내시경적 용종 절제술을 시행받은 145례의 위용종에 대한 임상 및 병리학적 연구 = Clinicopathologic Analysis of 145 Cases of Gastric Polyps Removed by Endoscopic Polypectomy

국문 초록 (Abstract)

내시경 시술의 발달로 위에서 발생되는 여러 종류의 용종 중 크기가 악성일 경우는 외과적 절제술이 시행되고 있고 그 외 대부분의 병변은 내시경적 치료가 가능해졌다. 이런 점에서 저자는 위에서 발생되는 용종의 임상적, 병리학적 특징과 각종 내시경적 용종 절제술의 치료 효과와 안정성을 관찰하고자 하였으며, 내시경적 용종 절제술 후 추적 관찰하여 용종의 재발이나 위암의 발생을 확인하고자 한다.

다국어 초록 (Multilingual Abstract)

Gastric polyps are narrowly defined as macroscopically localized mucosal elevations composed of epithelial elements. They can be divided into two types : hyperplastic polyp and adenoma. Hyperplastic polyps usually occur in a chronically inflamed mucosa with a mild degree of atrophy and composed of normal-appearing epithelial cells, so hyperplastic polyps rarely become malignant.
When dysplasia occurs to the polyps, malignant potential increases. Adenoma is composed of immature cells with varing degrees of dysplasia and its malignant potential is very high. So according to the size and pathologic findings, the therapeutic modalities are variable. And they should be removed for prevention of gastric cancer.
We have performed endoscopic polypectomy such as snare polypectomy, strip biopsy or "O"ring ligation in 145 patients from July 1988 to June 1995 and evaluated the clinical characteristics, histopathology of the polyps. Twenty three patients who had had adenoma and had been undergone mucosectomy were followed up endoscopically for 6 to 24 months. The results were as follows :
1.One hundred and forty five patients were enrolled in this study. The ratio of male to female was 0.7:1(59 men, 86 females) and mean age was 50.4 (range: 31-79). The polyps were most frequent in the 6th decades of age.
2.The common clinical symptoms were epigastric discomfortness(41.3%), epigastric pain(29.7%), indigestion(17.9%) and abdominal discomfortness(6.9%).
3.The location of polyps were antrum(47.3%), body(45.0%) and fundus(7.7%). The number of patients with multiple polyps were 16(11.0%) and 139 patients had single polyp. The most frequent size of polyps was 0.5-1.0 cm and the next was 1-2 cm.
4.The gross findings of polyps by Yamada's classification were type II (35.5%), type III (29.6%), type I (21.3%) and type IV(13.6%). On histologic examination, hyperplastic polyps were 68.6% and adenomatous polyps were 23.7%.
5.The methods of polypectomy were mucosectomy in 23 cases(strip biopsy : 18, "O"ring ligation : 5) and snare polypectomy in 122 patients. If adenomatous polyps were reseated incompletely, we applied the laser therapy. When snare polypectomy could not be performed, strip biopsy was done. The effectiveness and rate of complications of mucosectomy was not different from that of snare polypectomy.
6.The most frequent complication of polypectomy was epigastric pain(23.4%) and the next was bleeding(14.5%). We could manage epigastric pain with medical therapy. The bleeding was controlled with Nd : Yac laser in five cases, with hypertonic saline-epinephrine injection therapy in five cases and with conventional medical therapy in 11 cases.
7.Among the patients with adenomatous polyps or dysplasia, we followed up 23 cases for 6 to 24 months (mean: 16 mon). There was no recurrence, but in one case gastric carcinoma was detected on other site.
In the patients wish gastric polyp, polypectomy should be performed for precise diagnosis and treatment and the methods of polypectomy are taken according to their size and morphologies. Polypectomy is an effective preventive therapy for gastric cancer with low procedural complications.

목차 (Table of Contents)

• Ⅰ.서론
• Ⅱ.연구 대상 및 방법
• Ⅲ.결과
• 1.연령 및 성별 분포
• 2.임상 증상
• 3.용종의 발생 부위 및 크기
• 4.용종의 육안적 및 조직학적 형태
• 5.용종의 절제 방법
• 6.용종 절제술의 합병증
• 7.선종 절제 후 추적 관찰
• Ⅳ.고찰
• Ⅴ.결론