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"lead": "очаговые разрастания морфологически измененной опухолевой ткани в селезеночной паренхиме",
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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;\">Причины первичной опухолевой трансформации тканей селезенки окончательно не установлены. При вторичных новообразованиях процесс провоцируется системным поражением лимфоидной ткани или метастатическим распространением клеток. Точных доказательств, подтверждающих наследственный характер неоплазии, нет. По мнению специалистов, возможными этиологическими факторами первичных и вторичных селезеночных новообразований являются:</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;\">Воздействие повреждающих факторов. Патологическое разрастание тканей селезенки может происходить под воздействием ионизирующего излучения, инфекционных агентов, вирусов с онкогенным действием. Помимо этого, развитие неоплазии иногда связывают с влиянием полиароматических углеводородов и никотина, обладающих канцерогенным потенциалом. Иногда заболевание возникает на фоне ишемии или прямого повреждения паренхимы селезенки при травмах, а также вследствие паразитарного поражения органа.</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;\">Наличие внеселезеночных опухолей. Вторичное опухолевое изменение характерно для злокачественных лимфопролиферативных процессов — лимфогранулематоза, ретикулосарком, лимфолейкоза. В некоторых случаях поражение селезенки является единственным проявлением этих онкологических заболеваний. Метастазы в селезенку наблюдаются редко.</span></p>",
"pathogenesis": "<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;\">Основой механизма развития первичных и лимфопролиферативных опухолей селезенки являются неопластическая конверсия клеток и онкогенез. Под действием мутагенных факторов повреждается клеточная ДНК, ткани изменяют антигенный состав, в большей или меньшей мере утрачивают органоспецифическую структуру и функциональность. Из-за нарушения механизмов, контролирующих деление, рост, запрограммированную гибель (апоптоз) клетки селезенки начинают бесконтрольно делиться, формируя узлы патологической ткани. Растущая в объеме опухоль сдавливает, а при злокачественном процессе и прорастает окружающую паренхиму, капсулу, сосудисто-нервную ножку, смежные органы. При метастатическом механизме образования лиенальных неоплазий в формировании структуры патологических очагов участвуют анормальные клетки основного новообразования.</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;\">План обследования пациента с подозрением на опухоль селезенки включает следующие инструментальные и лабораторные методы:</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;\">УЗИ селезенки. При проведении ультразвукового исследования визуализируют структуру паренхимы, оценивают размеры и топографию органа. Иногда дополнительно назначают УЗДГ селезенки, по результатам которого можно судить о кровоснабжении подозрительных узлов, скорости кровотока в селезеночных артериях, венах.</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;\">КТ брюшной полости. Рентгенологическое исследование с болюсным внутривенным введением контрастного препарата помогает отграничить неизмененную паренхиму от некротических очагов, которые не накапливают контраст. Компьютерная томография имеет высокую информативность и обеспечивает обнаружение опухолей в 95% случаев.</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;\">Целиакография. Катетеризация чревного ствола, введение контраста с выполнением серии рентгенологических снимков позволяет оценить состояние артерий абдоминальных органов. При наличии опухолей на рентгенограмме обнаруживают бессосудистый участок или новообразованные сосуды в области проекции селезенки, выраженное смещение крупных артерий и вен.</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;\">Гистологический анализ. Морфологическое исследование пунктата селезенки назначается для уточнения характера процесса, проведения дифференциальной диагностики между доброкачественными и злокачественными новообразованиями. Основными признаками опухолевого поражения являются наличие атипичных клеток с патологическими митозами, потеря дифференцировки.</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 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\"><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 клиническом анализе крови выявляется значительное повышение СОЭ (более 20 мм/ч), резкое снижение количества эритроцитов и гемоглобина. Иногда наблюдается увеличение процентного содержания нейтрофилов. В биохимическом анализе крови определяется уменьшение количества общего белка за счет альбуминов, повышение показателей мочевины. При оценке результатов коагулограммы обнаруживается повышение свертывающей способности крови со склонностью к тромбозам. При затруднениях в постановке диагноза может выполняться МРТ органов брюшной полости.</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;\">Если нет серьезных противопоказаний к проведению операции, то опухоль селезенки удаляется посредством хирургического вмешательства. При выборе хирургической тактики учитывают морфологическое строение неоплазии, ее размеры, расположение, взаимоотношение с окружающими органами. </span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Если опухоль селезенки имеет вторичный характер и возникла на фоне какого-либо онкологического процесса в других органах и тканях также потребуется проведение терапии основного заболевания. Объем операции и метод хирургического вмешательства зависит от размеров, расположения (центральная, периферическая), от тяжести состояния пациента по сопутствующей терапевтической патологии. Для лечения опухолей выполняют резекцию органа, спленэктомию, при злокачественных поражениях в послеоперационном периоде проводят химиотерапию.</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;\">Рекомендованными видами вмешательств являются:</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;\">Резекция селезенки. Органосохраняющие операции производят только для удаления небольших доброкачественных опухолей.</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;\">Спленэктомия. Удаление селезенки необходимо при массивных доброкачественных неоплазиях, поразивших большую часть пульпы, злокачественных процессах. Предпочтителен менее травматичный лапароскопический метод операции. Пациентам со злокачественными образованиями после операции назначают химиотерапию.</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;\">Лечение опухолей, возникших в рамках лимфопролиферативных процессов или метастатического поражения селезенки, производится по соответствующим медицинским протоколам и предполагает назначение лучевой, таргетной, химиотерапии.</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;\">Вопрос об удалении селезенки в каждом случае решается индивидуально, у некоторых пациентов спленэктомия оказывает положительный эффект на течение основного заболевания.</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 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;\">Способы специфической профилактики пока не разработаны, однако при появлении первых симптомов следует обратиться к специалисту. При доброкачественных процессах удаление опухоли обычно позволяет добиться полного излечения пациента. Своевременная диагностика и адекватное комбинированное лечение злокачественных новообразований селезенки на ранних стадиях существенно увеличивает благоприятный прогноз и шансы на выздоровление.</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 ходе некоторых исследований была обнаружена связь между хроническим гепатитом C и B-клеточной неходжкинской лимфомой. Принятие мер по предотвращению гепатита С может помочь пациентам снизить риск этого заболевания.</span></p>\r\n<p> </p>",
"clinical_picture": "<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;\">При малых размерах опухолей заболевание длительное время протекает бессимптомно с минимальной выраженностью клинических проявлений. У пациента наблюдается синдром «малых признаков»: утомляемость, слабость, ухудшение работоспособности, потеря аппетита, депрессия, снижение массы тела. По мере прогрессирования опухоли (вплоть до разрыва селезенки) пациента начинают беспокоить боли постоянного характера, возникает тяжесть в области левого подреберья, чувство распирания, асимметрия и увеличение живота, длительная субфебрильная температура, болезненные ощущения в левых отделах брюшной полости. Иногда боль иррадиирует в левое надплечье и плечо. При значительном увеличении размеров селезенки и вовлечении в процесс соседних органов могут наблюдаться расстройства мочеиспускания, не поддающаяся медикаментозной терапии артериальная гипертензия, отеки нижних конечностей.</span></p>",
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},
"code": "C25",
"name": "Рак поджелудочной железы",
"icd_name": "Рак поджелудочной железы",
"gender": 0,
"age_min": 55,
"age_max": 100,
"cause": [
3,
0
],
"periodicity": 1,
"slug": "c25_rak_podzheludochnoy_zhelezy",
"lead": " злокачественное новообразование, исходящее из эпителия железистой ткани или протоков поджелудочной железы.",
"description": "Рак поджелудочной железы является одним из самых агрессивных типов онкологии. Наиболее распространенной формой рака поджелудочной железы является аденокарцинома.\r\n\r\n",
"etiology": "<p>Факторами риска рака поджелудочной железы являются:</p>\r\n<ul>\r\n<li>употребление спиртных напитков</li>\r\n<li>курение</li>\r\n<li>обилие жирной и острой пищи</li>\r\n<li>сахарный диабет</li>\r\n<li>цирроз печени<full></full></li>\r\n</ul>\r\n<p>К предраковым заболеваниям относятся:</p>\r\n<ul>\r\n<li>Аденома поджелудочной железы</li>\r\n<li>Хронический панкреатит</li>\r\n<li>Киста поджелудочной железы</li>\r\n</ul>",
"pathogenesis": "",
"diagnostics": "<p>При раке поджелудочной железы обследование пациента начинают с расспроса о жалобах и с объективного осмотра. Однако на ранних стадиях рака они малоинформативны. При пальпации органов брюшной полости почти всегда можно обнаружить увеличенные печень, селезенку и желчный пузырь. В запущенных случаях при РПЖ в брюшной полости определяется жидкость — <a href=\"/symptom/ascit/\" title=\"Перейти на страницу симптома Асцит\">асцит</a>. Характерные для РПЖ изменения в биохимическом анализе крови — увеличение билирубина, ферментов (липаза, амилаза и др.), печеночных трансаминаз (АсАт, АлАт), желчных кислот, на поздних стадиях — снижение уровня белков. УЗИ и более достоверные рентгенологические методы (компьютерная и магнитно-резонансная томография, ангиография, холангиография — чреспеченочная и чрескожная) позволяют увидеть место расположения опухоли, оценить ее размеры и степень прорастания в соседние органы. Биопсия и последующее изучение ткани опухоли под микроскопом позволяет подтвердить опухолевое происхождение клеток и определить тип рака.<br /><br /><br /></p>",
"treatment": "<p class=\"bodytext\">На первой стадии онкологии, когда опухоль не превышает 2 см и не выходит за пределы поджелудочной, а метастазы отсутствуют, можно избавиться от новообразования с помощью панкреатикодуоденэктомии (если опухоль в головке) или дистальная панкреатэктомии со спленэктомией (если опухоль в теле или хвосте). После операции необходимо пройти 6 курсов химиотерапии гемзаром или фторурацилом.</p>\r\n<p class=\"bodytext\">Опухоль поджелудочной железы на 2 и 3 стадиях характеризуется выходом новообразования за пределы органа, прорастанием онкологии в сосуды, окружающие ткани и нервов, поражением лимфоузлов. Чаще всего такие опухоли уже нерезектабельны. Лишь в отдельных случаях (когда отсутствует прорастание новообразования в нервы и магистральные сосуды) можно выполнить гастропанкреатодуоденальную резекцию. После нее пациенту показана химиотерапия гемзаром.</p>\r\n<p class=\"bodytext\">Рак поджелудочной железы четвертой стадии предполагает наличие отдельных метастазов. Основным видом лечения в данном случае будет являться химиотерапия. К препаратам первой линии относят гемцитабин, также можно давать пациенту сочетание гемзара с тарцевой. Вторая линия — это схемы лечения, включающие лечение оксалиплатином, иринотеканом, фторурацилом/кселодами, цисплатином. Эффективность препаратов первой линии значительно выше.</p>\r\n<full></full>\r\n<p class=\"bodytext\">Существуют две главные проблемы, которые беспокоят онкобольных с опухолью поджелудочной железы, — это боль и <a href=\"/symptom/zheltuha/\" title=\"Перейти на страницу симптома Желтуха\">желтуха</a>. При желтухе пациентам показана эндоскопическая установка стента. Стнетом называют пористую трубку или металлический проволочный каркас, который вводят в просвет суженого желчного протока. Стент растягивает проток, позволяя выводить желчь без нарушений. Опухоль не может сдавить стент, однако со временем прорастает сквозь его стенки и вновь нарушает отток желчи.</p>\r\n<p class=\"bodytext\">Еще один вариант обеспечения нормального оттока — это установка дренажа. В этом случае проходимость не восстанавливается, а желчь выходить наружу — в специальный мешочек.</p>\r\n<p class=\"bodytext\">Боль при онкологии поджелудочной железы является следствием разрастания опухоли и сдавливания окружающих ее нервов и органов. Чтобы устранить боль, обычно используют стандартные ненаркотические анальгетики, наркотические препараты (омнопон, промедол, морфин), пластыри и иные медикаменты.</p>\r\n<p class=\"bodytext\">Возможно также применение следующей обезболивающей методики: в просвет эпидурального пространства близ спинного мозга вводят катетер, через который поступает анестетик местного действия и блокирует проведение нервного болевого импульса. Катетер необходимо устанавливать выше места опухоли. Его фиксируют на коже. Это является заметным недостатком: катетер, торчащий из спины, вызывает массу неудобств. У этого способа есть и свои плюсы: отсутствует негативное влияние на организм, которое оказывают наркотические препараты.</p>",
"prevention": "",
"clinical_picture": "<p>Симптомы рака поджелудочной железы связаны с тем, что опухоль сдавливает окружающие органы, приводит к обтурации (закупорке) протоков или вызывает интоксикацию организма в результате распада тканей. Симптомы заболевания обнаруживаются уже на достаточно поздних сроках, когда опухоль достигает значительных размеров. Симптомы сдавления появляются первыми в виде болей. Это означает, что опухоль проросла сквозь нервные окончания. Интенсивность болей у всех пациентов разная — от ощущения сдавления и дискомфорта до острых приступов. При раке головки поджелудочной железы болевые ощущения беспокоят в области правого подреберья, при раке хвоста — слева, при общем поражении — носят опоясывающий характер. Они усиливаются при нарушениях диеты (употреблении жирной, острой пищи или алкоголя), а также в положении лежа на спине. Симптомы закупорки возникают при сдавлении опухолью желчевыводящих путей, кишечника или расположенных поблизости вен. При сдавлении желчного протока прекращается отток желчи из печени в кишечник, что приводит к механической желтухе. Внешне <a href=\"/symptom/zheltuha/\" title=\"Перейти на страницу симптома Желтуха\">желтуха</a> проявляется следующими симптомами: желтое окрашивание кожи, слизистых оболочек и склер; обесцвечивание стула; <a href=\"/symptom/temnaya_mocha/\" title=\"Перейти на страницу симптома Темная моча\">потемнение мочи</a> (моча становится цвета темного пива); увеличение размеров печени и желчного пузыря; появление кожного зуда. <a href=\"/symptom/zheltuha/\" title=\"Перейти на страницу симптома Желтуха\">Желтуха</a> прогрессирует медленно, с течением времени цвет кожи меняется от ярко-желтого до зеленоватого оттенка. Через некоторое время сдавление желчевыводящих путей приводит к печеночно-почечной недостаточности, постоянным кровотечениям и смерти. Прорастание рака поджелудочной железы в желудок и кишечник вызывает желудочную и кишечную непроходимость, при повреждении панкреатических островков самой железы развивается сахарный диабет. Если опухолью поражаются селезеночные вены, то это приводит к увеличению селезенки. Из любых органов, пораженных опухолью, может начаться <a href=\"/symptom/krovotechenie/\" title=\"Перейти на страницу симптома Кровотечение\">кровотечение</a>. Симптомы интоксикации появляются из-за отравления организма токсинами и продуктами распада самой опухоли. Они бывают следующими: резкое снижение веса; <a href=\"/symptom/snizhenie_appetita/\" title=\"Перейти на страницу симптома Снижение аппетита\">снижение аппетита</a> (особенно в отношении мяса, жирной пищи); <a href=\"/symptom/vyalost/\" title=\"Перейти на страницу симптома Вялость\">вялость</a>, <a href=\"/symptom/slabost/\" title=\"Перейти на страницу симптома Слабость\">слабость</a>; <a href=\"/symptom/vysokaya_temperatura_38-42/\" title=\"Перейти на страницу симптома Высокая температура 38-42° \">повышение температуры</a> тела; <a href=\"/symptom/apatiya/\" title=\"Перейти на страницу симптома Апатия\">апатия</a>. За признаками интоксикации часто скрываются сопутствующие признаки нарушения переваривания и усвоения пищи.<br /><br /><br /></p>",
"image": "http://api.symptomd.ru/storage/9b68be57089b1e9e313f2e6ee9412850_qVHAHyN.jpg",
"image_alt": "Поджелудочная железа",
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"parent": null,
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4675,
4683,
5187,
5209,
5212,
5343
]
},
{
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{
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{
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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 раку внепеченочных желчных путей предрасполагают следующие состояния:</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;\">склерозирующий холангит;</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;\">хронический язвенный колит;</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;\">желчекаменная болезнь;</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;\">аномальное строение желчных путей;</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;\">кисты желчных протоков;</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;\">бактериальные инфекции (описторхоз, клонорхоз, брюшной тиф).</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: 7pt; font-family: Verdana; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Повышают риск развития рака внепеченочных желчных протоков колит и другие заболевания печени.</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;\">Нередко к развитию опасной патологии приводит:</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;\">контакт с бензидином и бета-нафтиламином (высокий риск развития);</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;\">применение рентгеновских лучей с контрастным веществом;</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;\">неправильное питание;</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;\">алкоголизм, курение, наркомания;</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;\">наличие вируса иммунодефицита человека;</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;\">вирусные формы гепатита;</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;\">возраст старше 65 лет.</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;\">Объективными критериями рака внепеченочных желчных путей служат результаты лабораторных тестов и инструментальных исследований. Данные биохимических проб печени характеризуются гипербилирубинемией, гиперхолестеринемией, гиперфосфатаземией, умеренным повышением активности аминотрансфераз.</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;\">С помощью ультрасонографии желчных путей обнаруживается внутрипротоковая гипертензия, расширение внутрипеченочных желчных протоков. Уровень окклюзии желчных протоков выясняется с помощью МРТ или КТ желчевыводящих путей, чрескожной чреспеченочной холангиографии, РХПГ.</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;\">Выбор лечебной тактики при раке внепеченочных желчных протоков диктуется локализацией и стадией опухоли. К сожалению, заболевание часто обнаруживается уже в запущенных стадиях, что затрудняет радикальное хирургическое лечение.</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;\">При раннем обнаружении рака холедоха, в отсутствии заинтересованности соседних структур, возможно проведение резекции общего желчного протока с последующим сшиванием «конец в конец» либо вшиванием проксимального отдела холедоха в стенку 12-перстной или тощей кишки. В случае поражения супрадуоденального отдела общего желчного протока выполняется холецистэктомия и резекция протока. Локализация опухоли в дистальном отделе общего желчного протока диктует необходимость выполнения панкреатодуоденальной резекции.</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;\">При распространенном раке внепеченочных желчных протоков может потребоваться частичная гепатэктомия (сегментарная резекция, лобэктомия, гемигепатэктомия) или операция Виппла (включает резекцию головки поджелудочной железы, удаление желчного пузыря, резекцию желудка, части кишечника и желчного протока).</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;\">Паллиативные операции при раке внепеченочных желчных протоков облегчают симптомы и улучшают самочувствие пациентов. В качестве таких мер практикуется холецистогастростомия, холецистодуоденостомия, холецистоэнтеростомия, холедоходуоденостомия, холедохоэнтеростомия, чрескожное транспеченочное дренирование желчных протоков, эндоскопическое бужирование внепеченочных желчных протоков, стентирование холедоха и др.</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;\">Лечение рака внепеченочных желчных путей может дополняться дистанционной внутрипротоковой или сочетанной лучевой терапией, химиотерапией, гипертермией.</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;\">Для снижения рисков развития рака внепеченочных протоков важно рационально питаться, своевременно лечить заболевания желудочно-кишечного тракта и регулярно проходить профилактические обследования.</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;\">Данный тип рака характеризуется инфильтративным типом роста. Развивается вдоль прохода, может прорастать в поджелудочную железу, воротную вену, печеночную артерию и другие органы. Рак желчных протоков метастазирует в печень и регионарные лимфатические узлы.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Заболевание характеризуется двумя типами развития: сложным и неосложненным. При неосложненном типе развития происходит медленное увеличение опухоли без сопутствующих осложнений. При сложном типе на опухолевой капсуле имеются очаги гноя и кровоточащие участки.</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;\">Симптомы рака желчных протоков:</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;\">желтушность кожных покровов;</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;\">обесцвечивание испражнений;</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;\">билирубинурия (темная моча);</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;\">кожный зуд;</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;\">потеря веса;</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;\">боль в области живота.</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;\">Желтуха является наиболее распространенным проявлением холангиокарциномы. Обструкция и последующий холестаз обычно возникают на ранней стадии, когда опухоль находится в желчном или печеночном протоке.</span></p>",
"image": null,
"image_alt": null,
"standard_type": 0,
"danger": 30,
"published": 1,
"parent": 7930,
"block_rubric": 22,
"standards": []
}
]
}
