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},
"code": "C22",
"name": "Рак печени и внутрипеченочных желчных протоков",
"icd_name": "Рак печени и внутрипеченочных желчных протоков",
"gender": 0,
"age_min": 45,
"age_max": 100,
"cause": [
3,
0
],
"periodicity": 4,
"slug": "c22_rak_pecheni_i_vnutripechenochnyh_zhelchnyh_protokov",
"lead": "наиболее распространённая первичная злокачественная опухоль печени. Результат малигнизации (злокачественной трасформации) гепатоцитов.",
"description": "Злокачественное новообразование, которое развивается из клеток паренхимы печени, называют гепатоцеллюлярной карциномой (ГЦК). Если опухоль образуется из эпителия желчных протоков, то ее называют холангиокарциномой. Опухоль может иметь вид одного или нескольких узлов разных размеров, или же поражать весь орган. В последнем случае принято говорить о диффузной форме рака печени. ",
"etiology": "<p>Риск развития рака печени повышается при: циррозе; алкогольном и лекарственном гепатите; сердечной недостаточности; паразитарных инфекциях (описторхоз, амебиаз и др.); желчнокаменной болезни; сифилисе; приеме анаболических стероидов; контакте с промышленными химикатами.<br /><br /><br /></p>",
"pathogenesis": "",
"diagnostics": "<p>Злокачественная опухоль печени может быть обнаружена путем сдачи анализа крови на биохимические показатели, которые указывают на функцию печени. При уменьшении альбуминов, росте активности трансаминаза, повышении фиброногена и мочевины, креатинина и остаточного азота может указывать на наличие ракового образования. При таком результате анализа врач назначает проведение печеночных проб и коагулограммы, а так же начальное лечение рака печени в Москве.</p>\r\n<p>Чтоб получить более точную картину состояния здоровья человека делается ультра-звуковое исследование, МРТ и КТ печени, ангиография. Для подтверждения или опровержения диагноза большинство врачей рекомендуют пункционную биопсию тканей опухоли и печени для детального и составного обследования.</p>\r\n<p>Если злокачественная опухоль печени начала метастазирование в другие органы тела, то важно установить места расположения метастазов и вовремя начать лечение рака печени. Для этого проводятся следующие манипуляции:</p>\r\n<ul>\r\n<li>ЭГДС;</li>\r\n<li>Рентгенография желудка;</li>\r\n<li>Ультра-звуковое исследование молочных желез;</li>\r\n<li>Маммография;</li>\r\n<li>Флюорография легких;</li>\r\n<li>Колоноскопия;</li>\r\n</ul>",
"treatment": "<p>Рак печени с трудом поддается лечению. При метастатическом раке прогноз обычно хуже, чем при первичном. Радикальным способом является удаление опухоли после предварительной химиотерапии. К хирургическому способу прибегают в тех случаях, когда опухоль локализована, не имеет внепеченочных метастазов, небольшого размера, не проросла кровеносные сосуды, а печеночная ткань не изменена циррозом. При этом можно удалить достаточно большую часть органа, так как печень обладает хорошей способностью к регенерации и уже через 6 месяцев способна полностью восстановить прежний объем. Но такие операции достаточно сложны технически и показаны не всем пациентам. После удаления части печени при раке выживаемость в течение 5 лет составляет не более 20%. Химиотерапию, как самостоятельный способ борьбы с раком печени, применяют лишь в неоперабельных случаях. Она облегчает самочувствие пациентов. Химиотерапия оказывается более действенной и легче переносится, если препараты вводить непосредственно в печеночную артерию. Лучевая терапия при раке печени не используется. Она малоэффективна, а печень очень чувствительна к радиации, и пациенты тяжело переносят данный вид лечения. Из альтернативных способов лечения рака печени в последнее время все активнее применяют радиочастотную аблацию и криоаблацию, таргетную терапию нексаваром, введение этанола в опухолевые узлы, протонную терапию. <br /><br /><br /></p>",
"prevention": "",
"clinical_picture": "<p>И первичный, и вторичный рак печени имеют одинаковые признаки. Они неспецифичны именно для онкологических заболеваний, поэтому их легко спутать с другими заболеваниями печени — обострением хронического гепатита, желчнокаменной болезнью и пр. </p>\r\n<p>Ранние симптомы рака: ощущение дискомфорта из-за вздутия живота; <a href=\"/symptom/toshnota/\" title=\"Перейти на страницу симптома Тошнота\">тошнота</a>, иногда <a href=\"/symptom/rvota/\" title=\"Перейти на страницу симптома Рвота\">рвота</a>; запоры и поносы; сниженный аппетит; постоянное <a href=\"/symptom/utomlyaemost/\" title=\"Перейти на страницу симптома Утомляемость\">недомогание</a> и <a href=\"/symptom/utomlyaemost/\" title=\"Перейти на страницу симптома Утомляемость\">усталость</a>; снижение веса; иногда — <a href=\"/symptom/oznob/\" title=\"Перейти на страницу симптома Озноб\">озноб</a> и <a href=\"/symptom/vysokaya_temperatura_38-42/\" title=\"Перейти на страницу симптома Высокая температура 38-42° \">повышение температуры</a>. Когда опухоль достигает достаточно больших размеров, она блокирует отток желчи из печени в кишечник. У пациента появляются признаки механической желтухи, это происходит из-за того, что желчь попадает из внутрипеченочных протоков прямо в кровь. Более поздними признаками опухолевого процесса в печени является механическая <a href=\"/symptom/zheltuha/\" title=\"Перейти на страницу симптома Желтуха\">желтуха</a> — <a href=\"/symptom/zheltuha/\" title=\"Перейти на страницу симптома Желтуха\"><a href=\"/symptom/zheltuha/\" title=\"Перейти на страницу симптома Желтуха\">пожелтение</a> кожи</a>, слизистых и склер, <a href=\"/symptom/zud/\" title=\"Перейти на страницу симптома Зуд\">зуд</a> кожи, <a href=\"/symptom/temnaya_mocha/\" title=\"Перейти на страницу симптома Темная моча\">потемнение мочи</a> и осветление стула. Эти симптомы также неспецифичны и обнаруживаются при любых затруднениях оттока желчи. Кроме того, на этом этапе у больных появляются постоянные ноющие боли в правом подреберье. На поздних стадиях рак печени приводит к развитию анемии, кровотечений из разных органов, скоплению жидкости в брюшной полости, отравлению организма продуктами распада желчных кислот.<br /><br /><br /></p>",
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4853,
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5210
]
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},
"code": "C22.2",
"name": "Гепатобластома",
"icd_name": "Гепатобластома",
"gender": 0,
"age_min": 0,
"age_max": 5,
"cause": [
"0"
],
"periodicity": 1,
"slug": "c22.2_gepatoblastoma",
"lead": "злокачественная низкодифференцированная опухоль печени эмбрионального происхождения, развивающаяся в раннем детском возрасте.",
"description": "",
"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;\">Точно определить причину такой патологии медикам не удалось. Тем не менее, существуют теории, которые объясняют опухолевый рост в тканях печени в детском возрасте. Среди причин, которые врачи связывают с возникновением гепатобластомы, можно выделить:</span></p>\r\n<p> </p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #304080; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\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;\">аномалии внутриутробного развития плода (аденоматический полипоз, болезнь Бекуитта-Видеманна);</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #304080; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\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;\">сочетание гепатобластомы с другими детскими новообразованиями (опухоль Вильмса, которая разрушает ткани почек);</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #304080; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\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 вредных привычек у матери во время беременности, особенно алкоголизма;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #304080; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\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;\">прием некоторых гормональных препаратов.</span></p>\r\n</li>\r\n</ul>",
"pathogenesis": "<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;\">Новообразование обычно поражает правую долю печени, состоит из одного или нескольких узлов беловато-желтого цвета, не имеющих капсулы, свободно прорастающих в печеночную ткань и способных продуцировать желчь. На разрезе неоплазия имеет четко очерченное, дольчатое строение с очагами кровоизлияний и некроза. Гепатобластома возникает из эмбриональных клеток печени и содержит незрелые гепатоциты, находящиеся на разных стадиях развития и неспособные к выполнению нормальных функций. В современной онкологии выделяют эпителиальный и смешанный (эпителиально-мезенхимальный) морфологические типы опухоли.</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;\">Эпителиальный тип гепатобластомы характеризуется наличием эмбриональных, фетальных и мелкоклеточных недифференцированных клеточных структур. Опухоли из эмбриональных и фетальных клеток часто содержат очаги экстрамедуллярного кроветворения и сосудистые «озера» (расширенные сосуды, включающие эритроциты и костномозговые клетки). Мелкоклеточный недифференцированный компонент представлен лимфоцитоподобными клетками с высокой митотической активностью.</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;\">Смешанный тип гепатобластомы сочетает в себе фетальный и/или эмбриональный виды гепатоцитов с компонентами мезенхимы (фиброзной, хондроидной, остеоидной ткани). Смешанный тип новообразования также может содержать тератоидные структуры: островки многослойного плоского или железистого эпителия, поперечнополосатой мышечной ткани, меланинсодержащие клетки.</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;\">Диагностика болезни проводится гастроэнтерологом. Врач опрашивает родителей об онкологических заболеваниях ближайших родственников, о симптомах и жалобах на здоровье ребёнка. Чаще всего проблему вызывает наследственный фактор. Затем доктор осматривает пациента, прощупывает брюшную стенку, уделяя повышенное внимание области печени, измеряет температуру тела.</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;\">Обязательно учитывается протекание беременности матери, её питание и образ жизни. Возраст пациента может быть различным для проявления первых симптомов. Если женщина принимала наркотики или алкоголь в период вынашивания плода, токсические элементы обязательно попадали в кровь ребёнка.</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;\">Затем врач назначает лабораторные исследования. Сюда входят общий и развернутый анализы крови, биохимическое исследование, выявление онкологических маркеров. Назначаются печёночные пробы.</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;\">Помимо этого пациент должен пройти следующие исследования:</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #304080; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\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;\">Рентген грудной клетки.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #304080; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\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;\">УЗИ и УСГ брюшной полости.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #304080; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\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 диагностики метастазов в различных частях организма назначают МРТ и КТ. Ранний возраст ребёнка является причиной проведения диагностики под наркозом.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #304080; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\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;\">Проводят биопсию тканей печени. Результат несёт много информации и распознаёт рак.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #304080; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\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;\">Ангиографическое исследование печени и других сосудов.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #304080; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\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;\">Сцинтиграфия печени. Она определяет вид и дальнейшее лечение опухоли.</span></p>\r\n</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;\">Диагностика направлена на выяснение возникновения новообразования и интенсивности его развития. Врачи проводят всевозможные анализы для нахождения раковых клеток и мест их локализации.</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;\">Лечением заболевания занимается ряд врачей: гепатолог, онколог, хирург и гастроэнтеролог. После выяснения всех нюансов: почему возникла онкология, стадия опухоли, состояние больного, наличие метастазов и т.д., назначается операция. Без хирургического вмешательства побороть опухоль невозможно.</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;\">Операция направлена на иссечение больных тканей. Способы проведения хирургического вмешательства:</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #304080; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\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;\">Проводится частичная резекция печени. Удаляются поражённые доли. Данный способ называют гепатэктомией.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #304080; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\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;\">Печёночная лобэктомия. При ней удаляются только небольшие опухоли печени, которая не подвержена циррозу. В дальнейшем доли вырастают заново. Иссечение крупных опухолей чревато рецидивом.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #304080; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\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;\">Гемигепатэктомия – сложная операция. При вскрытии брюшной полости удаляют повреждённую долю печени и распространившиеся метастазы. Отсекается не один сегмент, а повреждённая половина печени, иногда вовлечена вторая печёночная доля. Этот вид хирургического вмешательства назначается в тяжёлых случаях.</span></p>\r\n</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;\">В зависимости от вида операции определяется срок восстановления. Обычно детский возраст позволяет быстро справиться с недугом. Лечение занимает много времени и сил. При грамотном подходе квалифицированного специалиста и дальнейшем обследовании пациентам удаётся избежать рецидивов.</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;\">Если рак достиг последней стадии, дополнительно применяют химиотерапию. Она убивает раковые клетки во всех органах.</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;\">Запущенные тяжёлые случаи предлагают единственный выход – полное удаление органа. Если донорский орган не удаётся найти до начала операции, после больной будет подключен к гемодиализу. Его ставят в очередь ожидания новой печени. Дети имеют преимущество в силу возраста и восстановительных способностей организма, поэтому новый орган чаще достается молодым пациентам.</span></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;\">Чтобы улучшить послеоперационный период восстановления, пациенту назнача</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;\">Для рождения здорового потомства родители должны ответственно подходить к вопросу зачатия. Болезни подвержены дети, зачатые в алкогольном опьянении. Кроме гепатобластомы у такого ребёнка возможны различные отклонения в работе всех систем. При систематическом употрeблении спиртных напитков в период беременности будущая мать умышленно отравляет ребёнка. Этиловый спирт разрушает клетки печени, нарушает её функционирование. </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;\">Будущим родителям рекомендуется пройти обследование, диагностировать и пролечить обнаруженные заболевания. Просчитать риск возникновения онкологии у малыша.</span></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 первый год жизни нужно систематически посещать педиатра, отслеживать динамику развития ребёнка. </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;\">Симптомы гепатобластомы без ярко выраженных клинических особенностей. Проблема в том, что маленькие дети не способны рассказать о своих ощущениях и болях, поэтому родителям нужно быть начеку, если:</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #304080; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\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 пациента отмечается увеличение живота и его уплотнение, особенно в правом подреберье.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #304080; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\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;\">Кожа имеет бледный или жёлтый цвет.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #304080; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\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;\">Высокая температура (39 градусов и выше).</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #304080; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\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;\">Слабость, вялость больного.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #304080; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\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;\">Отсутствие аппетита, отказ от еды.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #304080; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\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;\">Резкое похудение.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #304080; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\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;\">Жёлтый глазной белок.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #304080; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\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;\">Боли при прикасании к животу, сопровождающиеся плачем.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #304080; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\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;\">Тёмный цвет мочи.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #304080; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\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;\">Светлый, иногда белый цвет кала.</span></p>\r\n</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;\">Данный вид новообразования развивается быстро и провоцирует рост метастазов в ткани и органы всего тела. Попадая в кровоток, раковые клетки могут поразить костный и головной мозг, лёгкие и органы брюшной полости. При повреждении этих органов у больного возникают дополнительные болевые ощущения и симптомы.</span></p>",
"image": null,
"image_alt": null,
"standard_type": 0,
"danger": 40,
"published": 1,
"parent": 7928,
"block_rubric": 22,
"standards": [
4853
]
},
{
"id": 8813,
"symptoms": [
{
"id": 2602,
"synonyms": [
{
"name": "Живот болит"
},
{
"name": "Боли в животе"
},
{
"name": "Боль в левой части живота"
},
{
"name": "Боль выше пупка"
},
{
"name": "Боль ниже пупка"
},
{
"name": "Острые боли в животе"
},
{
"name": "Боль в области живота "
},
{
"name": "Боль в области пупка"
},
{
"name": "Боль в правой жасти живота"
},
{
"name": "Пупок тянет"
},
{
"name": "Болит пупок"
},
{
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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;\">Развитие ангиосаркомы печени связывается с канцерогенным воздействием некоторых химических соединений и токсических веществ: винилхлорида, торотраста, стероидов, радия соединений мышьяка и меди. У лиц, имевших контакт с торотрастом (диоксидом тория) - радиоактивным препаратом, до середины прошлого века использовавшимся в рентгенологии, ангиосаркомы составляют около 23% всех новообразований печени. Торотраст также может вызывать цирроз 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;\">Между действием гепатотоксичных веществ и развитием ангиосаркомы печени могут пройти многие годы. В ряде случаев встречаются ангиосаркомы печени, ассоциированнные с наследственными заболеваниями - нейрофиброматозом (болезнью Реклингхаузена) и идиопатическим гемохроматозом.</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: #ffffff; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Ангиосаркома печени развивается из эндотелия синусоидов - капилляров, расположенных в дольках печени. Макроскопически при ангиосаркоме печень увеличена, с нечеткими границами; содержит множественные узлы, напоминающие кавернозную гемангиому, с участками геморрагий. В 80% случаев ангиосаркома печени метастазирует в селезенку, в 60% - в легкие.</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;\">Раннее обнаружение ангиосаркомы печени представляет большие трудности. При объективном обследовании выявляется желтушность окраски кожных покровов, увеличение печени, иногда – пальпируемое объемное образование, при аускультации выслушиваются шумы в проекции 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;\">По данным УЗИ печени ангиосаркома представлена одиночными или множественными гиперэхогенными образованиями. При обзорной рен­тгенографии брюшной полости, КТ (МСКТ), МРТ определяются отложения торотраста в печени и селезенке. При ангиосаркоме печени вещество располагается по периферии опухолевого образования. При отсутствии отложения торотраста на томограммах ангиосаркома печени определяется как участок пониженной плотности ткани с высокоплотными включениями (очагами кровоизлияний). Характерно высокое стояние купола диафрагмы.</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;\">Диагноз ангиосаркомы подтверждается путем проведения биопсии печени или диагностической лапароскопии с иммуногистохимическим исследованием образца опухоли, в котором определяется маркер эндотелиальной дифференцировки CD31. При морфологическом исследовании биопсийного или операционного материала выявляются кавернозные синусы, выстланные злокачественным анаплазированным эндотелием – веретенообразными клетками с гиперхроматическими ядрами.</span></p>",
"treatment": "<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 операбельной ангиосаркоме необходимо выполнение резекции печени. Для уменьшения размеров ангиосаркомы перед резекцией или замедления роста неоперабельной опухоли применяется химиоэмболизация артерий печени. </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;\">Первичная гемангиоэндотелиома обладает чувствительностью к лучевой терапии, поэтому при нерезектабельных опухолях применяют радиотерапию. </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 рецидивных ангиосаркомах печени и отдаленных метастазах показана полихимиотерапия цитостатиками. </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;\">Прогноз при ангиосаркоме печени неутешителен: большая часть пациентов погибает в течение первого года после диагностирования опухоли.</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;\">Среди основных профилактических мероприятий можно выделить отказ от приема алкоголя, проведение вакцинации против вирусного гепатита В, а также защита от заражения другими типами инфекции. </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;\">Кроме того, важно своевременное распознавание и лечение патологий печени, лечение жирового гепатоза и цирроза.</span></p>",
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},
"code": "C23",
"name": "Рак желчного пузыря",
"icd_name": "Рак желчного пузыря",
"gender": 0,
"age_min": 50,
"age_max": 100,
"cause": [
3,
0
],
"periodicity": 4,
"slug": "c23_rak_zhelchnogo_puzyrya",
"lead": "это заболевание, при котором злокачественные (опухолевые) клетки поражают ткани желчного пузыря. ",
"description": "Рак желчного пузыря и желчевыводящих протоков встречается сравнительно редко. Рак желчного пузыря – это онкологическое заболевание, происходящее из желчного пузыря. Женщины подвержены ему в 1,5 раза больше, чем мужчины",
"etiology": "<p>раку желчного пузыря наиболее подвержены женщины. Свой негативный вклад здесь также вносит возраст человека, а также его образ жизни и питание. Повышает риск заболевания раком и наличие у пациента хронических заболеваний органов ЖКТ и наличие у него камней. С особым вниманием к своему здоровью должны относиться лица, ранее перенесшие рак других органов, здесь очень высок риск повторного развития болезни. Также не следует забывать о наследственности. Зачастую в семьях, где ранее уже встречались онкологические заболевания, формируется генетическая предрасположенность к заболеванию раком.</p>",
"pathogenesis": "",
"diagnostics": "<p>Диагноз рак желчного пузыря не может быть поставлен только на основании лабораторных анализов. Обычные рентгенологические исследования также не помогают в диагностировании рака желчного пузыря. Частые и плохо поддающиеся лечению воспаления желчного пузыря могут быть признаком наличия в нем опухоли. УЗИ или компьютерная томография (КТ) может показать утолщение стенки желчного пузыря и/или увеличенные лимфатические узлы. Различить изменения, вызванные воспалением, может быть весьма сложно.</p>\r\n<p>При обследовании на предмет распространенности рака УЗИ и КТ используют в качестве дополняющих друг друга процедур. Для диагностики рака зачастую прибегают к осмотру желчных протоков с помощью контрастного вещества. На сегодняшний день эту манипуляцию чаще всего проводят с помощью эндоскопии (внутреннего исследования) двенадцатиперстной кишки (ERC-исследование). Такое исследование, как магнитно-резонансная холангиография (МР-холангиография) на аппарате МРТ хорошо определяет непроходимость желчных протоков и показывает её локализацию.</p>",
"treatment": "<p>Наибольший эффект в деле лечения рака желчного пузыря, конечно же, дает хирургическое удаление опухоли, а также близлежащих тканей и лимфососудов. Сама операция носит название холецистэктомии и проводится с использованием лапароскопа. В ходе операции удаляется как сам желчный пузырь, так и окружающие его здоровые ткани, для предотвращения заражения больными клетками тех участков, где производились надрезы, производится резекция и этих тканей. </p>\r\n<full></full><full>Лучевая терапия может использоваться как самостоятельный вид лечения, так и в комплексе с оперативным вмешательством, например, когда требуется существенно уменьшить размеры опухоли. Благодаря высокочастотному воздействию на раковые клетки, удается прекратить их размножение, следовательно, и рост опухоли. Различают внешнюю и внутреннюю лучевую терапию. При проведении внешней терапии воздействие на опухоль оказывает прибор, испускающий радиоактивные лучи. Для внутренней же терапии радиоактивные вещества доставляются к желчному пузырю при помощи специального катетера.</full>\r\n<p>Химиотерапия, курсы которой проводятся в онкоцентре, подразделяется на общую и местную. В ходе общей терапии лекарственные препараты вводятся в кровеносную систему организма больного и разносятся по всем органам и тканям, включая пораженные раком. Это позволяет комплексно воздействовать как на пораженный орган, так и на соседние, что способствует предотвращению развития метастаз и прорастанию опухоли на другие участки. Кроме того возможно проведение регионарной химиотерапии, при которой химические препараты доставляются точечно в пораженные клетки. Преимуществом данного вида процедуры является уменьшение вредного воздействия лекарств на здоровые органы, как следствие, поддержание удовлетворительного самочувствия больного. Кроме того для повышения злокачественных клеток к действию препаратов в нашей клинике применяются радиосенсебилизаторы.</p>",
"prevention": "",
"clinical_picture": "<p><a href=\"/symptom/zheltuha/\" title=\"Перейти на страницу симптома Желтуха\">Желтуха</a>, боль и высокая температура могут свидетельствовать о раке желчного пузыря. <br />Эти и другие проявления могут быть вызваны как раком желчного пузыря, так и другими заболеваниями. При появлении одного из перечисленных симптомов следует проконсультироваться с врачом: <br />- <a href=\"/symptom/zheltuha/\" title=\"Перейти на страницу симптома Желтуха\">Желтуха</a> (желтая окраска кожи и белков глаз). <br />- Боль в верхних отделах живота. <br />- Высокая температура (<a href=\"/symptom/vysokaya_temperatura_38-42/\" title=\"Перейти на страницу симптома Высокая температура 38-42° \">лихорадка</a>). <br />- <a href=\"/symptom/toshnota/\" title=\"Перейти на страницу симптома Тошнота\">Тошнота</a> и <a href=\"/symptom/rvota/\" title=\"Перейти на страницу симптома Рвота\">рвота</a>. <br />- <a href=\"/symptom/meteorizm/\" title=\"Перейти на страницу симптома Метеоризм\">Вздутие</a> живота. <br />- Опухолевые образования в животе.</p>\r\n<full></full>\r\n<p><br /><br />Начало болезни медленное и малозаметное. Нередко клиническая картина долго маскируется проявлениями холелитиаза. Наиболее частым признаком рака желчного пузыря является боль различного характера, обычно тупая и постоянная, возникающая в результате прорастания опухоли в периневральные лимфатические пути. Стойкая тупая боль в правом подреберье у пожилых людей подозрительна на рак желчного пузыря, особенно если она сопровождается субфебрилитетом. Наряду с болями ухудшается аппетит, развиваются диспепсические явления, похудание. <a href=\"/symptom/zheltuha/\" title=\"Перейти на страницу симптома Желтуха\">Желтуха</a> возникает почти в половине случаев. <br /><br />Наиболее характерный признак рака желчного пузыря - прощупываемая плотная бугристая опухоль в правом подреберье. Печень нередко увеличена, иногда в ней прощупываются плотные узлы метастазов. В поздних стадиях могут появиться <a href=\"/symptom/ascit/\" title=\"Перейти на страницу симптома Асцит\">асцит</a> и анемия. Обычны <a href=\"/symptom/vysokaya_temperatura_38-42/\" title=\"Перейти на страницу симптома Высокая температура 38-42° \">лихорадка</a>, лейкоцитоз в крови и повышение СОЭ.</p>",
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},
"code": "C24.0",
"name": "Рак внепеченочного желчного протока",
"icd_name": "Рак внепеченочного желчного протока",
"gender": 0,
"age_min": 50,
"age_max": 100,
"cause": [
"0"
],
"periodicity": 1,
"slug": "c24.0_rak_vnepechenochnogo_zhelchnogo_protoka",
"lead": "злокачественное опухолевое поражение желчных протоков (общего печеночного, пузырного или общего желчного)",
"description": "",
"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>",
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"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>",
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"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>",
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