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},
"code": "N60",
"name": "Доброкачественная дисплазия молочной железы",
"icd_name": "Доброкачественная дисплазия молочной железы",
"gender": 0,
"age_min": 0,
"age_max": 94,
"cause": [
3
],
"periodicity": 1,
"slug": "n60_dobrokachestvennaya_displaziya_molochnoy_zhelezy",
"lead": "Нарушение здоровья, относящееся к группе болезни молочной железы",
"description": "Дисплазия молочной железы определяется как пролиферативные атрофические изменения в груди, возникающие под влиянием гормональных нарушений. Она может проявляться в двух вариантах: гиперплазия, или чрезмерное разрастание железистых тканей, и гипоплазия, или их недоразвитость. ",
"etiology": "<p>Основной причиной развития дисплазии груди является нарушение гормонального обмена в организме женщины. Появление фиброзных и кистозных образований в тканях железы связано с повышенной выработкой пролактина и эстрогенов.</p>\r\n<p> Самыми частыми причинами развития доброкачественной дисплазии молочной железы являются следующие причины:</p>\r\n<ul>\r\n<li>стрессовое воздействие (постоянное нервное перенапряжение, бессонница, переутомление);</li>\r\n<li>курение;</li>\r\n<li>употребление алкоголя;</li>\r\n<li>поздняя первая беременность;</li>\r\n<li>отсутствие родов;</li>\r\n<li>аборты и выкидыши в анамнезе;</li>\r\n<li>сбои цикла месячных (особо выделяется чрезмерно раннее первое менструальное кровотечение);</li>\r\n<li>воспалительные заболевания женских половых органов;</li>\r\n<li>длительное употребление гормональных препаратов;</li>\r\n<li>отказ от грудного вскармливания.</li>\r\n<li>заболевания органов эндокринной системы;</li>\r\n<li>хронические заболевания ЖКТ;</li>\r\n<li>срок наступления менопаузы. Риск заболевания повышается при раннем возрасте появления признаков менопаузы (50-52 года).</li>\r\n</ul>\r\n<p> </p>\r\n<p>Причинами развития гипоплазии (недоразвития) груди могут быть:</p>\r\n<ul>\r\n<li>генетическая предрасположенность;</li>\r\n<li>гипофункции яичников (может возникнуть в результате воздействия инфекции, опухоли, при операции на яичниках, интоксикации и т.д.);</li>\r\n<li>нарушение гормонального обмена, сопровождающееся внезапным прекращением роста железистой ткани в пубертатном периоде.</li>\r\n</ul>",
"pathogenesis": "<p>Одной из основных причин дисплазии молочной железы является сбой гормонального фона. Если количественная составляющая прогестерона и/или эстрогена меняется в большую или меньшую сторону, то резко повышается вероятность развития данного заболевания. Кроме этого, преимущественно к такому дисбалансу можно отнести:</p>\r\n<ul>\r\n<li>Снижение выработки фермента щитовидной железы;</li>\r\n<li>Гиперандрогению – увеличение уровня мужских половых гормонов (андрогенов) у женщин.</li>\r\n<li>Гиперпролактинемию - состояние организма, при котором гипофизом вырабатывается избыточное количество гормона пролактина. Особенно это актуально для развития фиброзно-кистозной мастопатии, когда повышенная концентрация пролактина вызывает болезненность, отёк, нагрубание молочных желез во вторую фазу менструального цикла;</li>\r\n<li>абсолютную или относительную гиперэстрогенемию. Эстрогены способны вызывать пролиферацию эпителия, выстилающего протоки альвеол молочных желез.</li>\r\n</ul>\r\n<p> Толчок к развитию заболевания способен стать апоптоз (вид клеточной гибели, при котором сама клетка активно участвует в процессе своего самоуничтожения). Данное заболевание сопровождается воспалительным процессом, ухудшающим структурное и физиологическое положение железистых тканей и капиллярной системы грудных желез.</p>",
"diagnostics": "<p>Чаще всего данную патологию женщины выявляют самостоятельно, обнаружив в груди уплотнение, по поводу чего обращаются к специалистам.</p>\r\n<p>Для выявления образований, определения их формы, размера, количества, а также для выявления диффузных патологических изменений в ткани железы применяют методы инструментальной диагностики:</p>\r\n<ul>\r\n<li>биоконтрастная маммография – рентгенологическое исследование молочных желез. Данное исследование является одним из наиболее информативных и специфичных. Маммографию оптимально проводить в первой фазе менструального цикла. Снимок груди делают в двух проекциях;</li>\r\n<li>УЗИ молочных желез – позволяет выявить фиброзно-кистозные изменения ткани желез;</li>\r\n<li>МРТ молочной железыотмечает зоны повышения и понижения температуры тканей железы. Методика диафаноскопии заключается в просвечивании молочной железы с помощью источника света. При этом новообразование в ее толще будет отмечаться как более темное пятно.</li>\r\n<li>С помощью дуктографии исследуется система млечных протоков. В молочную железу через сосок вводят контрастное вещество, после чего производят рентгенографию. На снимке визуализируется протоковая система, области дефицита наполнения контрастным веществом могут являться признаками новообразований. </li>\r\n<li>Пневмокистография проводится под контролем УЗИ. В полость кисты с помощью тонкой иглы вводят воздух, что позволяет расправить стенки и тщательно их исследовать на предмет пристеночных образований.</li>\r\n</ul>\r\n<p>При выявлении узлового образования производится биопсия молочной железы - с помощью тонкой иглой берется образец ткани для гистологического исследования.</p>\r\n<p>В диагностике также используется исследование гормонального статуса. Производят непосредственное определение содержания гормонов в крови: прогестерона и эстрогенов, фолликулостимулирующего, лютеинизирующего гормонов, а также гормонов щитовидной железы и тиреотропного гормона, гормонов надпочечников. Иногда производят тест на наличие аутоантител к клеткам щитовидной железы для выявление аутоиммунного тиреоидита.</p>\r\n<p>Для определения общего гормонального состояния организма проводят исследования органов эндокринной системы на предмет выявления возможных патологий (УЗИ щитовидной железы, надпочечников, печени, поджелудочной железы; рентгенография турецкого седла, КТ гипофиза). Для исключения иммунных и обменных патологий делают иммунограмму и производят биохимический анализ крови.</p>",
"treatment": "<ul>\r\n<li>Диета с ограничением кофеина (чай, кофе, шоколад, энергетические напитки), жирных и мясных продуктов, обогащение рациона растительной пищей, витаминами.</li>\r\n<li>Отказ от курения.</li>\r\n<li>Лечение хронических заболеваний и состояний, на фоне которых развилась мастопатия:\r\n<ul>\r\n<li>o восстановление нормальной функции яичников, щитовидной железы и других гормонально активных органов;</li>\r\n<li>o коррекция менструального цикла при его нарушениях с помощью оральных гормональных контрацептивов (выбирают в соответствии с гормональным статусом);</li>\r\n<li>o лечение сахарного диабета (нарушение обмена углеводов), ожирения и других заболеваний обмена веществ.</li>\r\n</ul>\r\n</li>\r\n<li>Коррекция гормонального баланса организма (применение гестагенов, андрогенов, препаратов гормонов щитовидной железы, комбинированных эстроген-гестагенных средств, антигонадотропинов, антиэстрогенов, агонистов дофамина и др.).</li>\r\n<li>Общеукрепляющая терапия (витаминно-минеральные комплексы, адаптогены).</li>\r\n<li>Нестероидные противовоспалительные средства для снятия отечности, болей в молочной железе.</li>\r\n<li>Хирургическое лечение проводится только при острой необходимости – при тяжелой форме болезни, высоком риске озлокачествления, отсутствии эффекта от проводимой медикаментозной терапии. Включает удаление узла, части молочной железы (секторальная резекция) или всей ткани железы целиком (мастэктомия) при узловой форме мастопатии или подозрении на рак молочной железы.</li>\r\n</ul>\r\n<p>Необходимо исключить тепловые процедуры — длительное пребывание на открытом солнце, в солярии, сауне, бане и т.д.</p>",
"prevention": "<p>Для того чтобы свести к минимуму риск развития дисплазии молочной железы необходимо соблюдать следующие рекомендации:</p>\r\n<ul>\r\n<li>вести здоровый образ жизни, отказаться от вредных привычек;</li>\r\n<li>заниматься спортом;</li>\r\n<li>вести полноценную половую жизнь;</li>\r\n<li>правильно питаться (избыточный вес и ожирение почти всегда приводят к нарушению гормонального обмена в организме, что является основной причиной развития дисплазии молочных желез);</li>\r\n<li>избегать стрессов, нервного перенапряжения, поддерживать комфортное психологическое состояние;</li>\r\n<li>своевременно диагностировать и лечить заболевания органов репродуктивной системы;</li>\r\n<li>с осторожностью относиться к приему медикаментозных средств (особенно тех, которые могут вызвать тяжелые нарушения гормонального обмена), все лекарства необходимо принимать только с разрешения лечащего врача, самолечение недопустимо;</li>\r\n<li>после 35 лет не реже раза в год посещать маммолога для проведения профилактического осмотра молочных желез;</li>\r\n</ul>\r\n<p>Помимо всего вышеперечисленного каждая женщина должна регулярно проводить самообследование груди, отслеживать любые изменения формы и симметричности молочных желез, пальпировать близлежащие подмышечные лимфоузлы, обращать внимание на цвет кожи в области груди, наличие выделений из сосков и уплотнений в тканях железы.</p>",
"clinical_picture": "<p>Самым характерным симптомом доброкачественной дисплазии молочной железы является выявление болезненного уплотнения в молочной железе при пальпации. Боль при этом обычно усиливается во второй фазе менструального цикла и непосредственно перед менструацией. Боль, как правило, имеет тупой, ноющий или тянущий характер. Ее возникновение связывают со сдавлением нервных окончаний в железистой ткани фиброзными разрастаниями, а также частичным их склерозированием. Интенсивность болевого синдрома зависит от выраженности патологии. Иногда отмечается иррадиация боли в лопатку, руку.</p>\r\n<p> У 10-15% женщин жалоб на болезненность не отмечается, хотя при осмотре обнаруживаются патологические изменения значительной степени выраженности. Это связывают с различным уровнем болевой чувствительности у женщин и индивидуальной разветвленностью нервной системы молочных желез.</p>\r\n<p>В 10% случаев мастопатии сопровождаются увеличением лимфатических узлов в подмышечных впадинах. Иногда пальпация лимфоузлов умеренно болезненна.</p>\r\n<p> Характерно увеличение молочных желез в объеме, периодическое их нагрубание (во втором периоде менструального цикла) связано с образованием венозного застоя в сосудистой сети желез и отеком соединительной ткани. При этом характерно ощущение дискомфорта и болезненности при пальпации. Совокупность этих признаков называют предменструальным синдромом.</p>\r\n<p> Иногда встречаются выделения из сосков разной степени обильности и различного характера. Они могут возникать при надавливании на сосок или выделяться произвольно. По консистенции, как правило, выделения прозрачные или беловатые, могут иметь зеленоватый, кровянистый или коричневый цвет. Появление любых выделений из сосков, вне зависимости от их характера является поводом обращения к маммологу.</p>\r\n<p> Уплотнение может быть одиночным, могут выявляться несколько узелков, уплотненной может ощущаться вся железа. Для мастопатий характерно поражение обеих желез, преимущественно их верхних отделов.</p>\r\n<p>Преобладание фиброзного компонента выявляется на ощупь как уплотнение, кистозные изменения на первых этапах могут вовсе не обнаруживаться при пальпации.</p>",
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