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"code": "K11.6",
"name": "Мукоцеле слюнной железы",
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"lead": "полостное опухолеподобное образование, заполненное слизистым содержимым",
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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;\">К причинам возникновения данного заболевания относятся перенесенные ранее травмы и воспалительные заболевания разнообразной этиологии. Нередки случаи возникновения мукоцеле из-за обструкции слюнной железы ротовой полости камнями. У младенца симптомы мукоцеле могут проявляться из-за ряда различных патологий – таких, например, как атрезия выводных протоков слюнных желез.</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;\">У специалистов нет единого мнения касательно причин развития ранул – например, многие стоматологи считают, что частотность образования данной патологии слюнной железы вызвана особенностями её строения. Другие же считают, что вероятность возникновения данной патологии закладывается генетически или же на стадии развития эмбриона.</span></p>\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;\">Одна из весомых причин появления мукоцеле слюнной железы – это привычка постоянно прикусывать нижнюю губу или любым другим способом её травмировать. Эти постоянные механические микротравмы приводят к созданию очага инфекции и заражению. Значительно реже новообразование появляется, например, на внутренней поверхности щек, на верхней губе или на языке.</span></p>",
"pathogenesis": "<p><span id=\"docs-internal-guid-b1314717-7fff-b8c9-9a33-7ced2f28bd18\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Патогенез мукоцеле слюнной железы следующий: в результате закупорки выводного протока происходит повышение гидростатического давления, ретенция слизи. В течение первых 24 часов наблюдается пропитывание окружающих тканей муцином (слизистым секретом). Защитные клетки крови способствуют ограничению патологического очага. Сдавливание сосудов ведет к возникновению дистрофии ацинусов с их последующей вакуолизацией. Далее формируется капсула, состоящая из соединительной ткани. Медленный безболезненный рост мукоцеле слюнной железы наблюдается в течение нескольких месяцев или лет.</span></span></p>",
"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;\">Процесс диагностики данной патологии включает в себя физикальное обследование, обнаруживающее наличие асимметрии лица, а также мягкого и эластичного новообразования, безболезненного при пальпации.</span></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;\">Пунктирование слюнной железы позволяет взять на обследование образец её содержимого – тягучей желтоватой жидкости. Биохимическое исследование обнаруживает повышение содержание белка слюны и амилазы.</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;\">Для диагностики также применяется ультразвуковое исследование слюнной железы. Оно выявляет наличие в ней округлого новообразования, имеющего ровные, четко очерченные границы. </span></p>",
"treatment": "<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;\">Основной метод лечения мукоцеле слюнной железы - хирургический. При локализации выпячивания на нижней губе в проекции кисты делают два сходящихся полулунных разреза, выделяют кисту и удаляют ее вместе с дольками железы. После завершения операции показано наложение швов и давящей повязки. Оперативное вмешательство проводится в амбулаторном порядке. При диагностировании мукоцеле слюнной железы подъязычной области могут быть применены операции полного вылущивания кисты (цистэктомия) или цистсиаладенэктомия (удаление образования вместе с железой). Киста приушной зоны является показанием к выполнению частичной или полной паротидэктомии, образование удаляют вместе с частью паренхимы. Если патологический очаг локализуется в поднижнечелюстном участке, показано радикальное вмешательство, которое заключается в удалении кисты вместе с железой. Иссечение верхней стенки (купола) мукоцеле слюнной железы проводится только у детей, ослабленных и пожилых людей.</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;\">Использование лакримальных катетеров для расширения выводных протоков показано в том случае, если мукоцеле слюнной железы возникло вследствие ретенции слизи. В педиатрической практике также применяют техники микромарсупиализации, криохирургии и CO2-лазерной аблации. </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;\">Микромарсупиализация осуществляется следующим образом: толстую шелковую нить протягивают через кистозную полость и завязывают на хирургический узел. Через 7 дней нить удаляют. Как правило, этого времени достаточно, чтобы образование полностью исчезло. Консервативные способы лечения мукоцеле слюнной железы используют не только у детей, но и у взрослых, которым по состоянию здоровья противопоказано длительное хирургическое вмешательство.</span></p>\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;\">Так как оболочка кистозного образования истонченная, выделение ее из окружающих тканей очень затруднительно и не всегда осуществимо. Оставление даже небольших участков капсулы мукоцеле слюнной железы грозит рецидивом. Поэтому операции цистотомии и цистэктомии используют редко. Хороших стойких результатов удается достичь при выполнении частичной или полной цистсиаладенэктомии, то есть при удалении кисты вместе с железой.</span></p>",
"prevention": "<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;\">Профилактические меры включают в себя:</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;\">регулярные осмотры стоматолога;</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 по уходу за ротовой полостью;</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 стоматологических 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;\">отказ от вредных привычек;</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;\">сбалансированный рацион и соблюдение здорового образа жизни.</span></li>\r\n</ul>\r\n<p> </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;\">При развитии мукоцеле слюнной железы пациенты предъявляют жалобы на появление полупрозрачного, безболезненного выпячивания на слизистой оболочке полости рта. Ощущение дискомфорта присутствует как во время приема пищи, так и в состоянии покоя. При достижении мукоцеле слюнной железы больших размеров капсула истончается, приобретая голубой оттенок. Образование подвижное, не спаянное с окружающими тканями. Ранула локализуется в подъязычном пространстве. Пациенты не ощущают боли, только иногда указывают на появление чувства стягивания слизистой.</span></p>\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;\">Мукоцеле слюнной железы может вскрываться в результате прикусывания, но вскоре раневая поверхность заживает, и киста опять наполняется содержимым. При развитии мукоцеле слюнных желез приушно-жевательной, поднижнечелюстной областей больные жалуются на появление припухлости, выраженную асимметрию лица. Кожа в цвете не изменена, открывание рта свободное. На слизистой оболочке ротовой полости видимые изменения отсутствуют.</span></p>",
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"danger": 11,
"published": 1,
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},
{
"id": 8607,
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{
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0
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"etiology": "<p>Патологии мошонки и яичек. К данной группе заболеваний относится варикоцеле, варикозное расширение вен, крипторхизм, водянка яичек, гипоспадия, эпидемический паротит.</p>\r\n<p>Непроходимость семявыводящих протоков. Врожденные патологии в строении семявыводящих канальцев, а также полное отсутствие указанных органов, могут являться одной из причин мужского бесплодия. Дефекты протоков также проявляются при травмах, после неудачных операций на органах малого таза, воспалительных процессов в тканях яичек, а также при наличии опухолей.</p>\r\n<p>ЗППП. Как правило, мужское <a href=\"/symptom/besplodie/\" title=\"Перейти на страницу симптома Бесплодие\">бесплодие</a> появляется не из-за самих заболеваний, а в результате осложнений – нарушается процесс выработки спермы, проходимость семявыносящих протоков снижается и т. д.</p>\r\n<p>Расстройства эякуляции. К данной группе причин специалисты относят эректильную дисфункцию и ретроградную эякуляцию.</p>",
"pathogenesis": "",
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"treatment": "<p>Патогенетическая. Она включает в себя консервативное и оперативное лечение заболеваний, которые привели к мужскому бесплодию. В частности, успешному лечению поддаются нарушения гормонального фона, воспалительные процессы в органах малого таза, варикоцеле, крипторхизм и т. д. Врач может назначить пациенту прием лекарственных средств или хирургическое вмешательство при наличии соответствующих показаний.</p>\r\n<p>Эмпирическая. Данная методика применяется только в тех случаях, когда патогенетическое лечение не принесло результата или не может быть проведено в силу ряда показаний. В рамках эмпиричеких методов могут применяться:</p>\r\n<ul>\r\n<li>ЭКО. Искусственное оплодотворение яйцеклетки происходит в лабораторных условиях, после чего эмбрион подсаживается в матку женщины. В данном случае сперма должна иметь высокое качество;</li>\r\n<li>ИКСИ. При инъекции сперматозоида в цитоплазму яйцеклетки качество спермы не имеет большого значения;</li>\r\n<li>искусственная инсеминация. В данном случае сперма мужа вводится во влагалище женщины в условиях лаборатории, без естественного полового акта. При использовании данного метода в канал шейки матки попадает не часть спермы, а весь ее объем, поэтому мужские половые клетки должны быть подвижными;</li>\r\n<li>экстракция сперматозоидов из яичка или его придатков. Данный метод показан мужчинам, у которых нет сперматозоидов в эякуляте – в такой ситуации врачи забирают их из непосредственно из яичка.</li>\r\n</ul>",
"prevention": "<p>Для того чтобы сохранить фертильность, мужчине достаточно помнить о ряде простых правил. В частности, регулярные половые акты (1 раз в 2-3 дня) способствуют выработке новых жизнеспособных сперматозоидов. Нижнее белье свободного кроя и из натуральных тканей не нарушает кровоснабжение органов малого таза. Отказ от вредных привычек (табакокурение, употребление алкоголя) позволяет значительно улучшить качество спермы. Сбалансированное питание, полноценный ночной сон, а также отсутствие стрессовых ситуаций положительным образом влияют не только на общее состояние организма, но и на интимное здоровье мужчины.</p>",
"clinical_picture": "<p>Секреторная форма. В данном случае нарушен сперматогенез – процесс образования новых сперматозоидов, которые способны оплодотворить яйцеклетку. Он является гормонально обусловленным и напрямую зависит от уровня тестостерона в организме мужчины. Лечение мужского бесплодия в данном случае подразумевает точный учет всех проблем сперматогенеза, обусловленных генетически (как в случае с тератозооспермией и азооспермией). Помимо этого, к секреторной форме мужского бесплодия могут привести эндокринные патологии, варикоцеле, крипторхизм, а также инфекции половых органов.</p>\r\n<p>Экскреторная (обтурационная) форма. Мужское <a href=\"/symptom/besplodie/\" title=\"Перейти на страницу симптома Бесплодие\">бесплодие</a> данного типа характеризуется нарушением процесса перемещения сперматозоидов по семявыводящим путям по причине нарушения их проходимости. Болезнь может быть как односторонней (при этом количество здоровых сперматозоидов в эякуляте часто снижено), так и двусторонней (жизнеспособные сперматозоиды полностью отсутствуют). Для лечения мужского бесплодия в данной форме используются хирургические методики в сочетании с новейшими технологиями репродуктивной медицины. К причинам экскреторного мужского бесплодия относятся кисты и опухоли яичка, сдавливающие семявыносящий проток, перенесенный ранее вирусный паротит, врожденные пороки развития протоков, а также последствия травм и неудачных оперативных вмешательств в области органов малого таза.</p>\r\n<p>Иммунологическая форма. В этом случае в организме мужчины вырабатываются антитела к его же сперматозоидам. В нормальном состоянии у представителя сильного пола имеется гемато-текстулярный барьер, который препятствует контакту спермий и клеток крови, способному спровоцировать иммунный конфликт. В случае если данный барьер нарушен, в организме начинает развиваться реакция, при которой сперматозоиды воспринимаются иммунной системой в качестве антигенного материала. Антитела значительно понижают оплодотворяющую способность семени, а иногда вызывают полную гибель всех половых клеток мужчины. Лечение иммунологической формы бесплодия не всегда бывает результативным, поэтому пациентам с таким диагнозом рекомендуется проведение процедуры ИКСИ.</p>\r\n<p>Другие формы. Причинами мужского бесплодия также могут стать заболевания, при которых совершение полового акта не представляется возможным (<a href=\"/symptom/erektilnaya_disfunkciya/\" title=\"Перейти на страницу симптома Эректильная дисфункция\">эректильная дисфункция</a>), сперма не может попасть в шейку матки женщины (гипоспадия 1 степени) и т д. Схема лечения в таких случаях определяется в индивидуальном порядке.</p>",
"image": null,
"image_alt": null,
"standard_type": 3,
"danger": 11,
"published": 1,
"parent": null,
"block_rubric": 153,
"standards": []
}
]
}