion: present
(9) Tumor necrosis: absent
(10) ICD code: M8500AoVca

NSAID º¹¿ëÁß ¹ß»ýÇÑ epigastric painÀ¸·Î ½ÃÇàÇÑ EGD¿¡¼­ ampulla of Vater cancer°¡ ¹ß°ßµÇ¾î ¼ö¼ú

AoV cancer

AoV cancer

AoV cancer with multiple liver metastasis

EGD·Î Àß º¸ÀÌÁö ¾Ê¾Æ duodenoscopy·Î È®ÀÎÇÏ¿´´ø AoV cancer

¾Öµ¶ÀÚ Áõ·ÊÆíÁö 33

À¯µÎºÎ ¼±¾Ï. Ãø½Ã°æ


5. Neuroendocrine carcinoma of ampulla of Vater involvement th multiple liver metastasis

Ȳ´Þ·Î ½ÃÇàÇÑ ³»½Ã°æ¿¡¼­ ½ÊÀÌÁöÀå Á¦2ºÎ¿¡ À¶±âºÎ°¡ ÀÖ¾ú½À´Ï´Ù. Ãø½Ã°æÀ¸·Î ¹Ù²ã °Ë»çÇÑ ¹Ù º´¼Ò°¡ Àß °üÂûµÇ¾ú½À´Ï´Ù. EST¸¦ Á¶±Ý ³ÖÀº ÈÄ Á¶Á÷°Ë»ç¸¦ ½ÃÇàÇÏ¿´½À´Ï´Ù.


6. PPPD ÈÄ ³»½Ã°æ ¼Ò°ß

PPPD ÈÄ ³»½Ã°æ ¼Ò°ßÀº ȯÀÚ¸¶´Ù ´Ù¸£°í »ó´çÈ÷ ¾î·Æ½À´Ï´Ù. Àúµµ ¾ÆÁ÷ ¸Ó¸®¿¡ Àß ±×·ÁÁöÁö ¾Ê½À´Ï´Ù. Ȥ½Ã Àß ¼³¸íÇØ ÁÖ½Ç ¼±»ý´Ô ¾È °è½Ê´Ï±î?

bile reflux°¡ ¾öû ½ÉÇÑ ºÐµµ °è½Ê´Ï´Ù.


[FAQ]

[2014-10-17. ¾Öµ¶ÀÚ Áú¹®]

Duodenum ampulla lesion¿¡ ´ëÇؼ­ ¹®Àǵ帳´Ï´Ù. °³ÀÎÀûÀ¸·Î Àú´Â ampulla ¸ð½Àµµ »ç¶÷¿¡ µû¶ó Âü ´Ù¾çÇÏ´Ù ´À³¢´Âµ¥ ÃÖ±Ù °ÇÁøÂÊ¿¡¸¸ °è¼Ó ÀÖ´Ùº¸´Ï ampulla adenoma °¡ ÀÖ´Â ¸ð½À°ú Á¤»óÀÎ ¸ð½ÀÀÌ ºÐ°£ÀÌ ¸ðÈ£ÇÏ´Ù »ý°¢ÀÌ µé¾î ±³¼ö´Ô ²²¼­´Â ¾î´À ¶§ »ý°ËÀ» ÇÏ°Ô µÇ´ÂÁö ±Ã±ÝÇÕ´Ï´Ù. »ç½Ç Àú´Â cost µîÀ» »ý°¢ÇÏ¸é ²À ÇÊ¿äÇÒ¶§ ¾Æ´Ï¸é ÇÏÁö ¸»ÀÚ´Â »ý°¢ÀÌ µé¾î ÇÊ¿äÇÑ °ÍÀÌ ¾Æ´Ï¸é Àß ¾ÈÇÏ°Ô µÇ´Âµ¥, ÀÌ·¸°Ô »ý°¢ÇÏ´Â Á¦°¡ ÀÌ»óÇÑ °ÍÀΰ¡ ÇÏ´Â »ý°¢ÀÌ ¿äÁò µì´Ï´Ù. ±³¼ö´ÔÀÇ °í°ßÀ» ºÎŹµå¸³´Ï´Ù.

[2014-10-20. ÀÌÁØÇà ´äº¯]

¹«Ã´ Áß¿äÇÑ Áú¹®ÀÔ´Ï´Ù. ±×·±µ¥ Àúµµ ´äÀÌ ¾ø½À´Ï´Ù. Ampulla of Vater´Â »ç¶÷¸¶´Ù ´Ù¸£°Ô »ý°åÀ¸´Ï±î¿ä. ±×¸®°í ¹«¾ùº¸´Ùµµ Á÷½Ã°æÀ¸·Î Á¤¸é»óÀ» º¼ ¼ö ¾ø±â ¶§¹®¿¡ ¾î·Æ½À´Ï´Ù.

¾ðÁ¦ »ý°ËÇØ¾ß ÇÏ´ÂÁö ¹®ÀÇÇϼ̴µ¥¿ä... Àú´Â ±×³É '¿Õâ Æ¢¾î³ª¿ÔÀ¸¸é Á¶Á÷°Ë»ç ÇÑ´Ù' Á¤µµ·Î »ý°¢ÇÏ°í ÀÖ½À´Ï´Ù. ¸ÞÀÏ ÁֽŠ°Íó·³ ¾Ö¸ÅÇÏ¸é ¾È ÇÑ´Ù´Â Àü·«µµ ³ª»ÚÁö ¾Ê´Ù°í »ý°¢ÇÕ´Ï´Ù. Ampulla of Vater adenoma °úÀ×Áø´Ü¿¡ µû¸¥ ÆóÇصµ ÀûÁö ¾ÊÀ» °ÍÀ̱⠶§¹®ÀÔ´Ï´Ù. »ÏÁ·ÇÑ ´äÀ» µå¸®Áö ¸øÇÏ¿© Á˼ÛÇÕ´Ï´Ù. Ȥ½Ã ´Ù¸¥ ¾Öµ¶ÀÚ²²¼­ ¼±»ý´ÔÀÇ ´äº¯¿¡ ´ë´äÀ» ÁÖ½Ç ¼ö ÀÖ´Ù¸é °¨»çÇÏ°Ú½À´Ï´Ù.

¹®µæ ¿¹Àü¿¡ ¾î¶² ¾Öµ¶ÀÚ²²¼­ º¸³»ÁֽŠ¸ÞÀÏÀÌ »ý°¢³ª¼­ ¿Å±é´Ï´Ù. ³»½Ã°æÀ» ÇÏ´Ù°¡ ¿ô´Â ¾ó±¼À» ¸¸³ª¼­ ³î¶ú´Ù´Â ÀÏÈ­ÀÔ´Ï´Ù.

[¾Öµ¶ÀÚ ÆíÁö 2013-4-3] ¾È³çÇϼ¼¿ä? ´©±¸³ª ´Ù ±×·¸°ÚÁö¸¸ ¹Ù»Û ÀÏÁ¤ ¼Ó¿¡ ½Ã°£À» µû·Î ³»¾î °øºÎÇϱâ¶õ ½±Áö ¾ÊÀºµ¥ ±³¼ö´ÔÀÇ Endotoday¸¦ ¹Þ¾Æº¸¸é¼­ ¸¹Àº µµ¿òÀ» ¹Þ°í ÀÖ½À´Ï´Ù. ´Ã °¨»çµå¸³´Ï´Ù. ¿À´Ã º¸³» ÁֽŠ½ÊÀÌÁöÀå °ü·Ã ³»¿ëÀ» º¸¸é¼­ ¹®µæ °ú°Å¿¡ Âü Àç¹ÌÀÖ´Â »çÁøÀ̶ó »ý°¢µÇ¾î ÀúÀåÇØ µÎ¾ú´ø ½ÊÀÌÁöÀå À¯µÎºÎ »çÁøÀÌ »ý°¢³µ½À´Ï´Ù.

½ÊÀÌÁöÀå Á¦2ºÎ·Î µé¾î°¡ ÁÖÀ¯µÎºÎ¸¦ È®ÀÎÇÏ´Â ¼ø°£ ±ô¦ ³î¶ú½À´Ï´Ù. ±× °÷¿¡´Â »ç¶÷ÀÇ ¾ó±¼ÀÌ ÀÖ¾ú½À´Ï´Ù. Áö±ÝÀº ±×Àú ¿ô°í ³Ñ±æ ÀÏÀÌÁö¸¸ ´ç½Ã¿¡´Â ÇØ¿ÜÅäÇÈ¿¡ °¡²û ³ª¿À´Â ¿¹¼ö´Ô ¾ó±¼ Çü»óÀ» ¹ß°ßÇÑ °Íó·³ ³î¶ú½À´Ï´Ù. Çй®ÀûÀÎ ³»¿ëÀº ¾Æ´ÏÁö¸¸ ¹Ù»Ú°í ÁöÄ¡½Å ÀÏ»ó ¼Ó¿¡ Çѹø ¿ôÀ¸½Ã¶ó°í »çÁø º¸³»µå¸³´Ï´Ù.


[2020-2-24. ¾Öµ¶ÀÚ Áú¹®]

½ÊÀÌÁöÀå 2ºÎ¿¡ prominent ampulla ¼Ò°ßÀ¸·Î º¸À̴µ¥¿ä, °¡²û ÀÌ·¸°Ô º¸ÀÌ´Â °æ¿ì Á¶Á÷°Ë»ç¸¦ ÇØ¾ß ÇÒÁö °í¹ÎÀÔ´Ï´Ù.

ÀÌ È¯ÀÚ´Â ÇùÁ¶µµ Àß µÇÁö ¾Ê¾Æ Á¶Á÷°Ë»ç¸¦ Çϱ⿡µµ ¹«¸®°¡ ÀÖ¾î °üÂû¸¸ ÇÏ°í °Ë»ç¸¦ ¸¶ÃƽÀ´Ï´Ù. ³»½Ã°æ ¼Ò°ßÀ» ¸®ºäÇϸ鼭 Á¤»ó variationÀÎ °Í °°Àº ´À³¦ÀÌ µé±ä ÇÏÁö¸¸ Á¶Á÷°Ë»ç¸¦ ÇÏÁö ¾ÊÀº°Ô Á¶±Ý ¸¶À½¿¡ °É¸³´Ï´Ù. ÀÌ·± °æ¿ì ¾ðÁ¦ ´Ù½Ã ÃßÀû°Ë»ç¸¦ ÇÏ´Â°Ô ³ªÀ»Áö °í¹ÎÀÔ´Ï´Ù. ±³¼ö´ÔÀÇ ÀÇ°ßÀ» µè°í ½Í½À´Ï´Ù.

[2020-2-24. ÀÌÁØÇà ´äº¯]

¾È³çÇϽʴϱî. »çÁø ¸î ÀåÀ¸·Î Á¤È®È÷ Æò°¡Çϱâ´Â ¾î·Æ½À´Ï´Ù. ±×·¡¼­ ÀϹݷÐÀ¸·Î ´äº¯À» ´ë½ÅÇÕ´Ï´Ù.

Ampulla of Vater´Â Ȳ´ÞÀ̳ª º¹Åë µî »óº¹ºÎ Áõ»óÀÌ Àִ ȯÀÚÀÇ symptom evaluation endoscopyÀÇ °üÂû´ë»óÀÔ´Ï´Ù. ¹«Áõ»ó ¼ºÀÎÀÇ screening endoscopy¿¡¼­ ampulla of Vater¸¦ ²À º¸¾Æ¾ß ÇÏ´ÂÁö, º»´Ù¸é ¾î´À Á¤µµ ÀÚ¼¼È÷ Æò°¡ÇØ¾ß ÇÏ´ÂÁö °í¹ÎÀÌ ¾Æ´Ò ¼ö ¾ø½À´Ï´Ù.

¹«Áõ»ó ¼ºÀÎÀÇ screening endoscopy¿¡¼­ ¾Ö¸ÅÇÏ°Ô º¸ÀÌ´Â ampulla of VaterÀÇ Á¶Á÷°Ë»ç¿¡¼­ ÀǹÌÀÖ´Â º´ÀÌ ³ª¿Í ¸ÚÁö°Ô Ä¡·áµÈ ȯÀÚ´Â ¸¹Áö ¾ÊÀ» °Í °°½À´Ï´Ù. (¹°·Ð ¶Ñ·ÇÇÑ º´¼Ò°¡ ÀÖÀ¸¸é Á¶Á÷°Ë»ç¸¦ ÅëÇÏ¿© Áø´ÜÇØ¾ß ÇÕ´Ï´Ù. 2018³â ÇÑ ¾Öµ¶ÀÚ²²¼­ ¹ß°ßÇÑ ampulla of VaterÀÇ µå¹® cancer Áõ·Ê¸¦ º¸½Ã±â ¹Ù¶ø´Ï´Ù.) ¹Ý´ë·Î ÀÌ ºÎÀ§ Ä¡·á¸¦ ÇÏ´Ù°¡ ¾öû °í»ýÇÑ È¯ÀÚµµ ¿©·¯¹ø º¸¾Ò½À´Ï´Ù. ¾Æ½Ã´Ù½ÃÇÇ ÀÌ ºÎÀ§ÀÇ Ä¡·á´Â ³»½Ã°æÀ̳ª ¼ö¼úÀ̳ª ¸ðµÎ °£´ÜÇÑ ÀÏÀÌ ¾Æ´Õ´Ï´Ù.

¿©ÇÏÆ° biliary tract³ª ampulla of Vater´Â °ËÁø ¿µ¿ªÀº ¾Æ´Õ´Ï´Ù. °ËÁø´ë»óÀÌ ¾Æ´Ñ ºÎÀ§¿¡ ´ëÇÑ ÀûÀýÇÑ °Ë»ç³ª Ä¡·á ¼öÁØÀ» °áÁ¤ÇÏ´Â °ÍÀº ½¬¿î ÀÏÀÌ ¾Æ´Õ´Ï´Ù. Àú´Â ¹«¸®ÇÏÁö ¾Ê´Â ÂÊÀÌ ³´´Ù°í »ý°¢ÇÏ´Â ÆíÀÔ´Ï´Ù. °¨»çÇÕ´Ï´Ù.

[2021-7-15. ¾Öµ¶ÀÚ ÆíÁö]

±³¼ö´Ô ¾È³çÇϽʴϱî? ¿£µµÅõµ¥ÀÌ·Î °øºÎÇÏ´Â ³»°ú °³¿øÀÇÀÔ´Ï´Ù. ¿äÁò ½ÊÀÌÁöÀå¿¡ AoV, minor papilla °¡ prominent ÇÒ °æ¿ì, Adenoma, SET °¨º°¿¡ À§ÇØ Á¾º´ ÀÇ·Ú¿©ºÎ ÆÇ´Ü¿¡ ¾î·Á¿ò ÀÖ½À´Ï´Ù. ¸î¸î ÄÉÀ̽º´Â Á¾º´¿¡ ÀÇ·ÚÇصµ ±¦ÂúÀº °ÍÀ¸·Î ³ª¿Ô½À´Ï´Ù. ?

AoV, minor papilla ³»½Ã°æ ¼Ò°ß¿¡ ´ëÇØ ¾ÆƲ¶ó½º Ã¥À» »ç¼­ °øºÎ¸¦ ÇÏ°í ½ÍÀºµ¥, Ã¥ °Ë»öÀ» ÇغÁµµ ±× ºÎºÐ¸¸ ³ª¿À´Â ³»½Ã°æ »çÁø Ã¥Àº ¸ø ã°Ú½À´Ï´Ù. AoV, minor papilla ¿¡ ´ëÇÑ ³»½Ã°æ ¾ÆƲ¶ó½º Ã¥ÀÌ È¤½Ã ³ª¿Í ÀÖ´ÂÁö Çؼ­ °í¹ÎÇÏ´Ù°¡ ¹®Àǵ帳´Ï´Ù. ±³¼ö´Ô, °¨»çÇÕ´Ï´Ù.

[2021-7-15. ÀÌÁØÇà ´äº¯]

ÃâÆÇ °­±¹ ÀϺ»À» µû¶ó°¥ ³ª¶ó°¡ ¾ø½À´Ï´Ù. Àú´Â ÀϺ»¾î¸¦ ¹è¿ìÁö ¸øÇßÀ¸³ª ÇÑÀÚ´Â Á¶±Ý ¾Ë°í È÷¶óÄ«³ª¿Í °¡Å¸Ä«³ª¸¦ Á¶±Ý ÀÍÇô¼­ ÀϺ» ³»½Ã°æÃ¥À» Âü°íÇÏ°í ÀÖ½À´Ï´Ù.

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[References]

1) ERCP in surgically altered anatomy 2023³â KSGE Webinar. ¾ÆÁÖ´ëÇб³ ¾ç¹ÎÀç. Log-in é© - Âü°í: Surg Endosc 2022

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