,,,,,,,,,,,,,,,,,,,,,, 1

,,, ;,,,,,,,,,,,,,,!,,,,,! 2

Q & A 1.? 3 2.? 4 3.? 5 4.? 8 5.? 10 6.? 10 7.? 12 8.? 13 9.? 15 10.? 17 11.? 18 1

12.? 19 13.? 21 14.? 22 15.? 24 16.? 25 17.? 27 18.? 28 19.? 29 20.? 30 21.? 31 22.? 33 23.? 34 24.? 35 25.? 36 26.? 37 27.? 38 28.? 40 29. -? 41 30.? 41 31.?? 42 32. 43 33.?? 44 34.? 45 35. 47 36.? 48 37.? 49 38.? 50 2

39.? 51 40.? 58 41.? 58 42.? 60 43.? 65 44.? 66 45.? 67 46.? 67 47.? 69 48.? 70 49.? 71 50.? 72 51.? 73 52.?? 75 53.? 77 54.? 79 55.? 79 56.? 81 57.? 82 58.? 84 59.? 85 60.? 87 61.,? 87 62.? 88 3

63.? 90 64.? 91 65.? 93 66.? 93 67.?? 94 68.? 95 69.? 96 70.? 97 71.? 98 72.,? 103 73.? 106 74.? 106 75.? 107 76.? 108 77.? 108 78.?? 109 79.? 110 80.? 111 81. B?? 112 82. B? 113 83.? 113 84. B? 114 85. B? 116 86. CT? 116 4

87. ( MRI)? 118 88. ERCP? EPT EST? 119 89. ERCP? 120 90.?? 121 91. ERCP? 123 92.? 123 93.? 124 94.? 126 95.? 126 96.? 129 97.? 130 98.? 132 99.? 134 100.? 139 101.? 140 102.? 143 103.? 144 104.? 146 105.? 148 106.? 149 107.? 149 108.? 150 109.? 151 110.? 153 5

111.? 154 112.? 155 113.? 156 114.? 157 115.? 158 116.? 159 117.? 160 118.? 161 119.? 162 120.? 163 121.? 163 122.? 165 123.? 166 124.? 167 125.? 168 6

1? ( pancreas ),,,,,, - ( ), ;, 1 3

2?,,, 12 15, 3 9, 1.5 3, 70 100, 20 50, 5 70.3, 62.9,,,,,,,,,,,, 2 3,,,,,,, 4

2 3?,,,, C,,,,,, 5

,,,,,,,, 2,,,,,,,,,,,,, ;, ;,,,,,,,, 1,,, 6

3 4 7

4?,,, 2 3,, 10 15,,,,, (Oddi s ),, 50,,, ( 5),,,,,,,,,,,,,,,,,, 8

: Y,,, Y,, 5,,, 70% ; V,,,, 5, 20% 30% ; U,,, 10% 20%, 5 9

5?,, ;,,,, ; 2 10, 6?,, ( 7 ),,, 10

6 ;,,,,, ;,,,, 11

,, ; 3 13, 7 7?,,,, ; 12

; ; ;, 8 8? 13

,,,,,, ;,,, ;,,,,,,,,, :,,,, 14

9?,,,,,,,, l, ( Vateo), ( 9), 70%, ", 5 30%, ;, 5.5% ;,,,,, 8 10,, 2 3,, 15

,, 0.2,, 47 % 99%,, 5,,,,, 60%, 20%,, 10 %,,, 9%, 9 16

10?,,,,, 1 2,,, ;,,,, 0.1 % 10 %,,,, A D E K 17

11?, 20 180, 1%,,,,,,,,,, A B D PP D1,,,, A PU D( ) EC EC, EC, U, 250 300, EC 5 - P 18

12?,, ( ), ;,, 1 000 2 000 ( ),,,, 20, ; ;, ;,,,,,,, 19

,, 20 180,, A, ;, A,, B,,, B, :,, 6 - ; 6 - ; ; ; ;, A B,,,,,, ( ) D,,,, ( ) ;,,, 20

PP,,, D1, A B C A B D, 13?, p H 7.6 8.2,, 1 2,,,,,,, 60 140 /,, 7, ; p H ( p H 7 8),,, 21

,,,,, 0.1% 10%,,,, 14? 1. : -,,, -, ph 6.7 7.0 : : : 2. 22

A B,, A B,,, :,,,,,,, ;,,,,,, ;,, N, C ;,,, ;, ;,,,,,, 3.,,, p H 23

7.0 9.0, A, A,,, B, 15?, 20%, 25 2 000,, 10, 4 000, 80% 100,,,,,,,, ( ), 24

,, 1. -,,,,,, 1 1 9, 10, ph 4 11, ph 6.7 7.0,,,, - 1, 4,,, - 1, 6, 2. 3. 4. 16? 0.5 0.7, 1 3 4, 20, 25

,,, 1.,,,,,,,, 2.,,,,, 3., N C 4.,, 5. 26

, 17?,,,,,, 1 37.65 ( 9 ), 1 16.73 ( 4 ) : 95% ;, A D E K :,,,,,,,,, 11 000,,,, 27

1 1,,, 2 - ; p H 8.0,, A : A,,,, B 18?, 1 1.5,,,,,,,,, 1., G,,, 28

2.,, 3.,,,,, 19?, 1.,,,, 2., G, 3.,,, 29

20?,,,,,,,, 1.,,,,,,,,, 2. S, 3.,,,,, 30

4.,, 5.,, P,,,,,,,,, 6.,,,, 21? 31

,,,, ;,,,,,,,,,,, X,,,,,,,,, 32

10 22?,,,,,, 90% ; Meckel ; ;,, 2 4,,,, 33

,,,,,,,,,,, 23?,,,, ;,,,,,,, 4% 10 %,,,,, 34

,, 20 50,, 25%,,,,,,,,, 70%, 24?,, 3 1.,,,, 35

2.,, 3.,,,,,,, 25?,,,,, 2,,,,,, X B, X, B 36

,,,,, 3 5,,,,,, 26?,,,,,,, 1,, 37

,,, 15 % 20% 48,,,,,,,,,, 5 : ; ; ; ;,,,, : ; ; ;,, 27? ( Shwachman ) Shwachman 1964,, 38

,,,,,,,,,,,, 4 6,,,,,,,,,,,,,, (, B12 ), 39

28?, 1. 1965, 0.1,,, 2.,, ;,,, 3., 1,, 3,, 4., 40

, 29 -? - ( Joh nson-blizzard ) 1971,,,,, : ; 30?, 6,,, ( 41

),,,,, ( ),,,,,,,,,, 31??,, 0.32% 2.04%,,,,, 1 1.7,,,,, 42

,,, 1% 2% ;, 10% 20%,,,,,,,,,,,, 32 1 : : 6 - ( ) ( ) L - 43

: ER CP B EB R eye : ER CP 33?? ( A H NP ) ( AN P ) ( ), ( ), 3 /4,,,,,, 44

, 90%, 10% ( SA P ),,,,,, 30% 60%,,,, ; ;,, CT,,,,,,, 34? 70 % 80 % 1., 70%,, 45

:, 3 4, B ;,,, ;,,, ( ERCP ),,,, 2.,,, 1998 ( SD) ( CBD) ( PD), SD CBD PD, 65% SD, 56% CBD PD, ES T (clostridium botulinum A toxin) 3.,,,,, 46

35 11 47

36?,,,,,, 1.,, 50%, T ST 2. 18% 27% 3 5,,,, 79.2%, 3. 48

,, 15% 20%,,,,, 4.,,,,, 5., 5%,,,, :, 37?,,,,,,, 49

,,,,,,,,,,,,, 38?,,,,, B ERCP CT MRI,,,,,,, 50

,,,, 50% 60 %,,, 175,, 15, 30 40, 25,,,,, 39?,, ERCP 1.,,, 51

,,,,,,,,,,,,,,,,,,,,,, 2.,,,,, : 52

,,,,,,, 95%,, 3.,,,,,,, 11 17, 11,,,,, 1 7,, 53

3 4,,,,,,,,,,, 4.,, 1,, ( ), (, ) ( ),, 54

,,,,,,,,,,,,,,, 5. E RCP ERCP ( ) ( post-ercp pancreatitis ) ERCP, ERCP,,, ERCP 0 39.5%,,, ERCP ERCP :, ERCP 55

E RCP,,, B CT,, B CT,, ERCP, ERCP,, ERCP ERCP, 2 3 ERCP,,,, 2 3 ERCP, E RCP,, 6.,, :,, 56

, :,,, ; Billroth,,,,,,, : T PN( ) ; ; ;,,,,,, :,,,,, ;,, ; :,,,,,,, 57

40?,, 5.9 % 11.9%,,,,,,,,,,, ;,,, C T,, 41?, 58

,, 100%,,,,,, 22 % 57 %,,,,,,,,,,, 6 14, 2 3, 4,,, ;,,,,,,, ;,,, 2,,, 59

1 2, 1 2,,, 42?,,,,,,,,,, :,,,,,,, 1,, 3 4,,,,,, 75%, 20%,, 60

,,,,,,,, :, 6, 40% ;,, ( 6 ) ;,, : ; ; 61

43?,,,,,,,,,,,,,,,, A,,,,,, 65

44?, 50%,,, 80 %,,,,,,,,,,,,,,,,,,,,,,,,,,, 66

45?,,,,,,,,,,,,,,,,,,,, 46? :, Y, 5,,,,,, 67

,,,,,,,,,,,,,,,,,,,, ;,,,,,,,,,,,, 68

47?,,,,,, 50, 1 ( 50 ), 25, 4 (200 ) 100,,,, ; ;,, 1% 9.5%, 17% 45%? 1.,,, ( ), 2.,,,,,,, 69

3.,,,, 4.,,,,,,,, 48?,,,,, 20 % :,, ; 70

, ;, ;,, : ;, ;,, 49?, 5% 20%,,,,,,,,, 71

,,,,,,, 11 /,,,,,, 50?, :,,,, ( annular pancreas ), Billroth,,,, 72

E RCP,,,,, :,,,,,,,,, 30 %,, 51? 1. ( 95 % ),,,,,,,, ;,, 73

2. 2 /3,,,,,, 3., 4. 20% 1 2,,,,, 5. : 38 39, 3 5,, 6.,,,,, < 1. 98 / ( 8mg% ),, 7.,,,,, 35. 7 / 74

8., 9. 23 %, 80 %,,, 10., 11. 5.9% 11.9%,,,,, 52?? ( ),, 1.7 17.1 /,,, 34.2 /,,,, ; 17.1 34.2 /,, 75

,,,,,,,, ( ) 100 120,, -,,,,,,,,,, 80 % 90%,,,, 10% 20 %,,, 15 % 50%,,, : 1.,,,,,, 76

2.,,, Dubin-Jouhn son Roter ;,,, 3., : ;,,,,,,,, 53?, : 77

12 78

54?,,,, 1. 2, 2. 2 2, ( ) 3. 2 3,,,, 55? ( ) ( ),,,, ;,,, ; 2 79

2 ( + ) ( + + ) ( + + + + + ) ( ) ( ) ( ) ( ) ( + ) ( + + + ) ( - ) ( ) ( + + + ) ( - ) ( + ) ( + ) ( + ) ( + ) ( + + ) ( ) ( + ) ( + + + ) ( - ) ( + ) ( + + + ) ( - ) ( ) ( + ), ( - ) ( ) ( + ) ( - ) ( ) ( + ) ( - ) ( ) ( + + + ) ( - ) ( ) ( + ) 40 % 45 % 30 % 30 % 80

A L T A ST PaO 2 56? 1.,,,,,,,, 2.,,,,,,, 3.,,,,, 81

4. ( Cullen ) ( Grey T urner ),,, 3 95 % 100 % 15 % 50 % 40 % 55 % 10 % 15 % 35 % 40 % 10 % 15 % 65 % 85 % 5 % 10 % 60 % 90 % 2 % 5 % 72 % 82 % 35 % 58 % Grey- T urn er Cull en 35 % 44 % 30 % 45 % 57?, 95%,,,, 82

,, ; ; ; 6 %,,, ;, ;,, ;,,,,,,,, Bliss,,,,,,,,,,,,,,,,,, 83

, 58?,,,,, 10,,,,,,,,,,,,,,, :,,,,,, 80 % 90%,,,, 10% 20 %,,,,,,,,, 84

,,,,,,,, ( ),,,,,,,, 59?,, 1., : EB 85

ECH O,,,,,, 2.,,,,,,,,,,,,,,, 10% 35%,,, ( E RCP ) 3. : 4. 5., 86

60?,,,,,,,,,,,,, ; ;,,, 61,? 1., ( Somogyi), 64, 500 3,, 87

24 48, 64,,,,,,, 300 500 2. 24,, 0.5 1 3.,,,,, ( ), 4. B,, 62?,,,,,,,, 88

1.,,,,,,,,, 500,, 500 2.,,,,,,,, B C T, 500, 3.,,,,, 4.,,,,,, B ERCP 5.,, 6.,,, 89

63? 4,,,,,,,,,, X,, X,,,,, X,,,,,, X 90

, A ST,, >, 20 10 9 / L,,,,,, 64? 1. (1 ),,,, (2 ),,, (3 ),, 91

B, B, (4 ), 3 5,,,,, 2. (1 ) (2 ),, (3 ), (4 ), B,,,,,,,,, (5 ),, 12 24, 92

65?,,,,,,?,,,,,,,,,,,, 66?,,,,,,,, 93

, ;,,?,, 1 3,,, ;,,,,,,,,, 67??,,,, 2 3,,,,,,,,,,, 94

,,,,,,, 68?,,,,,,,,,,, 9.4% 25%,,,,,,,, 80%, 95

,,,,,,,,,,,,, 69? : 3 7,, 85% ; 48, 2% 3 % ;, 2 6,, 6 % 8% ;, 1 6,,, ;,,, 5% ;,, 96

, 70?, 99%,,,, : 11% 3%, 30% 50%, 60% 1. 2., 7% 30% ( 5) 5 ( % ) ( % ) 300 20.6 3 0 4 100 143 13.2 5? 22 27 60 31 198 28 63 17.4 102 7 97

3. Ran son 11, 0 2, 3% ; 3 4, 18% ; 5 6, 38% ; 7 8, 98% 71?, 1., 10, 5.4, 10.0, 4.8, 11.4, 10, 0.9, 0.9, 1.1, 0.32% 2.04% 2., 50 10 : 1940 1949 6.8% ; 1950 1959 13.7% ; 1960 1969 11.4% 1955 1965 10 : 1955 0.001%, 1959 1961 0.0011%, 1965 0.0013% 1979 98

1980 28.1 /10 3., 1956 1976, 4., 53, 30 70 42, 5.,, 14,, 25% 40% 99

72,?,,,, 1. (1 ), ( 10 20 ) 10 9 /,,, (2 ),, (3 ),, 3P 2. ( H ct), H ct, 50%, H ct 30%,,, 3. (, mathemalbumin, M H A),,, 103

,,, 12,, 70%, 6%,,,, 4.,, 10 /, 5. (1 ), 1 /3, 2.12 /, 1.75 /,,, (2 ),, (3 ), 104

, ( ) 6.,, 5% 10%,,, 7.,, 4 7, ( AL P ) ( ALT ) ( AST ),,, 8. C ( CRP ) CRP, 95% CRP, 120 /, CRP 250 / CRP, CRP 8 / 9.,,, 10., C3 0.7 / (70 / ), C4 0.25 / ( 25 / ), 105

66% 78% ; ( MSOF ), 10, 98% 73?,,,,,,,,, 90 % 74?,,, 100 50 180 ( 50 180 / 106

),, 4 8, 18 24, 3 5, 3 4, 500, 300 500,,,,, 10,,,,,,,,, 75?, 24 : 1, 24, 2,, 107

,,,, 24, 1, 76?, 80 300,,, 12 24, 1,,, 1,,, 3 5,,, 77?,,, : 108

( 654-2 ) ( ) ( ), 78??,,,,,,,,,,, 1 1.5,, 2,,, 109

,, : 8, ( 654-2 ) 79?, 1 2,,,,,,,,, 2,,,,,, 110

80?, 10% 2, : 6 8, 48, 3 5 ; 12 24, 1 2,, :, :,, 5 7, :,,, :,, 24, 5 10 :, 111

,, : (, M H A) C ( CRP ) A2 ( P LA2 ) ( P T I) : B, CT 81 B?? B B,,,,,,, B,,, ( ), X C T M RI,,,,,, : ; 112

;,,, ;,,,,, ;, CT,,, 82 B? B,,, 1 B B :, 83?,,,,,,, 113

,,,,,,, 2.5, 2.0,, 3.5,, 84 B?,,, 90%,,,,,, ;,,,,,,,,,,, 114

,,,,,,,,,,,, 6 115

85 B?,,,,,,,,,,,,,,, 500 800,, 86 CT?,, C T,, CT,,, CT,, CT, CT 116

,, C T, ;, CT,,,? CT, 24 30, 5,, C T,,,,,, C T 90%,,,, CT B,, CT C T,, CT, CT, 1, 117

, 87 ( MRI )? ( MRI),,, ( ) ( ),,,,, MRI B CT ( MRCP ),,,, 100%, 75% MRCP ERCP, M RCP ERCP,,,, ERCP 118

MRCP 88 ERCP? EPT EST? E RCP,,,,,,, ERCP,, ERCP E RCP,,,,,, ( EP T ) ( EST ) ;, 119

, 75, 2 2.5,,,, 3 60, 4 2,,,,,,,, 89 ERCP E RCP ( ),, 80 % 90% 1. (1 ), (2 ) (3 ) X (4 ) (5 ) (6 ), 120

(7 ) (8 ) (9 ), 2. (1 ) (2 ), (3 ) (4 ) (5 ), (6 ) (7 ) ( Rou x-y),,,, 90?? B B 121

,,,,, ( B ),,,,,,, ;,,,,,, ( ), CT ERCP, ( ),, ( ),,, : CT (100 % ), ERCP (100% ) 122

91 ERCP? E RCP E P T, /,,, 6 8, 1 2 E RCP E P T ( ),, ERCP EP T,,,,,, 92?,, 70% 80% ERCP,,, ERCP EPT, 123

,, ; 24 ; ( 72 ), ERCP,, ERCP,,,,,, 93?,, 1.,,,,,,,,,,,, 2., 124

5 - H2,,, 3., 4., 5.,,, 6.,, ; ; ;,,, 7.,, 125

94?,, ",,, 13,,, : 95? :, ; 126

, ;, ; ; 1.,,,, (1 ),,,, (2 ),,,,,,, :,, ;, 24 2 500 3 500 ;, 3,, 1 000, 0.7, ;,,,,, ;, 4 127

7,,,, ( T PN), 300 500 3 750 ( ), 10 %, 2. (1 ),,,,, (2 ), H2 ( ) ( ) (3 ),, (4 ), A2,, A2 3.,, 2, 40% 50%,, 80 % 70%, 75%, 10%,,,,, : 128

4. 5. 96?, 1., ;, ; 2., 50 % ;,, : ; 129

97?,,,,, 3 8,,,,,,,,,,,,,,,,,,, 20 70,, 130

,, 80,, 30 % 50 %,,,, 100 %,,,,,,,,,,,, 2,,, C T CT CT CT 50%, CT,, 90% CT,, 48, CT 2 3, 60%, 131

98?,, : ; ; ; ;,,,,, (,, ) 7 ( ) 1. 132

,,,,,,,,, 2. T,, 24 48,,,,,, 3.,,, 75% 89 % : ;, ;, ;, ;,, : ; ; ; 133

4. :, : ; ;,, ; :, ;,,, ; ; 5.,,,,,,, ;, ; 99? 1., 134

, 100%, 5% 13.9%,, : ; ; 10,, 11% 2., 5, 6, 6, 40 % 6,, 3.,,,, 4.,,,,, 135

5.,,,, 6 3,,, 136

100?,,,, 8,,,, ( ),,, ( ),, ( ERCP ),,,,,,,,,, ;,,, ;,,, 139

101?,,,,,,,, 1. D,,,, 2.,,,, 3.,,,,, 4.,, 5.,,, 140

6.,, 7., 8., 2 3,, 9.,,,,,,, 10. ACT H, 28% 40%,, 11. 3, 12.,, 7, 13.,, 14.,, 15. 141

,, 16.,,,,,,,, 17.,,,,,,,,,, B C T,,,, 3 5,, 142

102?,,,,,,,,,,,,,,,,,,,,,,,,, 143

,,,, 103?,,,,, 4 7,, ( T PN ) l,,,,,,, 144

,,, : ; ;,,,,,,, : ; ; ; ( sa tiety syndrome ),,,,, 145

13 104?, 146

,,,,, : ;,, : 15 ; ;,,,, 2 4, Ranson 5 6, l, 7 2, 147

105?,,,,,, : ",,, 25 50 /,, 25%, 125 /,, : ;, ;, ; 148

106?,,,,, :, ; 24 2 500 3 500 ;,,,,,,,,, 60% 107?, ( 149

) ( ),,,, ;,,,,, ( ICU ),, 24,, ICU ICU,,,, ICU, 108?,,,,,, 150

,,, B CT,, :,,,, B C T,,,,,,,,, A D E K B12 109?,,,,, :,,, 151

;, ;, : (, ),,,,,,,,,,,,,,,,,,,,,,,, 152

, 110?,,,, (, ) 1.,,,,,,,, : ( ) ; 2.,,,,,,, : ( ) ( ) ;, 150 3.,,,,,, 153

: ( ) ( ) ; 4.,,,,,,,, : ( ) ( ), 111?,,, 1. :,,,,,, :, :, ( ) ( ) 2. :,,,,,,, : 154

:, 3. :,,,,,,,, :, :, 4. :,,,,,, :, :, 112? 1. : 4 6,,,,,,, 6,,, 155

, 2. : 12 48,,,,,,,,,, ( ),,,, 3., ( ), ( ) 113?, : ( ) ( ),,,,,,,,,,,, : ( ) ( ) 156

,,,,,,,,,,,,,,,,, :, ( ) 114?, : ; ;,,,, 8 157

8 (, * ) 7 6 % ( 15 1.5, 250 ) 1 9 ( 15 15, 250 )1 11 ( 30 15, 250 ) 1 13 ( 100, 250 ) 1 15 6 % ( 15 1.5, 250 ) 1 18 ( 100 5, 250 )1 20 ( 30 10, 250 ) 1 *,,, 115?,,, B1 C,, 5 7,,, 158

116?,,, 50 9 : 9 ( ) (, * ) ( 50 ) 1, 1 ( 50 ), 10 ( 30 15, 250 ) 1 ( 75 75 10 1 ), ( 50 10 0.5 3 ), 2 ( 125 ) ( 100 5, 250 ) 1 ( 55 75 1 10 100 50 )2 ( 25 5, 250 ) 1, (25 ) *,,, 159

117?,,,,,, 1 2, 2 3,,,,, 3 5, 1.,, 2.,,,, 3.,,,, 4., 160

5., 6., 5 6 118?,,,, 1.,,,,,,,, 2.,,, 3 6,,, 3., 161

,,,,,,,, 4.,,,, 119? 1.,,,, 2.,,, 3 7,,,, 3.,,,, 162

4.,,,,, 120?,,,,,,,,,, :,,, 121?, 163

,,,,,, 2 4,,, T PN, ( ) 10 1. B C ( ),,,,,,, 2. A D E K, (Bitot s pot, ), 164

3.,,, ( 2 4 ),,,,, 122? 2 2,,, B E RCP, E P T,,,,,,,, 165

,,,,,, ( ), 4 % 10 %,,,, 70%,,,,, 75%, 25% 123? 1.,, 166

2.,,,,,, 3. :, ;, ;,, ;,, ;, ;, ;,,, 124?,,,, : ; ; ; 167

, :, ;, ; ;,,,,, 125?,,, ; ; B ( ) 168