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"code": "C13",
"name": "Рак нижней части глотки",
"icd_name": "Рак нижней части глотки",
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"age_min": 35,
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"slug": "c13_rak_nizhney_chasti_glotki",
"lead": "это злокачественная опухоль, развивающаяся из клеток эпителия слизистой оболочки глотки.",
"description": "Болезнь эта, среди других онкологических недугов, распространена в степени выше среднего и входит в 20 самых частых обнаруживаемых раковых опухолей.",
"etiology": "<p>В настоящее время медицина не выяснила точную причину развития рака глотки. Однако существуют факторы риска, которые повышают вероятность возникновения опухоли глотки. К одним из таких факторов относятся курение табака, а также жевательный табак. Определенную роль играет и чрезмерное употребление алкоголя.</p>\r\n<full></full>\r\n<p><br /><br />Факторы риска рака глотки <br />Перечислим наиболее частые факторы риска, способствующие возникновению рака глотки: <br />1. Табак. Табачный дым оказывает раздражающее действие на клетки слизистой оболочки рта и глотки. Курящие люди намного больше подвержены риску рака глотки, чем не курящие. Примерно 90 % страдающих раком глотки, употребляют табак в той или иной форме. У лиц, использующих жевательный табак, кроме того, повышен риск развития рака десен, щек и губы. <br />2. Чрезмерное употребление алкоголя. Алкоголь так же оказывает раздражающее воздействие на слизистую глотки. Около ¾ пациентов с раком глотки или ротовой полости злоупотребляют алкоголем. Сочетание курения с чрезмерным употреблением алкоголя значительно повышает риск рака глотки или ротовой полости. <br />3. Длительное раздражение зубными протезами. Само по себе раздражение зубными протезами не является фактором риска развития рака глотки или ротовой полости. Однако плохо подходящие зубные протезы могут поглощать табак или алкоголь, которые и оказывают воздействие на слизистую оболочку. <br />4. Лейкоплакия. Лейкоплакия – при осмотре имеет вид ограниченного пятна белесоватого цвета, размером до 1 сантиметра. Они практически не возвышаются над поверхностью слизистой оболочки. Эти образования чаще бывают одиночными, хотя изредка бывают и множественными, встречаются на языке или слизистой оболочке щек. Лейкоплакия считается предраковым состоянием. <br />5. Эритроплакия – это красноватого цвета образования, которые, как и лейкоплакия встречаются на слизистой оболочке ротовой полости. Это так же одна из форм предрака. <br />6. Вирус папилломы человека – вирус, который ответственен за такие образования, как папиллома. Они могут быть как генитальные, так и кожные.</p>\r\n<p> </p>",
"pathogenesis": "",
"diagnostics": "<p align=\"justify\">Благодаря малосимптомному начальному периоду рак глотки может стать случайной диагностической находкой при осмотре на приеме у терапевта, отоларинголога или стоматолога. Подтвердить рак глотки может проведение гистологического исследования образца опухоли, взятого во время биопсии. Исследование мазков-отпечатков с поверхности опухоли малоинформативно и имеет значение только тогда, когда обнаруживает наличие атипичных клеток.</p>\r\n<p align=\"justify\">При подозрении на рак глотки биопсия должна проводиться под контролем фарингоскопии. Если опухоль находится в толще небной миндалины и не сопровождается изъязвлением, то биопсия может дать ложноотрицательный результат в связи с тем, что опухолевый участок не попал во взятый с поверхности миндалины биопсийный образец. Поэтому при одностороннем увеличении миндалины, предполагая рак глотки, желательно провести одностороннюю тонзиллэктомию с последующим тщательным изучением тканей различных участков удаленной миндалины.</p>\r\n<p align=\"justify\">Определить распространенность злокачественного процесса при раке глотки помогает риноскопия, ларингоскопия, исследование проходимости евстахиевой трубы, отоскопия, рентгенография черепа и околоносовых пазух, КТ черепа и глотки, МРТ головного мозга, биопсия лимфоузлов и др.</p>",
"treatment": "<p align=\"justify\">В основе лечения рака глотки лежит хирургический метод. Операция проводится под общим наркозом. Предварительно под местной анестезией выполняется трахеостомия и интубационная трубка вводится через трахеостому. Для избежания интраоперационного кровотечения проводится перевязка наружной сонной артерии. В зависимости от распространенности опухоли применяется наружный или чрезротовой доступ. В ходе операции опухоль должна быть удалена вместе с расположенными на 1 см по ее периметру визуально неизмененными тканями. Если рак глотки локализуется в небной миндалине, то операция заключается в удалении пораженной миндалины, прилегающей к ней области корня языка, небных дужек и парафарингеальной клетчатки. Если рак глотки прорастает в гортань, то проводят циркулярную резекцию глотки и удаление гортани. Операция заканчивается формированием трахеостомы, ортостомы и эзофагостомы. Спустя 3 месяца после ее проведения возможно выполнение пластики глотки и пищевода для восстановления естественного пути прохождения пищи.</p>\r\n<p align=\"justify\">Рак глотки I-II стадии подлежит только хирургическому лечению. Рак глотки III стадии является показанием к комбинированному лечению: операция в сочетании с лучевой терапией. Облучение как самостоятельный способ лечения применяется, когда операция противопоказана или пациент отказывается от нее, а также при послеоперационном рецидиве. Лечение может проводиться контактным или дистанционным способом.</p>\r\n<p align=\"justify\">В комбинации с хирургическим вмешательством или в качестве паллиативного лечения рака глотки возможно применение химиотерапии.</p>",
"prevention": "<p>Предупредить рак глотки поможет отказ от курения, жевания табака и злоупотребления спиртными напитками. Также необходимо следить за состоянием зубных протезов, своевременно лечить заболевания носоглотки и доброкачественные опухоли глотки. Своевременное обращение к отоларингологу позволяет врачу диагностировать рак глотки на I-II стадии заболевания, что значительно улучшает прогноз лечения.</p>",
"clinical_picture": "<p>К симптомам рака глотки и ротовой полости относятся: <br />- Язвочка в полости рта, которая не заживает длительное время или увеличивается в размере. <br />- Постоянная боль во рту. <br />- Образования или пятна на слизистой оболочке рта белого или красного цвета. <br />- Истончение слизистой щек. <br />- Затруднение жевания, глотания, а также движений языка. <br />- Затруднение движений нижней челюсти или боли при движениях ею. <br />- Ощущение комка в горле или язвочка на стенке глотки. <br />- Боль в области зубов либо выпадение зубов. <br />- Онемение во рту. <br />- Изменения голоса. <br />- Опухолевидное образование на шее. <br />- Неприятный запах изо рта</p>",
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},
"code": "C18",
"name": "Рак ободочной кишки",
"icd_name": "Рак ободочной кишки",
"gender": 0,
"age_min": 45,
"age_max": 65,
"cause": [
3,
0
],
"periodicity": 4,
"slug": "c18_rak_obodochnoy_kishki",
"lead": "это злокачественная опухоль, локализующаяся в одном из отделов ободочной кишки",
"description": "Ободочная кишка - самый длинный отдел толстой кишки, она состоит из восходящей ободочной, поперечной ободочной, нисходящей ободочной и сигмовидной ободочной кишки. Слепая кишка представляет собой начальный небольшой отрезок толстой кишки. Главные функции этого отдела желудочно-кишечного тракта - абсорбция, секреция и эвакуация остатков пищи из организма, все они находятся в тесной взаимосвязи, нарушения одной из них приводит к расстройствам других.\r\n",
"etiology": "<p>Основные причины рака кишечника в области ободочной кишки связаны с наличием:</p>\r\n<ul>\r\n<li>наследственности – при выявлении у близких родных такой формы рака, возрастает рисконкозаболевания;</li>\r\n<li>рафинированной пищи и животных жиров в меню и нерационального питания;</li>\r\n<li>малоактивного образа жизни, гиподинамии и ожирения;</li>\r\n<li>упорных хронических запоров и при этом травм кишки каловыми массами в ее физиологических изгибах;</li>\r\n<li>атонии и гипотонии кишечника у людей старшего возраста;</li>\r\n<li>предраковых заболеваний: семейного полипоза, одиночных аденоматозных полипов, дивертикулеза, язвенного колита, болезни Крона;</li>\r\n<li>возрастного фактора;</li>\r\n<li>вредной работы на производствах: контактов с химикатами и горной пылью.</li>\r\n</ul>",
"pathogenesis": "",
"diagnostics": "<p align=\"justify\">Диагноз рака ободочной кишки устанавливают на основании рентгенологического и эндоскопического исследований. Не менее важным методом физикального обследования больного является пальпация живота, позволяющая не только выявить опухоль в брюшной полости, но и оценить ее консистенцию размеры, мобильность.</p>\r\n<p>По данным ряда авторов, в 60-70% случаев опухоль толстой кишки доступна пальпации.</p>\r\n<p class=\"b\">Типы исследований</p>\r\n<ul>\r\n<li>Рентгенологическое исследование, наряду с колоноскопией, является ведущим в диагностике рака ободочной кишки.</li>\r\n<li>Ирригоскопия позволяет получить информацию о локализации новообразования, установить протяженность поражения, определить форму роста опухоли, оценить ее подвижность, а иногда – судить о взаимосвязи с другими органами. При выполнении ирригоскопии возможно также выявить синхронные опухоли толстой кишки. Последнее обстоятельство важно еще и потому, что при стенозирующем характере роста новообразования эндоскопическое исследование не позволяет до операции оценить состояние вышележащих отделов толстой кишки.</li>\r\n<li>Эндоскопическое исследование, наряду с визуализацией злокачественной опухоли, позволяет получить материал для гистологического исследования, являющегося необходимым атрибутом предоперационной диагностики злокачественного новообразования.</li>\r\n<li>Наиболее простым и широко распространенным методом эндоскопического исследования толстой кишки является ректороманоскопия, при которой возможно оценить состояние нижнего отдела кишечной трубки. При выполнении ректороманоскопии исследователь оценивает состояние слизистой оболочки толстой кишки, сосудистый рисунок, наличие патологических примесей в просвете кишки, эластичность и подвижность кишечной стенки. При выявлении опухоли толстой кишки изучают ее размеры, внешний вид, консистенцию, подвижность при инструментальной пальпации, производят биопсию.</li>\r\n<li>\r\n<p align=\"justify\">Применение рентгеновской компьютерной томографии (КТ) в медицине способствовало значительному улучшению диагностики различных патологических состояний.</p>\r\n<p align=\"justify\">Компьютерная томография обладает следующими важными преимуществами перед другими методами обследования:</p>\r\n<ul>\r\n<li>представляет изображение анатомических структур в виде поперечного среза, исключая совмещение их изображений;</li>\r\n<li>обусловливает четкое изображение структур, незначительно отличающихся по плотности друг от друга, что является крайне важным для диагностики;</li>\r\n<li>представляет возможность для количественного определения плотности тканей на каждом участке изображения исследуемого органа для дифференциальной диагностики патологических изменений;</li>\r\n<li>имеет неинвазивный характер диагностического метода, безопасность и малая лучевая нагрузка на организм больного.</li>\r\n</ul>\r\n<p align=\"justify\">По данным исследователей, при анализе КТ-картины метастатических опухолей колоректального рака в 48% случаев опухолевые узлы содержали кальцинаты, а иногда выявляли тотальное обызвествление метастатических опухолей.</p>\r\n<p align=\"justify\">Радионуклеидные (изотопные) методы диагностики и оценки степени распространения колоректального рака в повседневной практической работе лечебных учреждений используются достаточно редко. Одним из таких методов является позитивная сцинтиграфия, основанная на использовании таких специфических препаратов, как галлий в виде цитратного комплекса, а также меченый изотопом индия блеомицин.</p>\r\n</li>\r\n</ul>",
"treatment": "<p>Лечение рака (кишечника) ободочной кишки проводят радикальным хирургическим вмешательством и последующей лучевой и химиотерапией. Врачом учитывается тип и локализация опухоли, стадия процесса, метастазы и сопутствующие заболевания, общее состояние пациента и возраст.Лечение рака ободочной кишки без наличия осложнений (непроходимости или перфорации) и метастазов проводится радикальными операциями с удалением пораженных участков кишки с брыжейкой и регионарными ЛУ.При наличии опухоли в ободочной кишке справа выполняется правосторонняя гемиколонэктомия: удаляется слепая кишка, восходящая, треть поперечной ободочной и 10 см подвздошной кишки в терминальном отделе. Удаляют одновременно регионарные ЛУ, и поводится формирование анастомоза (соединение тонкой и толстой кишки).</p>\r\n<p>Лучевую терапию в зоне роста опухоли начинают через 2-3 недели после операции. При этом часто наблюдаются побочные симптомы за счет повреждения слизистой оболочки в кишечнике, что проявляются отсутствием аппетита, тошнотой и рвотой.</p>\r\n<p>Последующий этап – проведение химиотерапии современными препаратами для исключения побочных эффектов. Не всем удается легко перенести химию, поэтому кроме тошноты и рвоты возможно появление аллергических высыпаний на коже, лейкопении (снижения концентрации в крови лейкоцитов).</p>",
"prevention": "<p>Профилактика рака ободочной кишки направлена на проведение медицинских осмотров для выявления ранних симптомов онкоопухолей. Использование современных автоматизированных скринингов позволяет выявлять группы повышенного риска, направлять их на исследование с помощью эндоскопов.</p>",
"clinical_picture": "<p align=\"justify\">Клинические проявления рака ободочной кишки во многом зависят от места расположения злокачественного новообразования, степени распространения опухолевого процесса и наличия осложнений, отягчающих течение основного заболевания.</p>\r\n<p align=\"justify\">Наиболее частые симптомы: , нарушение моторно-эвакуаторной функции кишки клинически проявляющиеся чередованием запоров и поносов, патологические выделения с калом, изменение общего состояния больного и, наконец, пальпируемая через переднюю брюшную стенку опухоль.</p>\r\n<full></full>\r\n<p align=\"justify\"> – наиболее частый симптом рака ободочной кишки и отмечаются практически у 80% пациентов. В клинических наблюдениях при правосторонней локализации опухоли боли, как один из первых симптомов рака, встречались в 2-3 раза чаще, чем при раке левой половины. Опухоли ободочной кишки могут длительное время протекать без болевого синдрома и только при распространении новообразования за пределы кишечной стенки, при переходе на брюшину и окружающие органы появляются боли, интенсивность и периодичность которых может быть различной. В зависимости от локализации опухоли болевой синдром может симулировать хронические аппендицит, холецистит, язвенную болезнь желудка и 12-перстной кишки, хронический аднексит.</p>\r\n<p align=\"justify\">Для злокачественных новообразований правой половины ободочной кишки характерно сочетание болевого синдрома, гипертермической реакции (), лейкоцитоза и ригидности (напряженность) мышц передней брюшной стенки. </p>\r\n<p align=\"justify\">Нарушения моторно-эвакуаторной функции толстой кишки приводят к застою кишечного содержимого и обусловливают такие симптомы дискомфорта как чувство тяжести в животе, потерю аппетита, тошноту. </p>\r\n<p align=\"justify\">Скопление каловых масс выше опухоли сопровождается усилением процессов гниения и брожения, приводя к вздутию живота с задержкой стула и газов.</p>\r\n<p align=\"justify\">В тех случаях, когда течение опухолевого процесса осложняется развитием явлений кишечной непроходимости, в клинической картине больных раком ободочной кишки преобладают такие симптомы как живота с затрудненным отхождением кала и газов, \">, , \">Рвота\">\"><a href=\"/symptom/rvota/\" title=\"Перейти на страницу симптома Рвота\">рвота</a>. Боли носят приступообразный характер. По мнению ряда авторов при локализации злокачественной опухоли в левой половине толстой кишки стенозирующий характер опухолевого роста приводит к сужению просвета кишки, вследствие чего каловые массы, скапливаясь выше опухоли могут пальпироваться через брюшную стенку и иногда ошибочно принимаются за опухоль.Одними из довольно частых и сравнительно ранних клинических проявлений рака ободочной кишки являются патологические выделения из прямой кишки. К таковым относят слизь, кровь, гной, опухолевые массы и др. Одним из симптомов, свидетельствующих о далеко зашедшем опухолевом процессе, является пальпируемая через брюшную стенку опухоль. Частота этого симптома колеблется от 40 до 60%.Любой из перечисленных выше симптомов (боль, кишечные расстройства, наличие патологических примесей в стуле) может присутствовать при любом заболевании кишечника, не только опухоли. Анализ клинического течения рака ободочной кишки свидетельствует о значительном проценте диагностических ошибок (до 35%), приводящих к госпитализации в общетерапевтические и инфекционные клиники для лечения анемии неясной этиологии, дизентерии и др. Высоким остается процент больных, госпитализируемых в общехирургические стационары по экстренным показаниям на высоте обтурационной кишечной непроходимости.</p>",
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"name": "Рак органов пищеварения, выходящий за пределы одной и более локализаций",
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"standard_type": 3,
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"parent": 7932,
"block_rubric": 22,
"standards": []
}
]
}
