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},
"code": "C93.1",
"name": "Хронический моноцитарный лейкоз",
"icd_name": "Хронический моноцитарный лейкоз",
"gender": 0,
"age_min": 50,
"age_max": 100,
"cause": [
"0"
],
"periodicity": 1,
"slug": "c93.1_hronicheskiy_monocitarnyy_leykoz",
"lead": "опухолевый процесс со значительным увеличением содержания моноцитарных клеток при нормальном или невысоком лейкоцитозе",
"description": "",
"etiology": "<p> </p>\r\n<p><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Причины хронического моноцитарного лейкоза неизвестны. </span><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Единой теории, объясняющей возникновение опухолей системы крови, не существует. </span><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Наиболее признанной в настоящее время является вирусно-генетическая теория. </span><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;\">Согласно ей, особые вирусы (известно 15 видов таких вирусов) внедряются в организм человека и при воздействии предрасполагающих факторов, вызывающих срыв иммунитета, проникают внутрь незрелых клеток костного мозга. </span><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;\">Это препятствует созреванию клеток и вызывает их частое деление.</span></p>\r\n<p><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;\">Роль наследственности в возникновении опухолей системы крови не вызывает сомнений, так как эти заболевания чаще встречаются в некоторых семьях, а также у людей с нарушениями структуры хромосом (носители наследственной информации). </span></p>\r\n<p><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;\">Предрасполагающие факторы.</span></p>\r\n<p><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Физические: ионизирующая радиация, рентгеновское облучение (например, при нарушении техники безопасности на атомных электростанциях или при лечении рентгеновским облучением опухолей кожи).</span></p>\r\n<p><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Химические:</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;\">производственные – лаки, краски и др. (могут проникать в организм человека через кожу, при вдыхании или поступать с пищей и водой);</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">лекарственные – длительное применение солей золота (при лечении заболеваний суставов), некоторых антибиотиков и др.</span></li>\r\n</ul>\r\n<p><span style=\"background-color: transparent; font-size: 7pt; white-space: pre-wrap;\">Биологические:</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;\">вирусы;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">кишечные инфекции;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">туберкулез (инфекционное заболевание человека и животных, вызываемое особым видом микроорганизмов – микобактериями – и поражающее преимущественно легкие, кости и почки);</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">хирургические вмешательства;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">стрессы. </span></li>\r\n</ul>",
"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;\">В патогенезе хронического лимфолейкоза значимая роль принадлежит иммунологическим механизмам – об этом свидетельствует его частое сочетание с аутоиммунной гемолитической анемией и тромбоцитопенией, коллагенозами. Вместе с тем, у большинства больных хроническими лейкозами причинно значимых факторов выявить не удается.</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;\">Предполагаемый диагноз устанавливается на основании анализа гемограммы, с результатами которой пациент должен быть немедленно направлен к врачу-гематологу. Для подтверждения диагноза проводится:</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;\">Общий анализ крови. Типичные для хронического миелоидного лейкоза изменения включают: анемию, присутствие единичных миелобластов и гранулоцитов на разной стадии дифференцировки; в период бластного криза количество бластных клеток увеличивается более чем на 20%. При хроническом лимфолейкозе определяющими гематологическими признаками выступают выраженный лейкоцитоз и лимфоцитоз, наличие лимфобластов и клеток Боткина-Гумпрехта.</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;\">Пункции и биопсии. С целью определения морфологии опухолевого субстрата показано выполнение стернальной пункции, трепанобиопсии, биопсии лимфоузлов. В пунктате костного мозга при хроническом миелолейкозе увеличено количество миелокариоцитов за счет незрелых клеток гранулоцитарного ряда; в трепанобиоптате определяется замещение жировой ткани миелоидной. При хроническом лимфоидном лейкозе миелограмма характеризуется резким усилением лимфоцитарной метаплазии.</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;\">Инструментальные исследования. Для оценки выраженности лимфопролиферативного синдрома применяются УЗИ лимфатических узлов, селезенки, рентгенография грудной клетки, лимфосцинтиграфия, МСКТ брюшной полости и ряд других.</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>",
"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;\">На ранней доклинической стадии лечение неэффективно, поэтому больные подлежат динамическому наблюдению. Общережимные мероприятия предполагают исключение физических перегрузок, стрессов, инсоляции, электропроцедур и теплолечения; полноценное витаминизированное питание, длительные прогулки на свежем воздухе.</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 развернутом периоде миелолейкоза назначается химиотерапевтическое лечение (бусульфан, митобронитол, гидроксимочевина и др.), при выраженной спленомегалии проводится облучение селезенки. Подобная тактика, хоть и не приводит к полному излечению, но существенно тормозит прогрессирование болезни и позволяет отсрочить наступление бластного криза. Кроме медикаментозной терапии, при хроническом миелоцитарном лейкозе используются процедуры лейкафереза. В ряде случаев излечение достигается с помощью трансплантации костного мозга.</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 переходе хронического миелолейкоза в терминальную стадию назначается высокодозная полихимиотерапия. В среднем после установления диагноза больные хроническим миелолейкозом живут 3-5 лет, в отдельных случаях – 10-15 лет. Также проводится цитостатическая терапия (хлорбутин, циклофосфамид), иногда в сочетании со стероидной терапией, облучением лимфоузлов, селезенки, кожи. При значительном увеличении селезенки выполняется спленэктомия. Применяется трансплантация стволовых клеток, однако ее эффективность еще требует подтверждения.</span></p>",
"prevention": "<p> </p>\r\n<p><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Первичная профилактика хронического моноцитарного лейкоза (то есть до возникновения заболевания):</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;\">соблюдение техники безопасности на производстве с целью снижения контакта с потенциально опасными химическими веществами (лаки, краски и др.) и источниками ионизирующего излучения (радиации);</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">укрепление защитных сил организма для снижения заболеваемости простудными и прочими инфекционными заболеваниями (например, закаливание, прогулки на свежем воздухе, здоровое питание с достаточным содержанием овощей и фруктов и др.).</span></li>\r\n</ul>\r\n<p><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Вторичная профилактика (то есть после возникновения заболевания) заключается в регулярных профилактических осмотрах населения с целью наиболее раннего выявления у них признаков заболевания.</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;\">Все симптомы хронического моноцитарного лейкоза объединены в несколько синдромов (устойчивая совокупность симптомов, объединенных единым развитием).</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><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;\">Гиперпластический, или пролиферативный (связанный с ростом опухоли):</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;\">боль и тяжесть в левой верхней части живота (увеличение селезенки) встречается у половины больных;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">увеличение лимфоузлов обычно незначительное или отсутствует;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">боль и тяжесть в правой верхней части живота (увеличение печени) отмечается редко;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">боли в костях (разрастание костного мозга) выявляется при длительном течении заболевания.</span></li>\r\n</ul>\r\n<p><span style=\"background-color: transparent; font-size: 7pt; white-space: pre-wrap;\"> Интоксикационный (отравление организма продуктами распада опухоли). Развивается при большой массе опухоли. Симптомы:</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;\">выраженная общая слабость;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">утомляемость;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">снижение массы тела;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">потливость;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">повышение температуры тела. </span></li>\r\n</ul>\r\n<p><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Анемический (то есть за счет снижения уровня гемоглобина – особого вещества эритроцитов (красных клеток крови), переносящего кислород):</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;\">слабость, снижение работоспособности;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">головокружение;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">обморочные состояния;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">шум в ушах, мелькание «мушек» перед глазами;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">одышка (учащенное дыхание) и сердцебиение при незначительной физической нагрузке;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">колющие боли в грудной клетке.</span></li>\r\n</ul>\r\n<p><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Геморрагический (наличие кровоизлияний и кровотечений за счет снижения количества тромбоцитов – кровяных пластинок, склеивание которых обеспечивает начальный этап свертывания крови):</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;\">подкожные и подслизистые (например, в полости рта) кровоизлияния;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">десневые, носовые и другие кровотечения.</span></li>\r\n</ul>\r\n<p> </p>\r\n<p><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Иммунодефицитный (синдром инфекционных осложнений). Присоединение любых инфекций связано с недостаточным образованием нормальных лейкоцитов (белых клеток крови), обеспечивающих защиту от микроорганизмов. </span></p>",
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"slug": "d06_karcinoma_in_situ_sheyki_matki",
"lead": "Нарушение здоровья, относящееся к группе новообразования in situ",
"description": "Карцинома in situ считается самой ранней формой рака. Врачи нередко рассматривают данную опухоль как предраковое состояние. Это связано с тем, что раковые клетки при данной патологии обнаруживаются только в поверхностном слое шейки матки, и не распространяются на глубокие ткани. Рак шейки матки является одной из наиболее распространенных злокачественных опухолей у женщин, занимает второе место по частоте встречаемости после рака молочной железы.",
"etiology": "<p>Чаще всего раку шейки матки подвержены женщины в возрасте 40 – 55 лет. На развитие рака шейки матки могут влиять:</p>\r\n<p>— ранее начало половой жизни,<br /> — половые инфекции,<br /> — курение,<br /> — несоблюдение интимной гигиены,<br /> — слабый иммунитет,<br /> — хронические воспалительные процессы шейки матки и наличие заболеваний таких как: дисплазия шейки матки, эрозия шейки матки, лейкоплакия,<br /> — заражение вирусом папилломы человека (80-100% пациенток с раком шейки матки заражены ВПЧ). Существует более 100 типов вируса папилломы человека, среди которых 16 и 18 типы вызывают рак шейки матки, а также могут быть причинами плоскоклеточного рака глотки и рака ануса у женщин и у мужчин.</p>",
"pathogenesis": "<p>Факторами, способствующими запуску механизмов вирусного канцерогенеза, являются вирусного канцерогенеза, являются снижение иммунитета. Развитие рака шейки матки имеет ортодоксальный закономерный характер: в поверхностном (базальном) слое матки развивается гиперпластический процесс – дисплазия, для которого свойственна атипия эпителия с нарушением слоистости, но без вовлечения поверхностного слоя и стромы. Затем в этих участках формируется преинвазивный рак с поражением всего эпителиального пласта, затем происходит прорыв базальной мембраны и развитие инвазивного процесса. Чрезвычайно важен факт существования латентного периода (длительность которого весьма вариабельна), необходимого для перехода дисплазии в преинвазивный рак и далее в инвазивный. Этот период обеспечивает возможность активной профилактики заболеваемости инвазивным раком шейки матки путем выявления дисплазии и внутриэпителиального рака и своевременного адекватного их лечения.</p>",
"diagnostics": "<p>В современной онкогинекологии существует двухэтапная система обследования пациентки. На первом этапе производится первичное выявление — скрининг, на втором — используются методы углубленной диагностики при подозрении на предрак или рак репродуктивной системы.</p>\r\n<p>Цель скрининга:</p>\r\n<p>1) определение групп риска развития рака шейки матки;</p>\r\n<p>2) выявление контингента женщин с предраковой патологией шейки матки;</p>\r\n<p>3) направление женщин для второго этапа углубленного обследования.</p>\r\n<p>На этапе скрининга собирают анамнез, проводят общий осмотр и обследование молочных желез, осмотр наружных половых органов, влагалища и шейки матки в зеркалах, цитологическое исследование мазков, взятых с поверхности шейки матки из зоны трансформации и цервикального канала, бимануальное ректовагинальное исследование. Цитологическое залючение составляется с учетом классификации, аналогичной классификации Папаниколау, предусматривающей описание пяти типов мазков:</p>\r\n<p>I — цитограмма без особенностей;</p>\r\n<p>II — воспалительный тип мазка;</p>\r\n<p>III — морфологические изменения клеток, соответствующие дисплазии;</p>\r\n<p>IV — подозрение на рак;</p>\r\n<p>V — цитограмма рака.</p>\r\n<p>На основании клинико-цитологической информации отбираются женщины, которым показано более углубленное обследование.</p>\r\n<p>Задачи углубленной диагностики:</p>\r\n<p>1) верификация и установление стадии заболевания;</p>\r\n<p>2) определение местной распространенности опухолевого процесса;</p>\r\n<p>3) выявление отдаленных метастазов;</p>\r\n<p>4) оценка функционального состояния органов и систем.</p>\r\n<p>Для верификации диагноза производится осмотр шейки в зеркалах, выполняется кольпоскопия, из патологических очагов берется прицельно биопсия конхотомом, скальпелем, электропетлей и выполняется выскабливание цервикального канала ложечкой Фолькманна, кюреткой.</p>\r\n<p>Местное распространение опухоли определяется при осмотре в зеркалах, ректовагинальном бимануальном исследовании органов малого таза, параметральной клетчатки, мочевого пузыря и прямой кишки на глубину пальца. Степень местного распространения уточняется при цистоскопии, ректороманоскопии. Ультразвуковое исследование позволяет выявить метастазы в подвздошных, парааортальных лимфоузлах, печени и других паренхиматозных органах брюшной полости. Под контролем УЗИ выполняется тонкоигольная пункция через влагалищные своды с целью верификации метастатического поражения регионарных лимфоузлов. С целью исключения отдаленных метастазов выполняется рентгенография органов грудной полости, при подозрении метастатического поражения костей проводится сканирование скелета. На основании полученных результатов клинического обследования выставляется стадия заболевания.</p>",
"treatment": "<p>При выборе метода лечения ранней онкологической патологии шейки матки необходимо стремиться к соблюдению двух основных принципов:</p>\r\n<p>1) обеспечение надежного излечения, в результате чего предупреждаются рецидивы заболевания и переход в более выраженный патологический процесс;</p>\r\n<p>2) применение органосохраняющих и щадящих методов лечения у женщин молодого возраста.</p>\r\n<p>Конизация шейки матки (процедура, при которой удаляют конусообразный кусок шейки матки) может быть выполнена скальпелем, электроножом, хирургическим лазером. Основные достоинства метода конизации заключаются в радикальном удалении патологически измененных тканей шейки матки в пределах здоровых тканей, небольшом количестве осложнений, сохранении физиологических функций, включая детородную. Предпочтительнее применять методики конизации, позволяющие исследовать удаленный препарат шейки матки. Метод лазерной конизации исключает эту возможность. Метод электроконизации возможен даже в амбулаторных условиях.</p>\r\n<p>Ампутация шейки матки является альтернативным методом лечения преинвазивного рака шейки матки. Этот метод показан при грубых деформациях шейки матки, вызванных ее разрывами в родах, при поражении цервикального канала, когда выполнение электроконизации шейки матки сопряжено с большим риском развития рецидива.</p>\r\n<p>Экстирпация (удаление) матки показана:</p>\r\n<p>пациентам в возрасте старше 50 лет; при преимущественной локализации опухоли в шеечном канале; распространенном анапластическом варианте с врастанием в железы; отсутствии в препарате участков, свободных от преинвазивного рака (особенно по линии отсечения) после произведенной ранее конизации; сочетании преинвазивного рака с миомой матки или опухолями придатков; рецидивах после крио- или лазерной деструкции.</p>\r\n<p>Методы криодеструкции, лазерной коагуляции, лазерной конизации шейки матки, фотодинамической лазерной коагуляции, электрокоагуляции применяются в онкогинекологии. </p>\r\n<p>Они менее целесообразны для лечения преинвазивного рака шейки матки, так как не позволяют исследовать инвазию патологического процесса</p>",
"prevention": "<p>Предупредительные мероприятия в отношении рака включает:</p>\r\n<ul>\r\n<li>проведение широкомасштабной просветительской работы, с целью повышения онконастороженности;</li>\r\n<li>внедрение плановых скрининговых обследований, начиная с 21-25 лет с целью выявления дисплазии стенок половых органов;</li>\r\n<li>проведение планомерной вакцинации от вируса папилломы человека, в отношении рака шейки, создание системы контроля безопасности вакцинопрофилактики;</li>\r\n<li>совершенствование образа жизни, наиболее реальная рекомендация касается внимательного отношения к нормализации белкового, углеводного обмена.</li>\r\n</ul>\r\n<p> </p>",
"clinical_picture": "<p>Начальные стадии предрака в большинстве случаев протекает бессимптомно. Все это время женщина не замечает признаки серьезного недомогания, считает себя здоровой, планирует личную жизнь, рождение ребенка.</p>\r\n<p>В дальнейшем при прогрессировании заболевания могут возникнуть такие симптомы, как:</p>\r\n<p>Различные выделения в т.ч. кровянистые (не менструация), кровотечения; Боли в нижней части живота; Боли при мочеиспускании; Ощущение тяжести в области таза; Болевые ощущение во время полового акта; Отеки конечностей, наружных половых органов; Нарушение работы кишечника и мочевого пузыря; Задержка мочи (при поражении лифмоузлов); Отек нижней конечности с одной стороны (при поражении лимфоузлов).</p>\r\n<p>Также при раке шейки матки возможно наличие общих симптомов: потеря веса, общая слабость, плохой аппетит, повышенная температура, головокружения.</p>",
"image": null,
"image_alt": null,
"standard_type": 3,
"danger": 1,
"published": 2,
"parent": null,
"block_rubric": 36,
"standards": []
}
]
}