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  • ºÏ¸¶Å© ¾ÆÀÌÄÜ

Á¶Á÷°Ë»ç Çؼ®ÇÑ°ÅÁ» ºÁÁֽǺР°è½Å°¡¿ä????2

º´¸® º¸°í¼­

- cholangiocarcinoma(´ã°ü ¹× ´ã³¶¾Ï)

- extrahepatic(°£¿Ü)

- Intraductal growth type(´ã°ü³» ¼ºÀåÇü)

- adenocarcinoma ,well differentiated (°íºÐÈ­ È£»ê¼º °ú¸³¼¼Æ÷¾ÏÁ¾)

<ºÐÈ­»óÅ¿¡ µû¶ó well, poorly, undifferentiated, µîÀ¸·Î °¥¸². ¹ÌºÐÈ­Àϼö·Ï ¾Ç¼ºµµ ³ôÀ½>

- arising from Intraductal Papillary Neoplasm of the Bile duct (IPNB), multiple, up to1.5x1.3X1.0CM

  distal common bile duct[¿øÀ§ºÎ ÃÑ´ã°ü]

 (¿øÀ§ºÎ ÃÑ´ã°ü ³» ´Ù¼öÀÇ??? À¯µÎÁ¾¾çÀ¸·Î ºÎÅÍ ¹ß»ý, »çÀÌÁî 1.5 1.3 1.0) 


1) confinement to bile duct wall (´ã°üº®¿¡ ±¹ÇÑ)

2) no involvement of ampulla of Vater[¹ÙÅÍÆØ´ëºÎ], duodenal wall[½ÊÀÌÁöÀ庮] and pancreas[ÃéÀå]

 (¹ÙÅÍÆØ´ëºÎ ½ÊÀÌÁöÀ庮 ÃéÀå ħ¹ü¾øÀ½)

3) lymphovascular invasion : not identified(¸²ÇÁÇ÷°ü°­ ħ¹ü¾øÀ½)

4) perineural invasion : not identified(½Å°æÁÖÀ§ ħ¹ü ¾øÀ½)

5) no involvement of peripancreatic radial[ÃéÀå ÁÖº¯], pancreatic[ÃéÀå], common bile duct[ÃÑ´ã°ü], proximal duodenal[±ÙÀ§ºÎ ½ÊÀÌÁöÀå] and distal jejunal resction margins.[¿øÀ§ºÎ °øÀå ÀýÁ¦¸éµé]

(ÃéÀå ÁÖº¯, ÃéÀå, ÃÑ´ã°ü, ±ÙÀ§ºÎ ½ÊÀÌÁöÀå, ¿øÀ§ºÎ °øÀå ÀýÁ¦¸éµé ħ¹ü ¾øÀ½)

6) no metastasis in 12 lymp nodes (0/12) (12°³ÀÇ ¸²ÇÁÀý¿¡ ÀüÀÌ ¾øÀ½)

(LN #8, 0/2; regional LN, 0/10)


=======================================


1.

¼ö¼ú ÈÄ Á¶Á÷°Ë»ç °á°úÀ̸ç

Çѱ۷ΠÀûÈù ºÎºÐÀº Á¦°¡ ³ª¸§´ë·Î Çؼ®ÇÑ ºÎºÐÀÔ´Ï´Ù.

Á¦°¡ Çؼ®ÇÑ°Í Áß Æ²¸°ºÎºÐÀ̳ª Ãß°¡ÇØ¾ßµÉ »çÇ×ÀÌ ÀÖ´ÂÁö,,

µµ¿ÍÁÖ½Ã¸é °¨»çÇÏ°Ú½À´Ï´Ù.

À§ º»¹®Áß¿¡ multiple ÀÌ ¹«¾ùÀ» ÀǹÌÇÏ´ÂÁö ±Ã±ÝÇϳ׿ä


2. Intraductal growth type(´ã°ü³» ¼ºÀåÇü) À¸·Î °á°ú°¡ ³ª¿Ô´Âµ¥

   º¸ÆíÀûÀ¸·Î Ä§À±ÇüÀÌ ¸¹Àº °ÍÀ¸·Î ¾Ë°í ÀÖ½À´Ï´Ù.

   ħÀ±Çü¿¡ ºñÇØ ´ã°ü³» ¼ºÀåÇüÀÇ ¿¹ÈÄ°¡ »ó´ëÀûÀ¸·Î ´õ ÁÁÀº°ÇÁö ±Ã±ÝÇÕ´Ï´Ù.


3. ¸¶Áö¸·À¸·Î ÀÌÁ¤µµ º´±â¸é

   ¾î´ÀÁ¤µµ ÁøÇàÀÌ µÈ°ÇÁö,,

   Á¶±â ´ã°ü¾ÏÀ¸·Î ºÁµµ µÉ±î¿ä?

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