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},
"code": "C18",
"name": "Рак ободочной кишки",
"icd_name": "Рак ободочной кишки",
"gender": 0,
"age_min": 45,
"age_max": 65,
"cause": [
3,
0
],
"periodicity": 4,
"slug": "c18_rak_obodochnoy_kishki",
"lead": "это злокачественная опухоль, локализующаяся в одном из отделов ободочной кишки",
"description": "Ободочная кишка - самый длинный отдел толстой кишки, она состоит из восходящей ободочной, поперечной ободочной, нисходящей ободочной и сигмовидной ободочной кишки. Слепая кишка представляет собой начальный небольшой отрезок толстой кишки. Главные функции этого отдела желудочно-кишечного тракта - абсорбция, секреция и эвакуация остатков пищи из организма, все они находятся в тесной взаимосвязи, нарушения одной из них приводит к расстройствам других.\r\n",
"etiology": "<p>Основные причины рака кишечника в области ободочной кишки связаны с наличием:</p>\r\n<ul>\r\n<li>наследственности – при выявлении у близких родных такой формы рака, возрастает рисконкозаболевания;</li>\r\n<li>рафинированной пищи и животных жиров в меню и нерационального питания;</li>\r\n<li>малоактивного образа жизни, гиподинамии и ожирения;</li>\r\n<li>упорных хронических запоров и при этом травм кишки каловыми массами в ее физиологических изгибах;</li>\r\n<li>атонии и гипотонии кишечника у людей старшего возраста;</li>\r\n<li>предраковых заболеваний: семейного полипоза, одиночных аденоматозных полипов, дивертикулеза, язвенного колита, болезни Крона;</li>\r\n<li>возрастного фактора;</li>\r\n<li>вредной работы на производствах: контактов с химикатами и горной пылью.</li>\r\n</ul>",
"pathogenesis": "",
"diagnostics": "<p align=\"justify\">Диагноз рака ободочной кишки устанавливают на основании рентгенологического и эндоскопического исследований. Не менее важным методом физикального обследования больного является пальпация живота, позволяющая не только выявить опухоль в брюшной полости, но и оценить ее консистенцию размеры, мобильность.</p>\r\n<p>По данным ряда авторов, в 60-70% случаев опухоль толстой кишки доступна пальпации.</p>\r\n<p class=\"b\">Типы исследований</p>\r\n<ul>\r\n<li>Рентгенологическое исследование, наряду с колоноскопией, является ведущим в диагностике рака ободочной кишки.</li>\r\n<li>Ирригоскопия позволяет получить информацию о локализации новообразования, установить протяженность поражения, определить форму роста опухоли, оценить ее подвижность, а иногда – судить о взаимосвязи с другими органами. При выполнении ирригоскопии возможно также выявить синхронные опухоли толстой кишки. Последнее обстоятельство важно еще и потому, что при стенозирующем характере роста новообразования эндоскопическое исследование не позволяет до операции оценить состояние вышележащих отделов толстой кишки.</li>\r\n<li>Эндоскопическое исследование, наряду с визуализацией злокачественной опухоли, позволяет получить материал для гистологического исследования, являющегося необходимым атрибутом предоперационной диагностики злокачественного новообразования.</li>\r\n<li>Наиболее простым и широко распространенным методом эндоскопического исследования толстой кишки является ректороманоскопия, при которой возможно оценить состояние нижнего отдела кишечной трубки. При выполнении ректороманоскопии исследователь оценивает состояние слизистой оболочки толстой кишки, сосудистый рисунок, наличие патологических примесей в просвете кишки, эластичность и подвижность кишечной стенки. При выявлении опухоли толстой кишки изучают ее размеры, внешний вид, консистенцию, подвижность при инструментальной пальпации, производят биопсию.</li>\r\n<li>\r\n<p align=\"justify\">Применение рентгеновской компьютерной томографии (КТ) в медицине способствовало значительному улучшению диагностики различных патологических состояний.</p>\r\n<p align=\"justify\">Компьютерная томография обладает следующими важными преимуществами перед другими методами обследования:</p>\r\n<ul>\r\n<li>представляет изображение анатомических структур в виде поперечного среза, исключая совмещение их изображений;</li>\r\n<li>обусловливает четкое изображение структур, незначительно отличающихся по плотности друг от друга, что является крайне важным для диагностики;</li>\r\n<li>представляет возможность для количественного определения плотности тканей на каждом участке изображения исследуемого органа для дифференциальной диагностики патологических изменений;</li>\r\n<li>имеет неинвазивный характер диагностического метода, безопасность и малая лучевая нагрузка на организм больного.</li>\r\n</ul>\r\n<p align=\"justify\">По данным исследователей, при анализе КТ-картины метастатических опухолей колоректального рака в 48% случаев опухолевые узлы содержали кальцинаты, а иногда выявляли тотальное обызвествление метастатических опухолей.</p>\r\n<p align=\"justify\">Радионуклеидные (изотопные) методы диагностики и оценки степени распространения колоректального рака в повседневной практической работе лечебных учреждений используются достаточно редко. Одним из таких методов является позитивная сцинтиграфия, основанная на использовании таких специфических препаратов, как галлий в виде цитратного комплекса, а также меченый изотопом индия блеомицин.</p>\r\n</li>\r\n</ul>",
"treatment": "<p>Лечение рака (кишечника) ободочной кишки проводят радикальным хирургическим вмешательством и последующей лучевой и химиотерапией. Врачом учитывается тип и локализация опухоли, стадия процесса, метастазы и сопутствующие заболевания, общее состояние пациента и возраст.Лечение рака ободочной кишки без наличия осложнений (непроходимости или перфорации) и метастазов проводится радикальными операциями с удалением пораженных участков кишки с брыжейкой и регионарными ЛУ.При наличии опухоли в ободочной кишке справа выполняется правосторонняя гемиколонэктомия: удаляется слепая кишка, восходящая, треть поперечной ободочной и 10 см подвздошной кишки в терминальном отделе. Удаляют одновременно регионарные ЛУ, и поводится формирование анастомоза (соединение тонкой и толстой кишки).</p>\r\n<p>Лучевую терапию в зоне роста опухоли начинают через 2-3 недели после операции. При этом часто наблюдаются побочные симптомы за счет повреждения слизистой оболочки в кишечнике, что проявляются отсутствием аппетита, тошнотой и рвотой.</p>\r\n<p>Последующий этап – проведение химиотерапии современными препаратами для исключения побочных эффектов. Не всем удается легко перенести химию, поэтому кроме тошноты и рвоты возможно появление аллергических высыпаний на коже, лейкопении (снижения концентрации в крови лейкоцитов).</p>",
"prevention": "<p>Профилактика рака ободочной кишки направлена на проведение медицинских осмотров для выявления ранних симптомов онкоопухолей. Использование современных автоматизированных скринингов позволяет выявлять группы повышенного риска, направлять их на исследование с помощью эндоскопов.</p>",
"clinical_picture": "<p align=\"justify\">Клинические проявления рака ободочной кишки во многом зависят от места расположения злокачественного новообразования, степени распространения опухолевого процесса и наличия осложнений, отягчающих течение основного заболевания.</p>\r\n<p align=\"justify\">Наиболее частые симптомы: , нарушение моторно-эвакуаторной функции кишки клинически проявляющиеся чередованием запоров и поносов, патологические выделения с калом, изменение общего состояния больного и, наконец, пальпируемая через переднюю брюшную стенку опухоль.</p>\r\n<full></full>\r\n<p align=\"justify\"> – наиболее частый симптом рака ободочной кишки и отмечаются практически у 80% пациентов. В клинических наблюдениях при правосторонней локализации опухоли боли, как один из первых симптомов рака, встречались в 2-3 раза чаще, чем при раке левой половины. Опухоли ободочной кишки могут длительное время протекать без болевого синдрома и только при распространении новообразования за пределы кишечной стенки, при переходе на брюшину и окружающие органы появляются боли, интенсивность и периодичность которых может быть различной. В зависимости от локализации опухоли болевой синдром может симулировать хронические аппендицит, холецистит, язвенную болезнь желудка и 12-перстной кишки, хронический аднексит.</p>\r\n<p align=\"justify\">Для злокачественных новообразований правой половины ободочной кишки характерно сочетание болевого синдрома, гипертермической реакции (), лейкоцитоза и ригидности (напряженность) мышц передней брюшной стенки. </p>\r\n<p align=\"justify\">Нарушения моторно-эвакуаторной функции толстой кишки приводят к застою кишечного содержимого и обусловливают такие симптомы дискомфорта как чувство тяжести в животе, потерю аппетита, тошноту. </p>\r\n<p align=\"justify\">Скопление каловых масс выше опухоли сопровождается усилением процессов гниения и брожения, приводя к вздутию живота с задержкой стула и газов.</p>\r\n<p align=\"justify\">В тех случаях, когда течение опухолевого процесса осложняется развитием явлений кишечной непроходимости, в клинической картине больных раком ободочной кишки преобладают такие симптомы как живота с затрудненным отхождением кала и газов, \">, , \">Рвота\">\"><a href=\"/symptom/rvota/\" title=\"Перейти на страницу симптома Рвота\">рвота</a>. Боли носят приступообразный характер. По мнению ряда авторов при локализации злокачественной опухоли в левой половине толстой кишки стенозирующий характер опухолевого роста приводит к сужению просвета кишки, вследствие чего каловые массы, скапливаясь выше опухоли могут пальпироваться через брюшную стенку и иногда ошибочно принимаются за опухоль.Одними из довольно частых и сравнительно ранних клинических проявлений рака ободочной кишки являются патологические выделения из прямой кишки. К таковым относят слизь, кровь, гной, опухолевые массы и др. Одним из симптомов, свидетельствующих о далеко зашедшем опухолевом процессе, является пальпируемая через брюшную стенку опухоль. Частота этого симптома колеблется от 40 до 60%.Любой из перечисленных выше симптомов (боль, кишечные расстройства, наличие патологических примесей в стуле) может присутствовать при любом заболевании кишечника, не только опухоли. Анализ клинического течения рака ободочной кишки свидетельствует о значительном проценте диагностических ошибок (до 35%), приводящих к госпитализации в общетерапевтические и инфекционные клиники для лечения анемии неясной этиологии, дизентерии и др. Высоким остается процент больных, госпитализируемых в общехирургические стационары по экстренным показаниям на высоте обтурационной кишечной непроходимости.</p>",
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}
]
}
