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"lead": "Область медицины, включающая в себя лечение 351 заболевания. В 523 клиниках России оказывается помощь по этому направлению медицины.",
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"disease_count": null,
"name": "пульмонология",
"code": "B37",
"branch_medicine_code": "037",
"slug": "pulmonologiya",
"lead": "Область медицины, включающая в себя лечение 145 заболеваний. В 181 клинике России оказывается помощь по этому направлению медицины.",
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{
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"disease_count": null,
"name": "ревматология",
"code": "B40",
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"slug": "revmatologiya",
"lead": "Область медицины, включающая в себя лечение 136 заболеваний. В 177 клиниках России оказывается помощь по этому направлению медицины.",
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"disease_count": null,
"name": "оториноларингология",
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"branch_medicine_code": "028",
"slug": "otorinolaringologiya",
"lead": "Область медицины, включающая в себя лечение 685 заболеваний. В 631 клинике России оказывается помощь по этому направлению медицины.",
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"disease_count": null,
"name": "офтальмология",
"code": "B29",
"branch_medicine_code": "029",
"slug": "oftalmologiya",
"lead": "Область медицины, включающая в себя лечение 851 заболевания. В 696 клиниках России оказывается помощь по этому направлению медицины.",
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{
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"disease_count": null,
"name": "ультразвуковая диагностика",
"code": "B52",
"branch_medicine_code": "052",
"slug": "ultrazvukovaya_diagnostika",
"lead": "Область медицины, включающая в себя лечение 515 заболеваний. В 980 клиниках России оказывается помощь по этому направлению медицины.",
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{
"id": 27,
"disease_count": null,
"name": "онкология",
"code": "B27",
"branch_medicine_code": "027",
"slug": "onkologiya",
"lead": "Область медицины, включающая в себя лечение 354 заболеваний. В 378 клиниках России оказывается помощь по этому направлению медицины.",
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{
"id": 24,
"disease_count": null,
"name": "нейрохирургия",
"code": "B24",
"branch_medicine_code": "024",
"slug": "neyrohirurgiya",
"lead": "Область медицины, включающая в себя лечение 173 заболеваний. В 95 клиниках России оказывается помощь по этому направлению медицины.",
"image": null
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{
"id": 14,
"disease_count": null,
"name": "инфекционные болезни",
"code": "B14",
"branch_medicine_code": "014",
"slug": "infekcionnye_bolezni",
"lead": "Область медицины, включающая в себя лечение 518 заболеваний. В 499 клиниках России оказывается помощь по этому направлению медицины.",
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{
"id": 38,
"disease_count": null,
"name": "радиология и радиотерапия",
"code": "B38",
"branch_medicine_code": "038",
"slug": "radiologiya_i_radioterapiya",
"lead": "Область медицины, включающая в себя лечение 237 заболеваний. В 15 клиниках России оказывается помощь по этому направлению медицины.",
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{
"id": 18,
"disease_count": null,
"name": "колопроктология",
"code": "B18",
"branch_medicine_code": "018",
"slug": "koloproktologiya",
"lead": "Область медицины, включающая в себя лечение 37 заболеваний. В 153 клиниках России оказывается помощь по этому направлению медицины.",
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{
"id": 59,
"disease_count": null,
"name": "эндоскопия",
"code": "B59",
"branch_medicine_code": "059",
"slug": "endoskopiya",
"lead": "Область медицины, включающая в себя лечение 53 заболеваний. В 414 клиниках России оказывается помощь по этому направлению медицины.",
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{
"id": 55,
"disease_count": null,
"name": "фтизиатрия",
"code": "B55",
"branch_medicine_code": "055",
"slug": "ftiziatriya",
"lead": "Область медицины, включающая в себя лечение 204 заболеваний. В 249 клиниках России оказывается помощь по этому направлению медицины.",
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{
"id": 65,
"disease_count": null,
"name": "стоматология терапевтическая",
"code": "B65",
"branch_medicine_code": "065",
"slug": "stomatologiya_terapevticheskaya",
"lead": "Область медицины, включающая в себя лечение 87 заболеваний. В 1270 клиниках России оказывается помощь по этому направлению медицины.",
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"disease_count": null,
"name": "аллергология и иммунология",
"code": "B2",
"branch_medicine_code": "002",
"slug": "allergologiya_i_immunologiya",
"lead": "Область медицины, включающая в себя лечение 66 заболеваний. В 202 клиниках России оказывается помощь по этому направлению медицины.",
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"id": 32,
"disease_count": null,
"name": "неонатология",
"code": "B32",
"branch_medicine_code": "032",
"slug": "neonatologiya",
"lead": "Область медицины, включающая в себя лечение 54 заболеваний. В 163 клиниках России оказывается помощь по этому направлению медицины.",
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"id": 69,
"disease_count": null,
"name": "другое",
"code": "B69",
"branch_medicine_code": "069",
"slug": "drugoe",
"lead": "Область медицины, включающая в себя лечение 268 заболеваний. В 3931 клинике России оказывается помощь по этому направлению медицины.",
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{
"id": 64,
"disease_count": null,
"name": "стоматология и стоматология детская",
"code": "B64",
"branch_medicine_code": "064",
"slug": "stomatologiya_i_stomatologiya_detskaya",
"lead": "Область медицины, включающая в себя лечение 116 заболеваний. В 1200 клиниках России оказывается помощь по этому направлению медицины.",
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"id": 43,
"disease_count": null,
"name": "сердечно сосудистая хирургия, рентгенэндоваскулярная диагностика и лечение",
"code": "B43",
"branch_medicine_code": "043",
"slug": "serdechno_sosudistaya_hirurgiya_rentgenendovaskulyarnaya_diagnostika_i_lechenie",
"lead": "Область медицины, включающая в себя лечение 110 заболеваний. В 78 клиниках России оказывается помощь по этому направлению медицины.",
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"id": 68,
"disease_count": null,
"name": "челюстно лицевая хирургия",
"code": "B68",
"branch_medicine_code": "068",
"slug": "chelyustno_licevaya_hirurgiya",
"lead": "Область медицины, включающая в себя лечение 13 заболеваний. В 42 клиниках России оказывается помощь по этому направлению медицины.",
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"id": 46,
"disease_count": null,
"name": "сурдология оториноларингология",
"code": "B46",
"branch_medicine_code": "046",
"slug": "surdologiya_otorinolaringologiya",
"lead": "Область медицины, включающая в себя лечение 36 заболеваний. В 23 клиниках России оказывается помощь по этому направлению медицины.",
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"id": 67,
"disease_count": null,
"name": "стоматология хирургическая",
"code": "B67",
"branch_medicine_code": "067",
"slug": "stomatologiya_hirurgicheskaya",
"lead": "Область медицины, включающая в себя лечение 13 заболеваний. В 630 клиниках России оказывается помощь по этому направлению медицины.",
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"id": 8,
"disease_count": null,
"name": "дерматовенерология и косметология",
"code": "B8",
"branch_medicine_code": "008",
"slug": "dermatovenerologiya_i_kosmetologiya",
"lead": "Область медицины, включающая в себя лечение 376 заболеваний. В 728 клиниках России оказывается помощь по этому направлению медицины.",
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"id": 36,
"disease_count": null,
"name": "психиатрия наркология",
"code": "B36",
"branch_medicine_code": "036",
"slug": "psihiatriya_narkologiya",
"lead": "Область медицины, включающая в себя лечение 149 заболеваний. В 377 клиниках России оказывается помощь по этому направлению медицины.",
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"disease_count": null,
"name": "хирургия, хиругия (трансплантация органов и тканей) и комбустиология",
"code": "B57",
"branch_medicine_code": "057",
"slug": "hirurgiya_hirugiya_transplantaciya_organov_i_tkaney_i_kombustiologiya",
"lead": "Область медицины, включающая в себя лечение 253 заболеваний. В 632 клиниках России оказывается помощь по этому направлению медицины.",
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"id": 13,
"disease_count": null,
"name": "диетология",
"code": "B13",
"branch_medicine_code": "013",
"slug": "dietologiya",
"lead": "Область медицины, включающая в себя лечение 114 заболеваний. В 600 клиниках России оказывается помощь по этому направлению медицины.",
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"id": 25,
"disease_count": null,
"name": "нефрология",
"code": "B25",
"branch_medicine_code": "025",
"slug": "nefrologiya",
"lead": "Область медицины, включающая в себя лечение 175 заболеваний. В 146 клиниках России оказывается помощь по этому направлению медицины.",
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"id": 39,
"disease_count": null,
"name": "рентгенология",
"code": "B39",
"branch_medicine_code": "039",
"slug": "rentgenologiya",
"lead": "Область медицины, включающая в себя лечение 4 заболеваний. В 933 клиниках России оказывается помощь по этому направлению медицины.",
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"disease_count": null,
"name": "клиническая фармакология",
"code": "B17",
"branch_medicine_code": "017",
"slug": "klinicheskaya_farmakologiya",
"lead": "Область медицины, включающая в себя лечение 16 заболеваний. В 110 клиниках России оказывается помощь по этому направлению медицины.",
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"id": 26,
"disease_count": null,
"name": "общая врачебная практика (семейная медицина)",
"code": "B26",
"branch_medicine_code": "026",
"slug": "obschaya_vrachebnaya_praktika_semeynaya_medicina",
"lead": "Область медицины, включающая в себя лечение 151 заболевания. В 203 клиниках России оказывается помощь по этому направлению медицины.",
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"id": 49,
"disease_count": null,
"name": "торакальная хирургия",
"code": "B49",
"branch_medicine_code": "049",
"slug": "torakalnaya_hirurgiya",
"lead": "Область медицины, включающая в себя лечение 34 заболеваний. В 23 клиниках России оказывается помощь по этому направлению медицины.",
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"id": 12,
"disease_count": null,
"name": "диабетология",
"code": "B12",
"branch_medicine_code": "012",
"slug": "diabetologiya",
"lead": "Область медицины, включающая в себя лечение 33 заболеваний. В 15 клиниках России оказывается помощь по этому направлению медицины.",
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"id": 22,
"disease_count": null,
"name": "мануальная терапия",
"code": "B22",
"branch_medicine_code": "022",
"slug": "manualnaya_terapiya",
"lead": "Область медицины, включающая в себя лечение 11 заболеваний. В 217 клиниках России оказывается помощь по этому направлению медицины.",
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"id": 44,
"disease_count": null,
"name": "скорая медицинская помощь",
"code": "B44",
"branch_medicine_code": "044",
"slug": "skoraya_medicinskaya_pomosch",
"lead": "Область медицины, включающая в себя лечение 328 заболеваний. В 200 клиниках России оказывается помощь по этому направлению медицины.",
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"id": 42,
"disease_count": null,
"name": "сексология",
"code": "B42",
"branch_medicine_code": "042",
"slug": "seksologiya",
"lead": "Область медицины, включающая в себя лечение 3 заболеваний. В 9 клиниках России оказывается помощь по этому направлению медицины.",
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"slug": "stomatologiya_ortopedicheskaya",
"lead": "Область медицины, включающая в себя лечение 6 заболеваний. В 987 клиниках России оказывается помощь по этому направлению медицины.",
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"lead": "состояние, при котором в стенке органа присутствуют мешковидные углубления, сообщающиеся с основной полостью через канал – шейку дивертикула.",
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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;\">Нарушение может быть врожденным или приобретенным. Во втором случае дивертикул образуется из-за за нарушений в стенках органа. Постоянное чрезмерное растяжение приводит к истончению стенок и потере мышечного тонуса. Такие выпячивания чаще проявляются на боковой или задней стороне. Дивертикулы могут разниться по размерам: быть совсем небольшими или даже превосходить по объему мочевой пузырь.</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;\">Среди причин выпячивания стенки мочевого пузыря:</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;\">нарушение оттока мочи;</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;\">травматическое поражение;</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;\">операции на стенках органа;</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;\">мочекаменная болезнь;</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;\">хронические инфекционные процессы (пиелонефрит, цистит, ХПН);</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;\">повышение внутрипузырного давления из-за простатита, аденомы, рака мочевого пузыря, стриктуры уретры.</span></li>\r\n</ul>",
"pathogenesis": "",
"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;\">Дивертикул редко выявляют как самостоятельное заболевание. Обычно это происходит во время обследования мочевого пузыря из-за наличия у пациента при частых рецидивирующих циститах и пиелонефритах. Для этого проводят следующие исследования:</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">УЗИ мочевого пузыря для выяснения размера и форм образования;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">цистоскопию для выявления перешейка дивертикула;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">урофлоуметрию и цистометрию для определения уровня обструкции;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">цистографию с рентгеноконтрастным веществом.</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;\">Контраст накапливается в дивертикуле. После опорожнения мочевого пузыря он остается в полости образования. Его тень смотрится более плотной в сравнении самим пузырем. Это образование легче выявляется в боковой или косой проекциях.</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;\">Оперативное лечение дивертикула мочевого пузыря – «золотой стандарт» для удаления патологии. Оптимальными считаются малоинвазивные вмешательства, которые минимизируют травматическое повреждение тканей и существенно сокращают реабилитационный период.</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;\">В рамках лечения может проводиться трансуретральная резекция шейки дивертикула. В данном случае хирург через естественные отверстия мочевыводящих путей проникает в полость органа. Проводится пластика шейки выпячивания, через которую сообщаются две полости (нормальная – мочевой пузырь и патологическая – дивертикулезная полость). Дивертикул не иссекается полностью, однако прошивание шейки устраняет нарушение оттока мочи и связанную с этим симптоматику.</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;\">Радикальное оздоровление предусматривает полное устранение выпячивания. Его удаление может выполняться лапароскопическим и традиционным открытым путем. В первом случае хирург через небольшие проколы в брюшной стенке проводит инструменты к пузырю, иссекает выпячивание и проводит пластику дефекта. Преимуществом такой операции считается ее низкая травматичность, высокая эффективность и короткий восстановительный период. Открытое иссечение предусматривает выполнение надлобкового разреза с последующим выведением мочевого пузыря в рану и удалением выпячивания. Реабилитация в данном случае продлевается.</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;\">Больным доступен весь спектр операций, которые используются для устранения дивертикулов мочевого пузыря. В практической деятельности специалисты применяют только проверенные методики, целесообразность которых доказана в крупномасштабных исследованиях. При этом применяются новейшие эндоскопические и вспомогательные инструменты.</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;\">Хирурги отдают предпочтение лапароскопическим операциям. Популярность подобных вмешательств связана с низкой травматичностью, что существенно сокращает длительность реабилитационного периода. В зависимости от размеров патологического выпячивания хирурги подбирают оптимальный вариант лечения. В настоящее время проводятся следующие операции:</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;\">Трансуретральная резекция (ТУР) шейки дивертикула.</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;\">Лапараскопическое удаление дивертикула.</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;\">Открытое иссечение дивертикула.</span></li>\r\n</ul>\r\n<p> </p>\r\n<p><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;\"> </span></p>",
"prevention": "<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;\">Профилактика приобретенных дивертикулов требует своевременного устранения причин, способствующих возникновению патологии (гиперплазии простаты, склероза шейки мочевого пузыря, стриктур уретры и др.).</span></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;\">Клиническая картина дивертикула в мочевом пузыре зависит от его размеров. При небольшом объеме выпячивания не наблюдается нарушений оттока мочи. В таком случае больные не подозревают о своей проблеме.</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 врачам пациенты традиционно обращаются со следующими жалобами:</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li><span style=\"font-size: 7pt; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Ощущение неполного опорожнения мочевого пузыря.</span></li>\r\n<li><span style=\"font-size: 7pt; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Необходимость дважды помочиться. При повторном походе в туалет больные отмечают наличие мутной мочи.</span></li>\r\n<li><span style=\"font-size: 7pt; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Болевой синдром при сочетанном развитии мочекаменной болезни или воспалительного процесса.</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;\">Дивертикулы являются «подходящим» местом для образования конкрементов или роста опухолей. При отсутствии адекватного и своевременного лечения развивается атрофия стенки органа с возможным ее прорывом и присоединением перитонита.</span></p>",
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},
"code": "N30",
"name": "Цистит",
"icd_name": "Цистит",
"gender": 0,
"age_min": 0,
"age_max": 100,
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"slug": "n30_cistit",
"lead": "Нарушение здоровья, относящееся к группе другие болезни мочевой системы",
"description": "<p>Цистит – воспалительное заболевание слизистой и подслизистого слоя мочевого пузыря. В большинстве случаев цистит имеет инфекционную природу.</p>",
"etiology": "<p>Циститом болеют преимущественно женщины, что связано с анатомо-физиологическими и гормональными особенностями их организма.</p>\r\n<p>Предрасполагающими факторами для развития цистита являются: травма слизистой оболочки мочевого пузыря, застой крови в венах таза, гормональные нарушения, гиповитаминозы, переохлаждение и др. Большое значение имеет нарушение уродинамики, в том числе затрудненное или неполное опорожнение мочевого пузыря.</p>\r\n<p>Самый распространенный возбудитель цистита — кишечные бактерии, в частности, кишечная палочка.</p>\r\n<p>Вторичный цистит развивается на фоне заболеваний мочевого пузыря (камни, опухоль) или близлежащих органов (аденома и рак предстательной железы, стриктура уретры, хронические воспалительные заболевания половых органов).</p>",
"pathogenesis": "<p>Инфекционные циститы могут возникать восходящим, нисходящим, гематогенным, лимфогенным и контактным путями.</p>\r\n<p>Возбудители инфекций могут проникать в мочевой пузырь восходящим путем при воспалительных заболеваниях мочеиспускательного канала, предстательной железы, семенных пузырьков, яичка и его придатков. Нисходящий путь инфицирования чаще всего бывает при туберкулезном поражении почки. Гематогенный путь поражения слизистой оболочки мочевого пузыря бывает при инфекционных болезнях или наличии гнойного очага в организме: тонзиллите, пульпите, фурункулезе. Лимфогенный путь заражения бывает при заболеваниях половых органов: эндометрите, сальпингоофорите, параметрите. Инфицирование мочевого пузыря может наступить при его катетеризации или во время цистоскопии. Прямое инфицирование мочевого пузыря может возникать при наличии свищей, соединяющих влагалище с мочевым пузырем или влагалище с прямой кишкой.</p>\r\n<p>Слизистая оболочка мочевого пузыря обладает значительной устойчивостью к инфекции, поэтому одного его инфицирования недостаточно для развития цистита. В развитии цистита помимо инфекции важную роль играют дополнительные предрасполагающие факторы. К ним относят снижение резистентности организма, обусловленное переохлаждением, переутомлением, авитаминозами, истощением, перенесенными заболеваниями, вторичным иммунодефицитом, гормональными нарушениями, оперативными вмешательствами.</p>\r\n<p>Значение имеют нарушение оттока и застой мочи у больных с аденомой предстательной железы, стриктурой уретры, с камнем мочевого пузыря, нейрогенная дисфункция мочевого пузыря. Предрасполагающим моментом служит нарушение кровообращения в стенке мочевого пузыря или малом тазу.</p>\r\n<p> </p>\r\n<p> </p>",
"diagnostics": "<p>При неосложнённом цистите обязательно проведение общего анализа мочи (иногда выполняется с помощью тест-полосок), при этом в моче обнаруживаются лейкоциты, бактерии, белок и эритроциты.</p>\r\n<p>Обследование при осложнённом или рецидивирующем цистите, помимо общего анализа мочи, включает:</p>\r\n<ul>\r\n<li>бактериологическое исследование мочи, которое проводят для точного выявления возбудителя и его чувствительности к антибактериальным лекарственным средствам; ▪ обследование на инфекции, передаваемые половым путём (ПЦР из двух локусов — уретра, цервикальный канал);</li>\r\n<li>обследование на вирусные инфекции (ИФА для определения иммуноглобулинов к герпесу, цитомегаловирусу), мазок и посев отделяемого из влагалища с количественным определением лактобактерий) для исключения дисбиоза.</li>\r\n</ul>\r\n<p>Анализ мочи с использованием тест-полосок — альтернатива общему анализу мочи, который используется для постановки диагноза острого неосложненного цистита.</p>\r\n<p>Инструментальные вмешательства при остром цистите или обострении рецидивирующего цистита противопоказаны.</p>\r\n<p>УЗИ почек или органов малого таза, экскреторную урографию, цистоуретрографию, КТ или МРТ малого таза проводят при подозрении на камень, опухолевые или другие заболевания, требующие оперативного вмешательства, а также при рецидивах мочевой инфекции и отсутствии положительной динамики на антимикробную терапию.</p>",
"treatment": "<p>Немедикаментозное лечение</p>\r\n<p>Диета с исключением солёной, острой, раздражающей пищи (стол №10); питьё, достаточное для поддержания диуреза 2000–2500 мл (после разрешения дизурии). При рецидивирующем цистите — инстилляции препаратов в мочевой пузырь вне стадии обострения. Фитотерапия при цистите самостоятельного значения не имеет, но широко используется как вспомогательное лечение, на этапе долечивания.</p>\r\n<p>Медикаментозное лечение</p>\r\n<p>Этиологическое лечение — антибактериальная терапия. Длительная (до 7–10 дней). Выбор препарата с учётом выделенного возбудителя и антибиотикограммы. Назначение антибиотиков с бактерицидным действием.</p>\r\n<p>Патогенетическое лечение – коррекция анатомических нарушений, лечение воспалительных и гормональных гинекологических заболеваний у женщин.</p>\r\n<p>Симптоматическая терапия – при выраженной боли показаны анальгетики. У больных с бактериальным циститом потребность в обезболивающих препаратах возникает редко.</p>",
"prevention": "<p>Профилактика развития цистита:</p>\r\n<ul>\r\n<li>Строгое соблюдение гигиенических приёмов у новорождённых девочек для предотвращения развития вагинитов, а затем уретритов и циститов;</li>\r\n<li>Своевременная коррекция анатомических нарушений (аномалии расположения наружного отверстия мочеиспускательного канала) при наличии показаний;</li>\r\n<li>Адекватное лечение гинекологических заболеваний, инфекций, передаваемых половым путём, причём у обоих половых партнеров;</li>\r\n<li>Гигиена половой жизни и т.д.;</li>\r\n<li>Адекватная оценка и лечение бессимптомной бактериурии беременных;</li>\r\n<li>Антибиотикопрофилактика перед инвазивными урологическими вмешательствами, особенно при наличии факторов риска;</li>\r\n<li>Лечение урологических заболеваний, приводящих к нарушению уродинамики.</li>\r\n</ul>",
"clinical_picture": "<p>Самым характерным симптомом цистита является болезненное мочеиспускание, сопровождающееся остаточными ощущениями жжения и рези. Кроме того, больных циститом беспокоят боли в нижней части живота и ощущение неполного опорожнения мочевого пузыря. Иногда при цистите развивается недержание мочи, появляющееся при сильном желании помочиться.</p>\r\n<p>Моча при цистите может становиться мутной или приобретать красноватый оттенок вследствие примеси красных кровяных телец. Может незначительно повышаться температура тела до субфебрильных значений. Для тяжелых форм острого цистита (флегмонозный, гангренозный, геморрагический) характерны выраженная интоксикация, высокая температура тела, олигурия. Моча при этом мутная с гнилостным запахом, содержит хлопья фибрина, иногда пласты некротизированной слизистой оболочки, примесь крови. Продолжительность заболевания в этих случаях значительно увеличивается, возможно развитие тяжелых осложнений. При тотальном, диффузном воспалении слизистой оболочки мочевого пузыря боли усиливаются по мере накопления мочи, растяжения воспаленной слизистой оболочки. Усиление болей в конце акта мочеиспускания связано с сокращением воспаленной слизистой оболочки мочевого пузыря и с соприкосновением воспаленных поверхностей.</p>\r\n<p>Клиническая картина хронического цистита разнообразна и зависит от этиологического фактора, общего состояния больного и эффективности проводимого лечения. Основные клинические симптомы те же, что и при остром цистите, но выражены слабее. Хронический цистит протекает либо в виде непрерывного процесса с постоянными, более или менее выраженными жалобами и изменениями в моче (наличие лейкоцитов, бактерий), либо имеется рецидивирующее течение с обострениями, протекающими аналогично острому циститу, и ремиссиями, во время которых все признаки цистита отсутствуют.</p>",
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"standards": [
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5429
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}
]
}
