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19¼¼±â ÈÄ¹Ý Á¸½º ȩŲ½ºÀÇ Halsted¿¡ ÀÇÇؼ­ ºñ·Î¼Ò À¯¹æ¾ÏÀº À¯¹æ¿¡¼­ºÎÅÍ ÇغÎÇÐÀû ¼ø¼­¿¡ µû¶ó ±Ù¸· ¹× ¸²ÇÁÀýÀ» µû¶ó ¼øÂ÷ÀûÀ¸·Î ÆÛÁ®³ª°¡´Â ±¹¼ÒÁúȯÀ̶ó´Â °³³äÀÌ µµÀԵǾî Èä±ÙÀ» Æ÷ÇÔÇÑ À¯¹æ°ú ÁÖÀ§ ¾×¿Í ¸²ÇÁÀýÀ» ÀýÁ¦ÇÏ´Â ±ÙÄ¡Àû À¯¹æÀýÁ¦¼úÀÇ °³³äÀÌ Á¦½ÃµÇ¾ú°í,(2) ÀÌÀü¿¡ ºñÇØ ºñ¾àÀûÀÎ »ýÁ¸À²ÀÇ Çâ»óÀ» ¾ò°Ô µÈ´Ù.(3) À̾ Carey µîÀº À¯¹æ¾ÏÀÇ ±¹¼Ò Ä¡·á °³³äÀ» ´õ¿í °­Á¶ÇÏ¿© ³»À¯ ¸²ÇÁÀýÀÇ ÀýÁ¦¸¦ Æ÷ÇÔÇÑ È®´ë ±ÙÄ¡ À¯¹æÀýÁ¦¼úÀ» Á¦¾ÈÇϱ⵵ ÇÏ¿´´Ù.(4) ÇÏÁö¸¸, ÀÌ ÈÄ Patey ¹× Auchincloss µî¿¡ ÀÇÇØ Èä±ÙÀ» º¸Á¸ÇÏ´Â º¯Çü ±ÙÄ¡Àû À¯¹æÀýÁ¦¼úÀÇ È¿°ú°¡ ÀÌÀüÀÇ ±ÙÄ¡Àû À¯¹æÀýÁ¦¼ú°ú ´Ù¸¦ ¹Ù ¾ø´Ù´Â »ç½ÇÀÌ ÀÔÁõµÇ¾î,(5, 6) °ÅÀÇ ÇÑ ¼¼±â µ¿¾È À¯¹æ¾ÏÀÇ Ä¡·á´Â À¯¹æÀ» ¸ðµÎ ÀýÁ¦ÇÏ´Â ¼ö¼úÀÌ ÁÖ·ù¸¦ ÀÌ·ç¾ú´Ù.(3)
º¯Çü ±ÙÄ¡Àû À¯¹æÀýÁ¦¼ú ½ÃÇà ½Ã À¯¼±ÇÏ Áö¹æÃþ (retromammary fat)À» Æ÷ÇÔÇÏ¿© ´ëÈä±Ù ±Ù¸·ÀÌ ¹Ýµå½Ã Á¦°ÅµÇ¾î¾ß Çϸç, À°¾ÈÀûÀ¸·Î Á¾¾çÀÌ ±ÙÀ°ÃþÀ» ħ¹üÇÏ¿´À» °æ¿ì¿¡¼­ ħ¹üµÈ ±ÙÀ°ÃþÀ» Æ÷ÇÔÇÏ¿© °¡´ÉÇÑ ÃæºÐÇÑ ÀýÁ¦¿¬À» È®º¸Çϸ鼭 ÇÔ²² Á¦°ÅÇÑ´Ù. ±¤¹üÀ§ÇÑ ¾×¿Í ¸²ÇÁÀý ÀüÀÌ°¡ ÀÖÀ» °æ¿ì ¼ö¼úÀÇ ÆíÀÇÀ» À§ÇØ ¼ÒÈä±ÙÀ» ÀýÁ¦ÇÒ ¼öµµ ÀÖÀ¸³ª, ¿À´Ã³¯¿¡´Â ±¹¼ÒÁøÇ༺ ȯÀÚÀÇ ´ëºÎºÐÀÌ ¼ö¼ú Àü À¯µµÈ­Çпä¹ýÀ» ½ÃÇà ¹Þ¾Æ °æÇèÇϱⰡ ¾î·Æ´Ù.

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ÇÏÁö¸¸, À¯¹æÀ» ¸ðµÎ ÀýÁ¦ÇÏ´Â ¼ú½ÄÀº À¯¹æ¾ÏÀ¸·Î Ä¡·á¸¦ ¹Þ´Â ¿©¼ºµé¿¡°Ô Å« »ó½Ç°¨À» ÁÖ¾ú±â ¶§¹®¿¡, À¯¹æÀ» ¸ðµÎ ÀýÁ¦ÇÏÁö ¾Ê°í, Á¾¾ç¸¸À» ÀýÁ¦ÇÏ´Â ¼ú½Ä¿¡ ´ëÇÑ ¿¬±¸µéÀÌ ½ÃµµµÇ¾ú°í, 1970³â´ë°æ ½ÃÀÛµÈ ¹Ì±¹ NSABPÀÇ Dr. Fisher µî°ú ÀÌÅ»¸®¾Æ Milan National Tumor InstituteÀÇ Dr. Veronesi µîÀÌ ÁÖµµÇÑ °¢°¢ÀÇ ÀüÇâÀû Àӻ󿬱¸µé¿¡¼­ À¯¹æÀ» º¸Á¸Çϸ鼭 Á¾¾çÀ» Æ÷ÇÔÇÑ ÀϺθ¸ ÀýÁ¦ÇÏ´Â À¯¹æº¸Á¸¼ú(breast conserving surgery)ÀÌ ±âÁ¸ÀÇ À¯¹æÀ» ¸ðµÎ ÀýÁ¦ÇÏ´Â ¼ú½Ä¿¡ ºñÇؼ­ Á¾¾çÇÐÀû ¾ÈÀü¼ºÀÌ ¶³¾îÁöÁö ¾Ê´Â´Ù´Â °ÍÀ» ÀÔÁõÇÏ¿© 1990³â¿¡ À¯¹æ¾Ï ¼ö¼úÀÇ Ç¥Áؼú½ÄÀ¸·Î ÀÎÁ¤µÇ¾ú´Ù.(7) 20³â Àå±â°£ ÃßÀû °á°ú ¿ª½Ã À¯¹æº¸Á¸¼úÀ» ½ÃÇà ¹ÞÀº ȯÀÚÀÇ Àü½ÅÀç¹ßÀ² ¹× »ýÁ¸À²ÀÌ À¯¹æÀýÁ¦¼ú ȯÀÚ¿Í µ¿ÀÏÇÏ´Ù´Â °ÍÀ» ÀÔÁõÇÏ¿´´Ù. (8, 9) ÀÌ´Â ÀÌÈÄ À¯¹æ¾Ï ¼ö¼úÀÇ Æз¯´ÙÀÓÀ» ¹Ù²Ù´Â º¯È­¸¦ °¡Á®¿À°Ô µÇ¾ú´Ù.
¼º°øÀûÀÎ À¯¹æº¸Á¸¼úÀ» À§Çؼ­´Â ¼ö¼ú Àü Á¤È®ÇÑ ¿µ»óÀÇÇÐÀû Áø´Ü, ÀýÁ¦¿¬ È®º¸¸¦ À§ÇÑ ¼ö¼úÆÀÀÇ ¼÷·Ãµµ, ÀýÁ¦¿¬ÀÇ º´¸® °Ë»ç, ¹æ»ç¼± Ä¡·áÆÀÀÇ ¿ªÇÒ ¹× ¼ö¼ú ÈÄ Àü½Å º¸Á¶ ¿ä¹ýÀÇ »ç¿ë ¿©ºÎ µîÀÌ Áß¿äÇÏ´Ù. À¯¹æº¸Á¸¼ú ÈÄ ±¹¼ÒÀç¹ßÀ» ¿µÇâÀ» ÁÖ´Â ¶Ç ´Ù¸¥ Áß¿äÇÑ º¯¼ö´Â ¼ö¼ú ÈÄ ¹æ»ç¼± Ä¡·á ¿©ºÎ·Î, ¼ö¼ú ÈÄ ÀÜ¿©À¯¹æ¿¡ ´ëÇÑ ¹æ»ç¼± Ä¡·á¸¦ ÅëÇØ ±¹¼ÒÀç¹ßÀ²À» Çö°ÝÈ÷ °¨¼Ò½ÃŲ´Ù. EBCTCG (Early Breast Cancer Trialists' Collaborative Group)´Â ¸ÞŸºÐ¼®À» ÅëÇØ À¯¹æº¸Á¸¼ú½Ä ÈÄ ¹æ»ç¼± Ä¡·á¸¦ ½ÃÇàÇÑ È¯ÀÚÀÇ ±¹¼ÒÀç¹ßÀ²ÀÌ ¹æ»ç¼± Ä¡·á¸¦ ¹ÞÁö ¾ÊÀº ȯÀÚ¿¡ ºñÇØ À¯ÀÇÇÏ°Ô °¨¼ÒÇϸç, ÀÌ´Â ³ª¾Æ°¡ »ýÁ¸À² Çâ»ó¿¡µµ ±â¿©ÇÑ´Ù°í º¸°íÇÏ¿´´Ù.(10) µû¶ó¼­, ÇöÀçÀÇ À¯¹æº¸Á¸¼ú½ÄÀº ±âº»ÀûÀ¸·Î ¼ö¼ú ÈÄ ¹æ»ç¼± Ä¡·á¸¦ º´ÇàÇÏ°Ô µÇ¸ç, À¯¹æº¸Á¸¼ú½Ä°ú ¹æ»ç¼± Ä¡·á¸¦ ÇÕÃļ­ À¯¹æº¸Á¸Ä¡·á¹ý(breast conserving therapy)À̶ó°í ºÎ¸¥´Ù.
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ÃÖ±Ù µé¾î À¯¹æ¾Ï¿¡ ´ëÇÑ »çȸÀû °ü½ÉÀÌ Áõ°¡ÇÏ°í À¯¹æÃÔ¿µ¼ú µîÀ» ÀÌ¿ëÇÑ °ËÁøÀÌ ´Ã¸é¼­, »ó´ëÀûÀ¸·Î Á¶±â À¯¹æ¾Ï ÇÑÀÚ°¡ ´Ã¾î³ª°í ÀÖÀ¸¸ç, ¹æ»ç¼± Ä¡·á ¹× ¼ö¼ú Àü À¯µµÈ­Çпä¹ýµµ ²ÙÁØÈ÷ ¹ßÀüÇϸ鼭 À¯¹æº¸Á¸¼úÀÇ ´ë»ó ȯÀÚ°¡ °è¼Ó Áõ°¡ÇÒ °ÍÀÌ´Ù.

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À¯¹æ¾Ï ¼ú½ÄÀº ±âº»ÀûÀ¸·Î µ¿ÃøÀÇ ¾×¿Í ¸²ÇÁÀýÀ» ´ëºÎºÐ ÀýÁ¦ÇÏ¿©¾ß Çß°í, ÀÌ´Â ÆÈÀÇ ¸²ÇÁºÎÁ¾À» À¯¹ßÇÒ ¼ö ÀÖ¾ú±â ¶§¹®¿¡, À̸¦ ÁÙÀ̱â À§ÇÑ ³ë·ÂµéÀÌ ÀÖ¾î¿Ô´Ù. °¨½Ã ¸²ÇÁÀýÀ̶õ Á¾¾ç¿¡¼­ ¸²ÇÁÀý·Î ÀüÀÌ°¡ µÉ ¶§ óÀ½À¸·Î ÀüÀÌ°¡ ÀϾ´Â ¸²ÇÁÀýÀ» ÀǹÌÇϸç, À¯¹æ¾Ï¿¡¼­ °¨½Ã ¸²ÇÁÀý »ý°Ë¼úÀ̶õ, À¯¹æ¾Ï¿¡¼­ ù ¹ø°·Î ¹è¾×µÇ´Â ¾×¿ÍºÎ ¸²ÇÁÀýÀ» ã¾Æ °Ë»çÇÏ¿©, Ãß°¡ÀûÀÎ ¾×¿ÍºÎ ¸²ÇÁÀý ÀüÀ̸¦ ¿¹°ßÇÏ´Â ¹æ¹ýÀ» ¸»ÇÑ´Ù. µû¶ó¼­, °¨½Ã ¸²ÇÁÀý¿¡ ¸²ÇÁÀý ÀüÀÌ°¡ È®ÀεÇÁö ¾ÊÀ¸¸é, Ãß°¡ÀûÀÎ ¸²ÇÁÀý ÀýÁ¦¸¦ ÇÏÁö ¾Ê°Ô µÇ¸ç, ±×¿¡ µû¶ó ¾×¿ÍºÎ ¸²ÇÁÀý ÀýÁ¦¼ú¿¡ µû¸¥ ÇÕº´Áõ ¹ß»ýÀÌ °¨¼ÒµÇ´Â È¿°ú¸¦ ¾òÀ» ¼ö ÀÖ´Ù.
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°¨½Ã ¸²ÇÁÀý »ý°Ë¼úÀº ÀϹÝÀûÀ¸·Î ÀÓ»óÀû ¾×¿ÍºÎ ÀüÀÌ°¡ ¾ø´Â Á¶±â À¯¹æ¾Ï ȯÀÚ¿¡¼­ ½ÃÇàµÈ´Ù. ¿°Áõ¼º À¯¹æ¾ÏÀ̳ª ÀÓ»óÀûÀ¸·Î ¾×¿Í¸²ÇÁÀý ÀüÀÌ°¡ È®½ÇÇÑ È¯ÀÚ¿¡¼­´Â ¿øÄ¢ÀûÀ¸·Î ½ÃÇàÇؼ­´Â ¾ÈµÇ³ª, ÀÓ»óÀûÀ¸·Î ¾×¿Í¸²ÇÁÀý ¾ç¼ºÀΠȯÀÚ¿¡¼­ ½ÇÁ¦ º´¸®ÇÐÀûÀ¸·Î À½¼ºÀÎ °æ¿ì°¡ ¸¹¾Æ °¨½Ã¸²ÇÁÀý »ý°ËÀ» ½ÃÇàÇØ¾ß ÇÑ´Ù´Â ÁÖÀåÀÌ ÀÖ°í, ¶ÇÇÑ ¼ö¼ú Àü À¯µµ È­Çпä¹ýÀ» ¹Þ¾Ò°Å³ª, ÀÌÀü¿¡ ¾×¿ÍºÎ ¼ö¼úÀ» ¹ÞÀº ȯÀÚ¿¡¼­ °¨½Ã¸²ÇÁÀý ½ÃÇà ¿©ºÎ¸¦ ³õ°í ÇöÀç±îÁö ÀÌ·ÐÀÌ ÀÖ´Ù. °¨½Ã ¸²ÇÁÀý »ý°Ë¸¸À» ½Ç½ÃÇÑ °æ¿ìÀÇ ¿µ¿ªÀç¹ßÀ²Àº 1% ¹Ì¸¸À¸·Î ¾ÆÁÖ ³·´Ù°í º¸°íµÇ¾ú´Ù.(13, 14)

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ÃÖ±Ù µé¾î À¯¹æÀýÁ¦¼úÀÇ ´ë»óÀÌ µÇ´Â ȯÀڵ鿡°Ô¼­ ¹Ì¿ë È¿°ú¸¦ Çâ»ó½ÃÅ°°Å³ª »ó½Ç°¨ÀÇ °æ°¨À» À§ÇØ À¯¹æÀýÁ¦¼ú ÈÄ Àç°Ç¼úÀ» ½ÃÇàÇϱ⵵ ÇÑ´Ù. À¯¹æÀç°Ç¼úÀº ±× ½Ã±â¿¡ µû¶ó À¯¹æÀýÁ¦¼úÀ» ½ÃÇàÇÏ°í Áï½Ã º¹¿øÇÏ´Â ¹æ¹ý(immediate reconstruction), ¹æ»ç¼± Ä¡·á¿Í °°Àº Ãß°¡ÀûÀÎ º¸Á¶¿ä¹ý ½ÃÇà ÈÄ º¹¿øÇÏ´Â ¹æ¹ý(delayed reconstruction), ±×¸®°í º¸Á¶ ¹æ»ç¼± Ä¡·á¸¦ ¹ÞÀ» °¡´É¼ºÀΠȯÀÚ¿¡°Ô¼­ ÀÓ½ÃÀûÀ¸·Î Á¶Á÷È®Àå±â¸¦ ³ÖÀº ÈÄ ¹æ»ç¼± Ä¡·á°¡ ³¡³­ ÈÄ Àç°ÇÀ» ½ÃÇàÇÏ´Â ÀϽÃÀû Áö¿¬ ÈÄ Áï½ÃÀ¯¹æÀç°Ç(delayed-immediate breast reconstruction)ÇÏ´Â ¹æ¹ýÀ¸·Î ³ª´©¾îÁø´Ù.(16, 17) À¯¹æÀç°Ç¼úÀº ¶ÇÇÑ ¾î¶² ¹æ¹ýÀ¸·Î À¯¹æÀ» Àç°ÇÇÏ´À³Ä¿¡ µû¶ó ÀÚ°¡ Á¶Á÷À» ÀÌ¿ëÇÑ ÇÇÆǹý°ú º¸Çü¹°À» ÀÌ¿ëÇÑ Àç°Ç¼ú·Î ³ª´©¾îÁö¸ç, ÀÚ°¡ Á¶Á÷Àº ÁÖ·Î º¹Á÷±Ù ¶Ç´Â ±¤¹è±ÙÀ» ÀÌ¿ëÇÏ°í, º¸Çü¹° »ðÀÔ¼úÀº ½Ç¸®ÄÜ ¹éÀ̳ª »ý¸®½Ä¿°¼ö ¹éÀ» ÀÌ¿ëÇÑ´Ù.(18-20) Àç°Ç¼úÀÇ ¹æ¹ýÀº ȯÀÚÀÇ Ã¼Çü, ¹Ì¿ëÈ¿°ú, ½Ã¼úÀÇ Àå´ÜÁ¡ µîÀ» Á¾ÇÕÇÏ¿© °áÁ¤µÈ´Ù.

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ÃÖ±Ù¿¡´Â ¹Ì¿ë È¿°ú¸¦ ´õ¿í Áõ´ë ½ÃÅ°±â À§ÇØ, À¯µÎ-À¯·û º¹ÇÕü¿Í ¸ðµç À¯¼± Á¶Á÷À» Á¦°ÅÇϸ鼭 ÃÖ´ëÇÑÀÇ ÇǺθ¦ º¸ÀüÇÏ´Â ÇǺκ¸Á¸À¯¹æÀýÁ¦¼ú(skin-sparing mastectomy), À¯µÎ-À¯·ûº¹ÇÕü±îÁöµµ º¸Á¸Çϸ鼭 À¯¹æÀ» ÀýÁ¦ÇÏ´Â ¼ú½Ä(nipple-areolar complex-sparing mastectomy), ±×¸®°í ³»½Ã°æÀ» ÀÌ¿ëÇÑ À¯¹æ ÀýÁ¦¼ú µîÀÌ ¿¬±¸ °³¹ßµÇ¾î ½ÃÇàµÇ°í ÀÖ´Ù.(21-25) ±× ¹Û¿¡µµ À¯¹æº¸Á¸¼ú ÈÄ ¾à ÇÑ ´Þ ¹ÝÁ¤µµ ½ÃÇà ¹Þ°Ô µÇ´Â ¹æ»ç¼± Ä¡·áµµ ȯÀÚÀÇ ÆíÀǼºÀÇ ÁõÁøÀ» À§ÇØ ¼ö¼ú Áß ÇÑ ¹øÀÇ ¹æ»ç¼± Á¶»ç·Î ºñ½ÁÇÑ È¿°ú¸¦ ¾ò´Â ¼ö¼ú Áß ¹æ»ç¼± Ä¡·á(intraoperative radiotherapy) µîÀÌ ¿¬±¸ °³¹ßµÇ¾î, ÇÑ µÎ ¹øÀÇ ¹æ¹®À¸·Î ¼ö¼ú°ú ¹æ»ç¼± Ä¡·á¸¦ ÇѲ¨¹ø¿¡ ÇØ°áÇÏ´Â »õ·Î¿î À¯¹æº¸Á¸Ä¡·á¹ýµµ ÃÖ±Ù Á¦½ÃµÇ¾îÁö°í ÀÖ´Ù.(26)

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´Ù¸¥ ¿Ü°ú ºÐ¾ß¿Í ¸¶Âù°¡Áö·Î À¯¹æ¾Ï ¼ö¼úµµ ÃÖ¼Ò Ä§½ÀÀû ¼ú½ÄÀ» ÁöÇâÇÏ¿© ¹ßÀüµÇ¾î ¿Ô´Ù. ¼±µµÀûÀÎ ÀüÇâÀû Àӻ󿬱¸µéÀÇ °á°ú·Î ¿À´Ã³¯ ¸¹Àº À¯¹æ¾Ï ȯÀÚµéÀÌ À¯¹æÀ» ¸ðµÎ ÀýÁ¦ÇÏÁö ¾Ê°Ô µÇ¾ú°í, ¶ÇÇÑ °¨½Ã ¸²ÇÁÀý »ý°ËÀ» ÅëÇÑ ÃÖ¼ÒÇÑÀÇ ¾×¿ÍºÎ ¸²ÇÁÀý ÀýÁ¦¸¦ ÅëÇØ, À¯¹æ°ú ±â´ÉÀ» ÃÖ´ëÇÑ º¸Á¸Çϸ鼭 Ä¡·á¸¦ ¹Þ°í ÀÖ´Ù. ¶ÇÇÑ À¯¹æ ÀýÁ¦¼ú ÈÄ »ý±æ ¼ö Àִ ȯÀÚÀÇ »ó½Ç°¨Àº Àç°Ç¼úÀ» ÅëÇØ °æ°¨½Ãų ¼ö ÀÖ°Ô µÇ¾ú´Ù. ÀÌ·¯ÇÑ ¼ö¼ú¹æ¹ýÀÇ º¯È­´Â Á¾¾ç»ý¹°Çп¡ ´ëÇÑ Áö½ÄÀÇ ÃàÀû, ¼ö¼úÈÄ º¸Á¶Àû Ä¡·á¹ýÀÇ ¹ß´Þ, Áø´Ü¹ýÀÇ ¹ß´Þ ¹× ȯÀÚµéÀÇ Àǽĺ¯È­ µîÀÇ º¯È­¿¡ µû¶ó ÁøÇàµÇ¾î ¿Ô´Ù°í ÇÒ ¼ö ÀÖÀ¸¸ç ¾ÕÀ¸·Îµµ ȯÀÚÀÇ ºÎ´ãÀ» ÃÖ¼ÒÈ­ÇÏ°í »îÀÇ ÁúÀ» ¼Õ»ó½ÃÅ°Áö ¾Ê´Â ¹æÇâÀ¸·Î º¯È­ÇÒ °ÍÀ¸·Î »ý°¢µÈ´Ù.
Á¾ÇÕÀûÀ¸·Î ¼ö¼ú ¹æ¹ýÀÇ Áøº¸´Â ȯÀÚ·Î ÇÏ¿©±Ý °³º°ÀûÀÌ°íµµ Á¾ÇÕÀûÀÎ »ó´ãÀ» ÅëÇÑ ¡°¸ÂÃã ¼ö¼ú¡±À» °¡´ÉÇÏ°Ô ÇÏ¿´°í, À̸¦ ¼º°øÀûÀ¸·Î ½ÃÇàÇϱâ À§Çؼ­´Â À¯¹æ¾Ï°ú °ü·ÃµÈ Á¾¾ç»ý¹°ÇÐ, »õ·Î¿î Áø´Ü, Ä¡·á¹ý µî¿¡ Áö¼ÓÀû °ü½É°ú Áö½Ä½ÀµæÀÌ ÇÊ¿äÇϸç ȯÀÚµéÀÇ ÀÇ½Ä º¯È­¿¡µµ °ü½ÉÀ» °¡Áö°í ´ëóÇÏ´Â °ÍÀÌ ÇÊ¿äÇϸç, ÀÌ·¯ÇÑ ³ë·ÂÀÌ À¯¹æ¾ÏÀ» Ä¡·áÇÏ´Â ¿Ü°ú ÀÇ»çÀÇ »ç¸íÀÌ´Ù.

Âü°í¹®Çå
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