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"etiology": "<p>Рак мочеточника составляет в среднем 4% от всех опухолей верхних мочевых путей. Переходно-клеточный рак мочеточника составляет приблизительно 7% всех почечных опухолей. Факторы риска те же, что и для рака мочевого пузыря. Самый распространенный – это курение. Также доказано увеличение риска заболевания при злоупотреблении обезболивающими лекарственными препаратами (например, фенацетин), хроническом раздражении слизистой оболочки (при мочекаменной болезни, шистосомозе), при длительном контакте химическими веществами, используемыми в промышленности. Кроме того, жители Балкан с эндемической семейной нефропатией имеют необъяснимую предрасположенность развития рака мочеточников.</p>",
"pathogenesis": "<p>По мнению большинства патоморфологов, все папиллярные опухоли лоханки и мочеточника, являются разными стадиями единого процесса. Опухоли мочеточника бывают эпителиального (папиллома, сосочковый и плоскоклеточный рак) и соединительнотканного (фиброма, лейомиома, саркома) происхождения. Чаще наблюдаются эпителиальные опухоли. Первичные новообразования склонны к раннему метастазированию. Метастазы распространяются гематогенным и лимфогенным путем.</p>",
"diagnostics": "<p>Во время исследования крови и мочи обнаруживают такие же изменения, и при опухолях почечной лоханки.</p>\r\n<p>При цистоскопии в момент гематурии удается уточнить источник кровотечения. Кроме того, в случае локализации папиллярного новообразования в нижнем отрезке мочеточника, при цистоскопи, иногда можно наблюдать, как в момент сокращения его отверстия, ворсинки опухоли появляются в просвете мочевого пузыря. Расположение папиллярных опухолей вокруг отверстия одного из мочеточников может свидетельствовать о первичной опухоли в мочеточнике или почечной лоханке.</p>\r\n<p>Катетеризация мочеточника позволяет выявить характерный признак его опухоли - выделение крови из мочеточникового катетера в момент чистой мочи после проведения его выше (симптом Шевассю).</p>\r\n<p>С помощью экскреторной урографии определяют нарушения секреторной и экскреторной функции почек, проявляют уретерогидронефроз на стороне поражения и дефект наполнения мочеточника. На уретеропиелограмме по обе стороны от дефекта наполнения мочеточника определяют затёки рентгенконтрастного вещества (симптом жала змеи).</p>\r\n<p>Если диагноз сомнителен, выполняют уретероскопию, которая позволяет осмотреть мочеточник, установить размеры поражения и характер распространения опухоли, инфильтрацию стенки, изменения мочевых путей выше опухоли. Выполнение биопсии опухолевой ткани с последующим гистологическим ее исследованием, помогает определить до операции правильный диагноз и даже установить стадию заболевания.</p>",
"treatment": "<p>Радикальным методом лечения может быть только оперативное вмешательство. При тотальном поражении мочеточника опухолью показана нефроуретерэктомия с резекцией мочевого пузыря, при условии хорошо функционирующей противоположной почки. При низком расположении допустимы резекция мочеточника вместе с прилегающей к устью стенкой мочевого пузыря и уретероцистоанастомоз (прямой или по Боари). Помимо хирургического лечения применяют химио- и радиотерапию, однако чувствительность опухолевых клеток к ним мала.</p>\r\n<p>После проведённого лечения пациентам рекомендуют выполнение контрольных цистоскопий через определённые промежутки времени, т.к. рак мочеточника имеет тенденцию распространяться в мочевой пузырь. В случае выявления такого процесса в ранней стадии может потребоваться выполнение трансуретральной резекции мочевого пузыря или внутрипузырных инстилляций противоопухолевых препаратов. Контрольное обследование, направленное на выявление метастазов такое же, как для рака мочевого пузыря.</p>",
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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;\">Среди причин развития ретинобластомы принято выделять наследственные и внешние факторы. При этом, в соответствии с причиной, определяют 2 формы заболевания:</span></p>\r\n<p> </p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Наследственная ретинобластома составляет примерно 60-70% случаев и носит генетический характер. У родителей, в детстве болевших ретинобластомой, дети тоже рождаются с этим недугом. Данная форма заболевания развивается достаточно быстро, как правило, поражая оба глаза, и со временем, проникая в ближайшие ткани. Наследственную ретинобластому, обычно сопровождает множество других пороков развития, таких как кортикальный детский гиперостоз, расщелина нёба, пороки сердца и предрасположенность к возникновению опухолей в остальных тканях и органах.</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Спорадическая ретнобластома возникает случайно, как результат неблагоприятного воздействия экологической среды и генномодифицированных продуктов. В случае этой формы заболевания, поражается обычно только один глаз. Проявляется спорадическая опухоль намного позже наследственной и лечится проще.</span></li>\r\n</ul>",
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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;\">Для оценки распространенности опухоли, назначаются следующие диагностические исследования:</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Магнитно-резонансная и компьютерная томография пораженного глаза (глаз).</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Пункция головного мозга (с целью выявления степени поражения);</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Рентген легких;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">УЗИ брюшной полости (с целью выявления очагов метастаз);</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Анализ мочи и крови (с целью оценки работы внутренних 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;\">У детей ретинобластома нередко сопровождается сбоями функций других органов, поэтому в комплекс диагностических мероприятий включают консультации с неврологом и ЛОР-врачом.</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;\">План лечения разрабатывается врачом в зависимости от стадии ретинобластомы. Если имеется двустороннее поражение, тактику лечения разрабатывают для каждого глаза отдельно.</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;\">В ходе лечения может быть использовано несколько разных методов, их правильное сочетание во многом определяет шансы на сохранение зрения и глаза. Современные методы диагностики позволяют выявить ретинобластому на ранней стадии, когда для успешного лечения еще достаточно криотерапии, фотокоагуляции и лучевого воздействия.</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;\">Методы лечения ретинобластомы:</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;\">хирургическое вмешательство;</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;\">лучевая химиотерапия;</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;\">лекарственная химиотерапия;</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;\">криотерапия;</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;\">лазерная коагуляция;</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;\">термотерапия.</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;\">Современная медицина предпочитает консервативное лечение ретинобластомы. Такая тактика эффективна только при наличии небольших единичных образований, которые остаются в пределах глаза, но за границами макулярной и перипапиллярной зон.</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 лечения рака глаза активно применяют криотерапию и фотокоагуляцию, позволяющие сохранить зрение и редко дающие осложнения. Криотерапия воздействует на поражения в передней камере глазного яблока, а фотокоагуляция – в задней. Контроль за ходом лечения осуществляют при помощи офтальмоскопии и ультразвукового исследования.</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;\">Методы локального лечения ретинобластомы:</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;\">Брахитерапия. Техника локального облучения опухолей, которая заключается в подшивании к глазу офтальмоаппликатора (радиоактивная пластинка). Преимущество метода заключается в том, что можно подводить максимальные дозы излучения непосредственно к очагу без воздействия на здоровые ткани глаза и организм.</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;\">Криодеструкция. Метод воздействия низкими температурами. При замораживании клетки опухоли перестают расти и разрушаются. Лечение осуществляют при помощи аппарата с наконечником в несколько миллиметров. Криодеструкция применима к опухолям в переднем отделе сетчатки, которые не превышают 7 мм в диаметре.</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;\">Фотокоагуляция. Лечение с применением лазерного луча. Эффективно при размерах ретинобластомы до 4 мм и расположении в заднем отделе сетчатки.</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;\">Транспупиллярная диод-лазерная термотерапия (ТТТ). Бесконтактное лечение внутриглазных опухолей, основанное на инфракрасном излучении. Метод заключается в длительном прогревании ретинобластомы до 45-55°С.</span></li>\r\n</ul>\r\n<p> </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;\">Поскольку в подавляющем большинстве случаев заболевание имеет врожденную природу, профилактикой будет генетическое консультирование семей, в которых были случаи рака сетчатки. Очень важно регулярно обследовать детей из групп риска и соответствующих по возрасту.</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;\">При онкологии глаза могут проявляться следующие симптомы:</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;\">непрозрачное белое пятно на зрачке (лейкокория), иначе это белое свечение зрачка при определенном виде освещения (такая симптоматика обычно обнаруживается первоочередно);</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;\">косоглазие;</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;\">снижение остроты зрения (поражается сетчатка);</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;\">когда один глаз начинает видеть хуже, чем другой;</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;\">дискомфорт, болевые ощущения в глазной области;</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;\">отечность глаза, покраснение (эритема конъюнктивы).</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;\">Поначалу заболевание признаков практически не имеет. Недомогания появляются при разрастании опухоли или вследствие ее дислокации в другие области глаза.</span></p>\r\n<p><span id=\"docs-internal-guid-f393e761-7fff-31b7-0456-32a26ad0f57c\"> </span></p>",
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