기출·모의문제 › 의학 › 외과 각론
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결장 및 직장
70세 남성이 6개월간의 만성적인 철 결핍성 빈혈(IDA)과 전신 쇠약감을 주소로 내원했다. 대변 잠혈 검사 양성이었다. 대장 내시경 검사상 맹장(cecum)에 궤양을 동반한 융기성 종괴가 관찰되었고, 조직검사상 선암(Adenocarcinoma)으로 진단되었다. 이 환자에게 필요한 근치적 수술은?
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좌측 결장 절제술 (Left hemicolectomy)
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우측 결장 절제술 (Right hemicolectomy)
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S상 결장 절제술 (Sigmoid colectomy)
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저위 전방 절제술 (Low anterior resection)
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복회음 절제술 (Abdominoperineal resection)
해설
맹장(Cecum), 상행 결장(Ascending colon), 간 만곡부(Hepatic flexure)에 위치한 암(우측 결장암)의 표준 근치적 수술은, 회장 말단부 10cm, 횡행 결장 일부, 그리고 관련 림프절(Ileocolic, Right colic, Middle colic a. 분지)을 포함하는 우측 결장 절제술입니다.
같은 주제 다음 문제 30세 남성이 반복되는 복통과 복부 팽만으로 내원하였다. 환자는 크론병으로 진단받아 수년간 약물 치료를 받아왔으며, 최근 수개월간 음식 섭취 후 복통과 구토가 반… 이 문제가 수록된 문제집 메르시 의대 내신 문제은행 [ 외과 각론 ] 19,000원
KMLE 핵심 해설
이 환자는 만성 철결핍성 빈혈과 대변 잠혈 양성으로 내원하여, 대장 내시경에서 맹장(Cecum) 의 선암(Adenocarcinoma) 이 확인된 경우입니다.
증상 분석 및 진단 (Diagnosis): 우측 결장암(맹장암)은 종양이 궤양을 형성하며 만성적으로 출혈하여 철결핍성 빈혈을 유발하는 전형적인 증상을 보입니다. 좌측 결장암이 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