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"code": "C57",
"name": "Рак других и неуточненных женских половых органов",
"icd_name": "Рак других и неуточненных женских половых органов",
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"slug": "c57_rak_drugih_i_neutochnennyh_zhenskih_polovyh_organov",
"lead": "Злокачественные новообразования неуточненные женских половых органов- онкологические заболевания",
"description": "Рак маточной трубы наблюдают достаточно редко. По данным мировой и отечественной литературы, встречаемость рака маточной трубы составляет 0,11–1,18% среди опухолей женских половых органов.\r\n\r\n",
"etiology": "<p>Считают, что предрасполагающими факторами, способствующими возникновению рака маточной трубы, служая воспалительные заболевания органов малого таза в анамнезе, <a href=\"/symptom/besplodie/\" title=\"Перейти на страницу симптома Бесплодие\">бесплодие</a>, возраст старше 40 лет. Воспалительные заболевания маточных труб отмечают более чем у 1/3 больных; большинство больных страдают бесплодием (40–71%).</p>\r\n<p>В последние годы появились сообщения, свидетельствующие о возможной вирусной этиологии рака маточных труб.</p>",
"pathogenesis": "<p>На ранних стадиях заболевания маточная труба макроскопически может быть не изменена. При запущенных стадиях она увеличивается в размерах и деформируется, приобретая колбасовидную, ретортообразную, яйцевидную и другие формы.</p>\r\n<p>При запаянном отверстии ампулы маточной трубы внешне характерна картина гидрогематопиосальпинкса. Поверхность опухоли обычно мелкобугристая, мелковорсинчатая, сероватобелого или розоватобелого цвета (напоминает цветную капусту). Большая часть поверхности поражённых маточных труб серосинюшного цвета, иногда темнобагрового, что наблюдают при перекруте трубы с резко выраженной дисциркуляцией. При открытом отверстии ампулы маточной трубы опухолевые массы чаще всего выступают в брюшную полость в виде опухолевых узлов или разрастаний бородавчатого вида.</p>",
"diagnostics": "<p>Правильная предоперационная диагностика рака маточной трубы крайне неинформативна (всего 10%). Даже интраоперационно правильный диагноз устанавливают только в 50% случаев. Следует подчеркнуть, что ни одна деформация маточной трубы не должна быть оставлена во время операции без обследования (исследовать следует весь операционный материал).</p>\r\n<p>Учитывая отсутствие высокоинформативного метода диагностики, большинство клиник применяют комплексный подход, включающий целый ряд клинических, лабораторных и инструментальных методов исследования. Среди них наиболее часто выполняют УЗИ и рентгеновскую КТ, лапароскопию, определение опухолеассоциированных маркёров.</p>",
"treatment": "<p>Первым этапом при раке маточной трубы проводят хирургическое лечение — выполнение радикальной операции, включающей экстирпацию матки с придатками, удаление большого сальника, биопсию парааортальных и подвздошных лимфатических узлов, биопсию и взятие смывов с брюшины таза, латеральных каналов и диафрагмы. При невозможности выполнения лимфаденэктомии выполняют биопсию этих узлов.</p>\r\n<p>Выборочные исследования и широкое применение различных химиопрепаратов, их комбинации, а также сочетание химиотерапии с лучевой терапией не позволяют провести адекватное сравнение различных подходов лечения. Высокая частота неэффективности лечения даже при ранних стадиях подчеркивает необходимость адъювантного лечения на каждой стадии заболевания.</p>",
"prevention": "<p>Профилактика рака маточной трубы мало изучена и сводится к своевременному лечению воспалительных процессов.</p>",
"clinical_picture": "<p>В отличие от рака яичников, в большинстве случаев характеризующегося долгим бессимптомным течением, при раке маточных труб существует достаточное разнообразие симптомов. Наиболее частыми симптомами бывают обильные водянистые и кровянистые выделения, боли внизу живота. Однако сочетание этих трёх признаков отмечают лишь в 12,5% случаев.</p>\r\n<p>Кровянистые выделения из половых путей на фоне менопаузы или ациклические кровянистые выделения у женщин репродуктивного возраста отмечают в 50–60% случаев. Кровянистые выделения преимущественно обусловлены прорастанием слизистой оболочки маточной трубы опухолью, а также распадом опухоли. В этом случае часто ошибочно ставят диагноз рака эндометрия и более чем в половине случаев производят диагностическое выскабливание матки (иногда повторно). Даже в повторно произведённых соскобах не всегда обнаруживают опухолевую ткань. Это приводит к задержке в постановке истинного диагноза.</p>\r\n<p>Подозрение на рак маточных труб вызывают также обильные, периодически возникающие водянистые выделения (иногда с примесью крови), совпадающие с уменьшением мешотчатой опухоли придатков матки. Этим выделениям предшествуют схваткообразные боли внизу живота. Симптом «перемежающейся водянки» маточной трубы считают патогномоничным для рака маточной трубы (наблюдают в 3–14% случаев).</p>\r\n<p>Метастатическое поражение лимфатических узлов (парааортальных, надключичных, шейных) может быть первым клиническим признаком рака. Такую клиническую картину наблюдают в 8–12,5% случаев. К объективным симптомам рака маточных труб относят <a href=\"/symptom/uvelichenie_zhivota/\" title=\"Перейти на страницу симптома Увеличение живота\">увеличение живота</a> в объёме вследствие скопления свободной жидкости в брюшной полости у больных с III и IV стадией заболевания или вследствие роста опухолей.</p>",
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"description": "\r\nЗлокачественные опухоли вульвы составляют 2–5% среди злокачественных онкогинекологических заболеваний, занимая четвёртое место после РШМ, рака эндометрия и рака яичников. ",
"etiology": "<p>Основные причины развития рака вульвы — нейроэндокринные нарушения, возникающие в постменопаузе. Определённое значение имеет снижение уровня рецепторов к эстрогену в тканях вульвы. У подавляющего числа пациенток злокачественная опухоль возникает на фоне возрастных инволютивных изменений вульвы. Этот процесс проходит несколько этапов: возрастная инволюция кожи и слизистой оболочки, дистрофические изменения, на фоне которых формируются участки пролиферации, развитие дисплазии и трансформация в преинвазивный и инвазивный рак.</p>",
"pathogenesis": "<p>Среди потенциальных экзогенных факторов патогенеза особое место следует отвести вирусу папилломы человека, имеющему чётко обозначенную тропность к плоскому эпителию.</p>",
"diagnostics": "<p>При сборе анамнеза следует обращать внимание на следующие факторы: позднее менархе, раннее наступление менопаузы, укорочение репродуктивного периода на фоне высокой фертильности, воспалительные процессы.</p>\r\n<p>Первичная локализация рака вульвы чётко определяется только при начальных стадиях процесса.</p>\r\n<p>Наиболее агрессивным течением отличаются опухоли с локализацией в области клитора. Обильное кровоснабжение и особенности лимфооттока обусловливают быстрое прогрессирование, раннее метастазирование в паховобедренные и подвздошные лимфатические узлы. Изолированные гематогенные метастазы (без поражения лимфатических узлов) выявляют в основном при раке клитора.</p>\r\n<p>Опухоли, ограниченные малыми половыми губами, имеют наиболее благоприятное течение.</p>\r\n<p>Рак вульвы с локализацией в области больших половых губ диагностируют наиболее часто (до 60%), и по клиническому течению опухоль занимает промежуточное место между раком клитора и раком малых половых губ.</p>\r\n<p>Рак бартолиновой железы диагностируют приблизительно в 1% случаев.</p>\r\n<p>По характеру роста опухоли выделяют экзофитную, эндофитную и инфильтративноотёчную форму. Наиболее часто встречается экзофитная форма рака вульвы. Наиболее неблагоприятное течение имеет инфильтративноотёчная форма.</p>\r\n<p>Характерная черта рака вульвы — мультифокальность очагов малигнизации.</p>\r\n<p>Рак вульвы метастазирует преимущественно лимфогенным путём.</p>\r\n<p>Первый этап — паховобедренные лимфатические узлы.<br />Второй этап — подвздошные лимфатические узлы. Чаще поражаются наружные подвздошные и запирательные.<br />Третий этап — общие подвздошные лимфатические узлы.</p>\r\n<p>Частота метастазирования в паховобедренные лимфатические узлы зависит от размеров опухоли. При опухоли до 1 см в диаметре их поражение выявляют у 5% больных, а при размерах опухоли 4 см и более — у 30–50%. Поражение тазовых лимфатических узлов возникает в среднем у 5% больных.<br />Гематогенные метастазы развиваются крайне редко.</p>\r\n<p>ЛАБОРАТОРНЫЕ ИССЛЕДОВАНИЯ</p>\r\n<ul>\r\n<li>Цитологическое исследование мазков с опухоли.</li>\r\n<li>Вульвоскопия.</li>\r\n<li>Фотодинамическая диагностика.</li>\r\n<li>Гистологическое исследование биопсийного материала подозрительного участка или опухоли.</li>\r\n</ul>\r\n<p>ИНСТРУМЕНТАЛЬНЫЕ ИССЛЕДОВАНИЯ</p>\r\n<p>При инвазивном раке вульвы для уточнения распространённости процесса необходимо выполнение:</p>\r\n<ul>\r\n<li>УЗИ малого таза, печени, паховобедренных и забрюшинных лимфатических узлов (при их увеличении выполняют<br />пункцию с цитологическим исследованием);</li>\r\n<li>рентгенографии органов грудной клетки;</li>\r\n<li>цистоскопии и ректоскопии при значительном распространении опухоли;</li>\r\n<li>общего клинического обследования;</li>\r\n<li>КТ, МРТ (по показаниям).</li>\r\n</ul>\r\n<p>Степень распространения опухолевого процесса определяют на основании совокупности данных клинического, лабораторно-инструментального обследования, а также результатов цитологического и гистологического исследования.</p>\r\n<p>Правильное определение стадии рака вульвы и адекватная оценка общего соматического статуса пациентки позволяют выработать оптимальную тактику лечения и достичь наилучшего результата.<br />Все больные с подозрением на рак вульвы должны быть направлены на консультацию к онкологу (онкогинекологу) для проведения углублённого обследования.</p>",
"treatment": "<p>НЕМЕДИКАМЕНТОЗНОЕ ЛЕЧЕНИЕ РАКА ВУЛЬВЫ</p>\r\n<p>Наиболее широко используют хирургический и лучевой методы. При интраэпителиальной неоплазии вульвы (дисплазии и карциноме in situ) возможна фотодинамическая терапия и лазерная аблация.</p>\r\n<p>МЕДИКАМЕНТОЗНОЕ ЛЕЧЕНИЕ (ХИМИОТЕРАПИЯ) РАКА ВУЛЬВЫ</p>\r\n<p>Применение химиотерапии при раке вульвы ограничено в связи с невысокой эффективностью. При местнораспространённом процессе проводят химиолучевое лечение в предоперационном периоде.<br />При отдалённых метастазах используют препараты, имеющие активность при плоскоклеточном раке.</p>",
"prevention": "<p>Наиболее реальная возможность профилактики инвазивного рака вульвы — своевременная диагностика и лечение фоновых, предраковых заболеваний и преинвазивного рака.</p>\r\n<p>Особо выделяют фоновые дистрофические процессы, к которым относят, в первую очередь, крауроз и лейкоплакию вульвы.</p>",
"clinical_picture": "<p>Симптоматика рака вульвы разнообразна. Иногда специфические симптомы могут отсутствовать. Чаще пациенты предъявляют жалобы на раздражение и в области гениталий, дискомфорт. По мере роста опухоли и присоединения воспалительного компонента появляются жалобы на боли, наличие изъязвления или экзофитного образования, гнойные и кровянистые выделения.</p>\r\n<p>Вторичные симптомы развиваются в результате регионарного метастазирования и поражения соседних органов: вульвы, лобка, конечностей, нарушение функции мочеиспускания, температура, общая , \"></a>, .</p>",
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