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"icd_name": "Рак бронхов и легкого",
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"lead": "злокачественное новообразование, развивающееся из покровного эпителия бронхов различного калибра и бронхиальных желез.",
"description": "Рак бронхов и легкого обычно рассматривают вместе, объединяя их названием \"бронхопульмональный рак\". ",
"etiology": "<p>Развитию рака легкого могут предшествовать хронические воспалительные процессы: хроническая пневмония, бронхоэктатическая болезнь, хронический бронхит, рубцы в легком после ранее перенесенного туберкулеза и т. п. Немалую роль играет и курение, так как, согласно большинству статистик, рак легкого у курящих наблюдается значительно чаще, чем у некурящих. Так, при выкуривании двух и больше пачек сигарет в сутки частота рака легкого возрастает в 15- 25 раз. Другие факторы риска - работа на асбестовом производстве, облучение.</p>",
"pathogenesis": "<p>По гистологической структуре раки легкого чаще всего бывают плоскоклеточными, хотя наблюдаются также железистые формы (аденокарциномы), резко анаплазированные - мелкоклеточный рак, овсянноклеточный и некоторые другие варианты.</p>",
"diagnostics": "<p>Когда центральный рак лёгкого находится на ранней стадии, распознать его очень трудно. Осмотр терапевта, рентгенологические исследования — малоэффективны. Если сделать такому человеку бронхоскопию с биопсией, то правильный диагноз может быть поставлен. Иногда распознать болезнь на ранних стадиях помогает компьютерная томография. Если рак периферический, то сделать биопсию невозможно, так как добраться до подозрительного места с помощью бронхоскопии просто не получится. Поэтому проводится трансторакальная игловая биопсия, то есть забор кусочка ткани через прокол в грудной стенке. Если очаги есть в области средостения (части грудной полости, находящейся между грудиной, позвоночником, диафрагмой, плеврой и поверхностями лёгких), проводится медиастиноскопия (осмотр с целью биопсии через разрез на шее). Иногда нельзя обойтись без диагностических торакоскопии и торакотомии (вскрытия грудной полости). Чтобы уточнить, насколько опухоль распространена, применяются самые разные диагностические методы: УЗИ, бронхоскопия, мультиспиральная компьютерная, магнитно-резонансная и позитронно-эмиссионная томография, а также радионуклидные исследования. Без этого невозможно выбрать лучший подход к лечению конкретного пациента.<br /><br /><br /></p>",
"treatment": "<p>Выбор лечения зависит от гистологической формы рака, его распространенности, наличия метастазов. При немелкоклеточном раке лёгкого лечение рака легкого может быть как чисто хирургическим, так и комбинированным. Последний метод дает лучшие отдаленные результаты. При комбинированном лечении его начинают с проведения дистанционной гамма-терапии на зону первичной опухоли и метастазов. После интервала в 2-3 педели предпринимают хирургическое вмешательство: удаление всего легкого - пульмонэктомия - или удаление одной (двух) доли - лобэктомия и билобэктомия. Операции на легком, особенно у ослабленных раковых больных, - крайне ответственное и тяжелое вмешательство, требующее специальной подготовки больного, высокой квалификации хирурга, умелого обезболивания и тщательного послеоперационного ухода.Рецидивы рака легкого возникают после недостаточно радикальных операций, обычно в виде возобновления роста опухоли в оставленной культе бронха в тех случаях, когда имелась значительная инфильтрация его стенки далеко за видимыми пределами опухоли. Лечение рецидивов обычно сугубо паллиативное. При диссеминированной форме заболевания основным методом лечения является химиотерапевтический. В качестве дополнительного метода применяют лучевую терапию. Оперативное вмешательство применяют очень редко. При распространённом раке, наличии отдалённых метастазов, поражении надключичных лимфатических узлов или экссудативном плеврите показана комбинированная химиотерапия. При отсутствии эффекта от химиотерапии или наличии метастазов в головном мозге облучение даёт паллиативный эффект. При очень распространенных, неоперабельных формах рака легкого с паллиативной целью проводят дистанционную гамма-терапию или курсы химиотерапии, иногда комбинируя оба эти метода. Паллиативная лучевая терапия или лечение противоопухолевыми средствами позволяет получить временное улучшение и продлить жизнь больному.</p>",
"prevention": "<p>Лучший способ уменьшить вероятность развития рака лёгкого — это бросить курить и избегать пассивного курения. По имеющимся данным, после 10 лет без курения риски становятся минимальными. Если человек работает на «вредном» производстве, то обязательно нужно защищать дыхательные пути от контакта с асбестовой пылью и тяжёлыми металлами.<br /><br /><br /></p>",
"clinical_picture": "<p>Симптомы бронхопульмонального рака различны в зависимости от того, где возникает первичная опухоль - в бронхе или в ткани легкого. При раке бронха (центральный рак) заболевание обычно начинается с сухого надсадного кашля, а затем появляется <a title=\"Перейти на страницу симптома Влажный кашель\" href=\"../../../symptom/vlazhnyy_kashel/\">мокрота</a>, нередко с примесью крови. Очень характерно для этой формы периодическое беспричинное возникновение воспаления легкого - так называемого пневмонита, сопровождающегося усилением кашля, высокой температурой, общей слабостью, иногда болями в груди.</p>\r\n<full></full>\r\n<p>Причиной развития пневмоиитов служит временная закупорка бронха опухолью вследствие присоединяющегося воспаления. При этом наступает ателектаз (безвоздушность) того или иного сегмента или доли легкого, который неизбежно сопровождается вспышкой инфекции в ателектазировавном участке. При уменьшении воспалительного компонента вокруг опухоли или распаде ее просвет бронха снова частично восстанавливается, ателектаз исчезает, и все явления временно прекращаются с тем, чтобы вспыхнуть вновь через несколько месяцев. Очень часто эти \"волны\" пневмонита принимают за грипп, обострение бронхита и проводят медикаментозное лечение, не обследуя больного рентгенологически. В других случаях проводят просвечивание легких по стихании явлений пневмонита, когда исчезает характерный для рака симптом ателектаза, и болезнь остается нераспознанной. В дальнейшем течение заболевания принимает стойкий характер: упорный <a title=\"Перейти на страницу симптома Кашель\" href=\"../../../symptom/kashel/\">кашель</a>, нарастающая <a title=\"Перейти на страницу симптома Слабость\" href=\"../../../symptom/slabost/\">слабость</a>, <a title=\"Перейти на страницу симптома Высокая температура 38-42° \" href=\"../../../symptom/vysokaya_temperatura_38-42/\">повышение температуры</a> и боли в груди. Нарушения дыхания могут быть значительными при развитии гиповентиляции и ателектаза доли или всего легкого. Для периферического рака легкого, развивающегося в самой легочной ткани, начало болезни почти безсимптомно. В этих стадиях опухоль нередко обнаруживают случайно при профилактическом рентгенологическом обследовании больного. Лишь с увеличением размеров, присоединяющимся воспалением или при прорастании опухолью бронха или плевры возникает яркая симптоматика сильных болей, кашля с повышением температуры. В запущенной стадии вследствие распространения опухоли в полость плевры развивается раковый плеврит с прогрессирующим накоплением кровянистого выпота.</p>",
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"lead": "онкологическое заболевание дыхательных путей, характеризующееся наличием новообразования, которое произрастает из тканей стенки трахеи",
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"etiology": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Одна из основных причин возникновения рака трахеи – отягощенная наследственность. Риск развития злокачественного новообразования значительно увеличивается, если подобный диагноз был поставлен близким родственникам.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">К другим причинам относятся:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Активное и пассивное курение.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Вирусная инфекция. Главный инфекционный агент – вирус папилломы человека.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Применение лучевой терапии в борьбе с онкологией смежных с трахеей органов.</span></li>\r\n</ul>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Выделяют 4 стадии первичной онкопатологии трахеи. Учитывается степень распространенности опухолевого процесса, вовлеченность лимфатических узлов, наличие отдаленных от опухоли метастатических очагов.</span></p>",
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"diagnostics": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">При обращении в клинику пациент направляется на комплексное обследование, которое включает:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Лабораторные исследования. Диагностика включает биохимическое и развернутое клиническое исследование крови, определение онкомаркеров РЭА, коагулограмму и общий анализ мочи. При проведении исследования крови могут быть определены характерные специфические изменения.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Физикальное обследование. Врач оценивает функциональный статус для определения сопутствующих патологий и вторичных признаков заболевания, оказывающих влияние на выбор лечебной тактики.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Инструментальные методы. Проводится трахео-бронхоскопию, при которой делают биопсия. Данный метод является наиболее информативным, т. к. позволяет не только визуализировать опухоль, но и определить ее размеры, а также область локализации. Бронхоскопия оценивает угрозу осложнений и позволяет получить материал для проведения морфологического исследования.</span></li>\r\n</ul>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Среди дополнительных диагностических мер следует выделить УЗИ шейной и надключичной зоны, рентген грудины, компьютерной томографии органов грудной клетки и ЭКГ.</span></p>",
"treatment": "<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Основным методом лечения рака трахеи является хирургическое удаление опухоли. Хирург удаляет пораженный участок трахеи с захватом небольших участков выше и ниже, затем соединяет оставшиеся концы. Такие операции очень сложны из-за особенностей кровоснабжения трахеи. Если сильно повредить кровеносные сосуды, то заживление будет происходить дольше и хуже.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Некоторым пациентам, которым противопоказано хирургическое лечение, могут быть выполнены эндоскопические вмешательства. Они помогают уменьшить злокачественную опухоль и впоследствии упросить ее удаление:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Лазерная хирургия предполагает уничтожение опухолевой ткани с помощью луча лазера высокой интенсивности.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Криохирургия. Во время процедуры на злокачественное новообразование наносят жидкий азот в виде спрея, и низкая температура уничтожает раковые клетки.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Брахитерапия является разновидностью лучевой терапии. Источник излучения находится на конце бронхоскопа, его направляют непосредственно на злокачественную опухоль. Раковые клетки получают максимальную дозу облучения, при этом практически не затрагиваются здоровые ткани.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Фотодинамическая терапия. На поверхность опухоли наносят специальное вещество — фотосенсибилизатор, а затем воздействуют на нее светом определенной длины волны. Под действием света фотосенсибилизатор активируется и разрушает опухолевые клетки.</span></li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Если неоперабельная опухоль блокирует просвет трахеи, можно выполнить паллиативные хирургические вмешательства. Во время стентирования в заблокированный участок устанавливают короткую трубку с сетчатой стенкой из металла — стент. Это эндоскопическая процедура. Также можно выполнить трахеостомию — сформировать отверстие, которое будет сообщать просвет трахеи с передней поверхностью шеи ниже места сужения. Через эту трахеостому пациент сможет дышать.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Лучевая терапия</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Лучевую терапию зачастую назначают после удаления рака трахеи, чтобы уничтожить опухолевые клетки, которые могли остаться в организме пациента. </span></p>",
"prevention": "<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Отказ от курения и алкоголя</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Своевременное лечение хронических заболеваний</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Соблюдение правил работы с токсичными веществами</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Ежегодное прохождение профилактических осмотров</span></li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>",
"clinical_picture": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Симптомы рака трахеи возникают, когда опухоль достигает определенных размеров:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">приступообразный кашель (трахеит, бронхит);</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">выделение небольшого количества густой мокроты;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">наличие кровянистых прожилок в отделяемой слизи;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">одышка, которая возникает сначала после физической нагрузки, а затем и в состоянии покоя;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">изменение голоса (осиплость или полное исчезновение).</span></li>\r\n</ul>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">На присутствие опухоли в области трахеи могут также указывать такие симптомы, как боли в горле, дискомфорт в области грудины, болезненность при глотании, свист при дыхании, снижение аппетита и повышение температуры тела без видимых на то причин. Проявляться онкологический процесс может частыми фарингитами и ангинами, изменениями в анализах крови и увеличением лимфатических узлов в области шеи и под челюстью.</span></p>",
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},
"code": "C32",
"name": "Рак гортани",
"icd_name": "Рак гортани",
"gender": 0,
"age_min": 40,
"age_max": 65,
"cause": [
3,
0
],
"periodicity": 1,
"slug": "c32_rak_gortani",
"lead": "злокачественное новообразование гортани, происходящее из эпителиальной ткани.",
"description": "Рак гортани – это злокачественные новообразования, которые возникают во всех отделах гортани (вестибулярном, среднем, и подсвязочном) и чаще всего образуются из эпителия.\r\nРак гортани занимает лидирующее место среди опухолей головы и шеи и 8 место во всей структуре онкологических заболеваний. Ежегодно в мире отмечается увеличение на 8-10% числа больных этой формой рака.",
"etiology": "<p>Раку гортани зачастую предшествует хронический многолетний ларингит. Особое значение в возникновении рака гортани относятся предраковые заболевания:</p>\r\n<ul>\r\n<li>длительно существующая папиллома</li>\r\n<li>лейкоплакия слизистой оболочки гортани</li>\r\n<li>дискератозы</li>\r\n<li>пахидермия</li>\r\n<li>фиброма на широком основании</li>\r\n<li>кисты гортанных желудочков</li>\r\n<li>хронические воспалительные процессы</li>\r\n</ul>\r\n<p>Часто наблюдается малигнизация папиллом и лейкоплакии.</p>",
"pathogenesis": "",
"diagnostics": "<p>При диагностике используются следующие процедуры: Непрямая ларингоскопия, внешний осмотр и пальпация. Фиброларингоскопия. Данный метод является одним из основных методов в диагностике рака горла. При проведении этой процедуры есть возможность осмотреть все отделы гортани в большом разрешении и без «слепых зон». Инструмент вводится в гортань легко и безопасно, есть возможность взять биопсию для цитологического исследования. Ко всему прочему, есть возможность визуализации подскладочного отдела и выполнения высококачественной фотосъемки. Морфологическое исследование (гистологическое, цитологическое) материала полученного при биопсии, пункции и соскобах. Компьютерная томография (КТ) гортани. Используется для оценки состояний хрящей гортани, которые нельзя увидеть при ларингоскопии. Также этот метод дает дополнительную информацию о вестибулярном отделе гортани и гортаноглотке. Магнитно-резонансная томография (МРТ). Этот метод позволяет оценить состояние голосовых складок, подскладочного отдела, просвета гортанных желудочков, черпалонадгортанных складок, грушевидных синусов. Рентгенография легких. Используется в случае подозрения на отдаленные метастазы. Ультразвуковое исследование печени и лимфоузлов шеи. Используется в случае подозрения на отдаленные и регионарные метастазы. При наличии увеличенных регионарных лимфоузлов — пункция их для цитологического подтверждения. Все эти методы позволяют однозначно поставить диагноз и назначить подходящее лечение.</p>\r\n<p> </p>",
"treatment": "<p>Существует консервативное и хирургическое лечение рака гортани. В настоящее время достаточно много внимания уделяется качеству жизни пациентов, поэтому при ранних стадиях рака среднего и надскладочного отдела начинают с консервативного лечения – лучевой и химиотерапии. Оно по эффективности одинаково с хирургическим, однако не нарушает функции гортани, и больные могут продолжать трудовую деятельность.</p>\r\n<full></full>\r\n<p class=\"ramka2\">Комбинированное лечение – сочетание хирургии и лучевой терапии. Проводится пациентам с большими опухолями и распространенностью процесса. Предоперационная лучевая терапия способствует уменьшению размеров опухоли и снижает жизнеспособность раковых клеток. Однако после больших доз ЛТ <a href=\"/symptom/yazva_naruzhnaya/\" title=\"Перейти на страницу симптома Язва наружная\">рана</a> может заживать хуже.</p>\r\n<p>Операция</p>\r\n<p>Объемы операций могут различными. Возможно удаление части гортани (резекция), при этом сохраняется дыхательная функция и голос. При больших опухолях гортань удаляется полностью, после таких операций дыхание осуществляется через трахеостому и человек лишается звучного <a href=\"/symptom/sluhovye_gallyucinacii/\" title=\"Перейти на страницу симптома Слуховые галлюцинации\">голоса</a>. Для восстановления речи проводятся занятия с логопедом, пациенты учатся образовывать звук с помощью заглатываемого в желудок воздуха, такая речь позволяет общаться с окружающими людьми и даже вернутся к труду. Кроме того, применяются специальные силиконовые голосовые протезы.</p>\r\n<p> </p>\r\n<p>Лучевая терапия</p>\r\n<p>Лучевая терапия, облучения рака гортани проводится с боковых полей и включает всю гортань и зону регионарного метастазирования. Общие реакции – <a href=\"/symptom/slabost/\" title=\"Перейти на страницу симптома Слабость\">слабость</a>, головные боли, <a href=\"/symptom/toshnota/\" title=\"Перейти на страницу симптома Тошнота\">тошнота</a>. Местные реакции возникают в гортани и на коже шеи. Больные жалуются на боли при глотании, <a href=\"/symptom/otek_tkaney/\" title=\"Перейти на страницу симптома Отек тканей\">отек тканей</a> шеи. Изменения в гортани характеризуются <a href=\"/symptom/vospalenie/\" title=\"Перейти на страницу симптома воспаление\">воспаление</a> и отеком слизистой и голосовых связок. Это может приводить к усилению охриплости и сужению просвета гортани, поэтому при большом размере опухоли пациенту предлагается наложение трахеостомы (ниже расположения опухоли в трахею вводится трубка, через которую пациент дышит, она после лечения удаляется). При лучевой терапии функция звукообразования не страдает и после лечения восстанавливается звучный голос.</p>\r\n<p>Химиотерапия</p>\r\n<p>Химиотерапия при раке гортани применяется только в сочетании с лучевым и хирургическим лечением. Используются в основном препараты платины – цисплатин. Наблюдение осуществляется в первый год каждый месяц, на второй год – раз в 4 месяца, с 3 до 5 лет – раз в полгода, а после пяти раз в год.</p>",
"prevention": "<p>Рак гортани, как и любое заболевание, легче предупредить, чем вылечить. Поэтому: откажитесь от курения и неумеренного употребления алкоголя; соблюдайте правила индивидуальной профилактики при работе с перечисленными ранее химическими веществами; своевременно лечите хронические заболевания гортани, удаляйте доброкачественные новообразования. В заключение отметим, что при появлении длительно не проходящих охриплости и осиплости не следует месяцами заниматься самолечением или ожидать самоизлечения. Необходимо как можно раньше обратиться к врачу и не отказываться от предложенных обследований и лечения.</p>\r\n<p> </p>",
"clinical_picture": "<p>Признаки заболевания весьма разнообразны и зависят от формы и места роста опухоли, степени ее распространения. Начальный период заболевания характеризуется незначительными и часто скрыто протекающими симптомами. Должны насторожить следующие симптомы: <a href=\"/symptom/ohriplost/\" title=\"Перейти на страницу симптома Охриплость\">Охриплость</a> или другие изменения <a href=\"/symptom/sluhovye_gallyucinacii/\" title=\"Перейти на страницу симптома Слуховые галлюцинации\">голоса</a>. <a href=\"/symptom/otek_tkaney/\" title=\"Перейти на страницу симптома Отек тканей\">Припухлость</a> в области шеи. <a href=\"/symptom/bol_v_gorle/\" title=\"Перейти на страницу симптома Боль в горле\">Боль в горле</a> и ощущение дискомфорт при глотании, першение. Ощущение инородного тела в гортани при глотании. Постоянный <a href=\"/symptom/kashel/\" title=\"Перейти на страницу симптома Кашель\">кашель</a>. <a href=\"/symptom/vydeleniya_iz_uha/\" title=\"Перейти на страницу симптома Выделения из уха\">Боль в ухе</a>. <a href=\"/symptom/anormalnaya_poterya_vesa/\" title=\"Перейти на страницу симптома Анормальная потеря веса\">Потеря веса</a>.</p>\r\n<p> </p>",
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}
]
}
