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"description": "Стриктура уретры – патологическое сужение внутреннего просвета мочеиспускательного канала, приводящее к расстройствам мочеиспускания различной степени выраженности. Мочеиспускание при стриктуре уретры становится затрудненным, частым и болезненным, сопровождается разбрызгиванием струи мочи и чувством неполного опорожнения мочевого пузыря.",
"etiology": "<p>Причинами патологии могут стать: </p>\r\n<ul>\r\n<li>Травмы половых органов. </li>\r\n<li>Перелом пениса. </li>\r\n<li>Проникающие ножевые или огнестрельные ранения передней уретры. </li>\r\n<li>Катетеризации (особенно при длительных операциях). </li>\r\n<li>Хирургические вмешательства. </li>\r\n<li>Переломы таза в результате производственных травм или падений с высоты. </li>\r\n<li>Радикальная простатэктомия. </li>\r\n<li>Венерические заболевания, возбудителями которых становятся трихомонады, хламидии, микоплазмы, гонококки. </li>\r\n<li>Туберкулез половых органов. </li>\r\n<li>Химические повреждений уретры в результате самолечения. </li>\r\n<li>Ухудшение кровоснабжения области половых органов при системном атеросклерозе сосудов или сахарном диабете. </li>\r\n</ul>",
"pathogenesis": "<p>Существует три основные фазы развития патологии: </p>\r\n<ul>\r\n<li>При травмировании переходного эпителия повреждается слизистая оболочка органа; </li>\r\n<li>Из-за присутствия мочи, представляющей собой благодатную среду для микроорганизмов, происходит интенсивное вторичное инфицирование; </li>\r\n<li>Структура внутренних тканей видоизменяется, слизистая заменяется твёрдой рубцовой тканью. </li>\r\n</ul>\r\n<p>Результатом тяжёлой стадии становится большая площадь неэластичной грубой ткани. </p>",
"diagnostics": "<p>У мужчин и женщин обязательными методами диагностики при подозрении на сужение уретры являются: </p>\r\n<ul>\r\n<li>УЗИ уретры – для поиска места расположения и причины стриктуры;</li>\r\n<li>УЗИ мочевого пузыря после опорожнения – для определения остаточной мочи и ее количества; </li>\r\n<li>МРТ или КТ с контрастом – для уточнения вида, размера, локализации стриктуры уретры, особенно необходимы перед операцией;</li>\r\n<li>Уретроскопия – для визуализации внутренних стенок мочеиспускательного канала;</li>\r\n<li>Общий анализ мочи – для оценки работы мочевыделительной системы;</li>\r\n<li>Бакпосев мочи – для исключения инфекционного процесса;</li>\r\n<li>Урофлоуметрия – для анализа скорости опорожнения мочевого пузыря.</li>\r\n</ul>\r\n<p>Также мужчинам делают пальцевое ректальное исследование простаты и прямой кишки для исключения поражения этих органов. </p>",
"treatment": "<p>Существуют различные методы лечения стриктуры уретры, одним из них является бужирование. Процедура предполагает расширение и растягивание уретры с помощью металлического стержня. Такой вид операции показан при единичной, короткой или средней стриктуре. Медики утверждают, что бужирование не предохраняет от рецидива и со временем уретра вновь сузиться. В таком случае повторное лечение таким методом не эффективно и противопоказано. </p>\r\n<p>Уретротомию применяют в том случае, когда стриктура небольшого размера. Процедура проводится с применением цистоскопа, которым рассекают суженную часть органа, затем вставляют металлический стержень. Процедура не спасает от рецидива, после которого операцию такого типа делать нельзя. Самым безопасным является лечение с использованием лазера. Прежде чем начать операцию, следует провести оптическое обследование, а затем проводит хирургическое вмешательство. </p>\r\n<p>При стентировании в участок, где образовалась стриктура, вправляют уретральную пружину или стент, за счет которых происходит расширение отверстия. Стентирование используется в редких случаях, поскольку возможны побочные эффекты. Нередко наблюдается смещение пружины в стороны, что влечет за собой опасные последствия. </p>",
"prevention": "<p>Предупреждение развития стриктуры уретры заключается в профилактике ЗППП, своевременном лечении уретрита под врачебным контролем, осторожном проведении эндоуретральных процедур, исключении травм и других неблагоприятных факторов. Профилактика рецидива стриктуры уретры требует выбора адекватного метода лечения патологии. </p>\r\n<p> </p>",
"clinical_picture": "<p>При стриктурах уретры симптоматика проявляется достаточно быстро и имеет ярко выраженные признаки. В первую очередь пациент жалуется на проблемы с выведением мочи. Это связано с тем, что просвет сужается и не дает урине выходить в полной мере. Со временем проявляются такие признаки: </p>\r\n<ul>\r\n<li>боль в тазовом отделе; </li>\r\n<li>кровянистые выделения при мочеиспускании; </li>\r\n<li>у мужчин кровь в сперме; </li>\r\n<li>выведение урины тонкой струей; </li>\r\n<li>болезненное мочеиспускание; </li>\r\n<li>ощущение переполненного мочевого пузыря; </li>\r\n<li>сокращение количества урины. </li>\r\n</ul>\r\n<p>В тяжелых случаях наблюдается выведение урины несколькими каплями или вовсе прекращается процесс мочеиспускания за счет закупорки просвета. При появлении вышеперечисленных признаков, следует как можно скорее обратиться за медицинской помощью, поскольку осложнения стриктуры уретры крайне опасны и грозят непоправимыми последствиями. </p>",
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},
"code": "N35.9",
"name": "Стриктура уретры неуточненная",
"icd_name": "Стриктура уретры неуточненная",
"gender": 0,
"age_min": 0,
"age_max": 100,
"cause": [
"0"
],
"periodicity": 1,
"slug": "n35.9_striktura_uretry_neutochnennaya",
"lead": "патологическое сужение внутреннего просвета мочеиспускательного канала, приводящее к расстройствам мочеиспускания различной степени выраженности",
"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;\">Врожденные стриктуры уретры довольно редки (около 2%) и обусловлены, главным образом, передним клапанным сужением мочеиспускательного канала. Гораздо чаще врачам-урологам приходится сталкиваться с приобретенными сужениями, которые могут вызываться:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">травмами (70%). Посттравматические стриктуры уретры, как правило, развиваются вследствие тупых травм промежности, проникающих ранений уретры, сексуальных эксцессов (инородных тел мочеиспускательного канала, переломов полового члена), переломов костей таза (в результате автотравм, падений с высоты, производственных травм), химических, термических повреждений уретры.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">воспалительными процессами (15%). Стриктуры уретры воспалительного генеза могут развиваться в результате перенесенных уретритов (при гонорее, хламидиозе, туберкулезе), баланита, неспецифических дегенеративно-дистрофических процессов (склерозирующий лихен) и др.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">ятрогенными причинами (13%). Ятрогенные стриктуры уретры могут быть обусловлены неосторожным проведением урологических манипуляций и операций – уретроскопии, цистоскопии, бужирования, катетеризации, удаления конкрементов или инородных тел, ТУР простаты, радикальной простатэктомии, фаллопротезирования, брахитерапии. У женщин сужения мочеиспускательного канала могут возникать после родовых травм, влагалищной гистерэктомии, ампутации шейки матки и пр.</span></li>\r\n</ul>\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\"> </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;\">Формирование патологии может быть связано с заболеваниями, сопровождающимися ухудшением кровоснабжения и метаболизма тканей мочеиспускательного канала – системным атеросклерозом сосудов, ИБС, сахарным диабетом, артериальной гипертензией.</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: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">В патогенетическом плане развитие стриктуры уретры проходит несколько стадий: повреждение уротелия и нарушение целостности слизистой, образование мочевых затеков, наслоение вторичной инфекции, пролиферация и грануляция тканей, приводящая в итоге к рубцово-склеротическим процессам.</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 стриктуры уретры проводится с целью определить причину дефекта. Это могут быть заболевания или обстоятельства, которые предшествовали развитию стеноза. Для этого в комплекс диагностических мероприятий включают:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Мазок на половые инфекции с бакпосевом или ПЦР-диагностикой.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Урофлоуметрия – исследование динамики мочеиспускания и скорости потока мочи.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Рентгенография для выявления ложных ходов, камней мочевого пузыря или дивертикулов уретры.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Цистоскопия или уретроскопия с биопсией ткани.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">УЗИ мочевого пузыря для оценки объема остаточной мочи и определения степени тяжести стеноза.</span></li>\r\n</ul>\r\n<p> </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 метода лечения осуществляется сугубо индивидуально в зависимости от локализации, степени и протяженности рубцово-склеротических процессов.</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Бужирование уретры. При простых, одиночных и непротяженных стриктурах лечение, как правило, начинают с бужирования уретры. С этой целью используются бужи-дилататоры различного диаметра и формы (прямые, кривые) или уретральные баллонные катетеры. Недостатком бужирования является высокая частота рецидивов.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Стентирование уретры. Для предотвращения повторного сужения мочеиспускательного канала прибегают к установке уретрального стента, способного поддерживать адекватный просвет стенозированной части уретры. Однако частые случаи смещения или миграции уретральных стентов делают распространение метода достаточно ограниченным.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Уретротомия. При коротких (менее 0,5 см длиной) стриктурах, расположенных в бульбарном или бульбомембранозном отделе уретры, может быть выполнено рассечение стенозированного участка - внутренняя уретротомия под визуальным эндоскопическим контролем.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Резекция уретры. При участках сужения протяженностью 1-2 см предпочтительным является проведение открытой резекции мочеиспускательного канала с анастомотической уретропластикой «конец в конец». Иссечение стриктуры уретры длиной более 2 см требует проведения уретропластики с использованием трансплантата из собственных тканей пациента (кожи крайней плоти, слизистой оболочки щеки).</span></li>\r\n</ul>\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\"> </p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>",
"prevention": "<p><span id=\"docs-internal-guid-f0464fa6-7fff-653f-37d9-fc555a5d4427\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Профилактика стриктуры уретры заключается в своевременном лечении уретрита и инфекций, передающихся половым путём (в первую очередь гонококковой инфекции), исключительно под контролем врача, а также в снижении травматизма и других факторов, способствующих появлению стриктуры (в том числе и переохлаждение).</span></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;\">В случае формирования стриктуры мочеиспускательного канала симптомы проявляются быстро. Первым признаком является устойчивое затруднение отхождения мочи вначале процесса мочеиспускания с дальнейшим появлением прогрессирующих клинических признаков: накопления, опорожнения и постмикционных проявленмй (после мочеиспускания).</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;\">Ведущие симптомы стриктурной болезни уретры:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">боль и жжение во время мочеиспускания;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">чувство неполного опорожнения мочевого пузыря;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">слабый напор струи и уменьшение объёма мочи;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">преобладание ночного диуреза над дневным;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">частые позывы к мочеиспусканию;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">неспособность контролировать мочеиспускание (недержание);</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">болевой синдром в области таза и в нижней части живота;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">боль с локализацией в области полового члена;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">наличие крови в сперме и моче;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">потемнение мочи;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">снижение силы эякуляции;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">невозможность мочеиспускания (это состояние очень серьёзное и требует немедленной медицинской помощи).</span></li>\r\n</ul>\r\n<p> </p>",
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},
"code": "B78",
"name": "Стронгилоидоз",
"icd_name": "Стронгилоидоз",
"gender": 1,
"age_min": 0,
"age_max": 100,
"cause": [
2,
5,
7
],
"periodicity": 1,
"slug": "b78_strongiloidoz",
"lead": "Гельминтоз, в ранней стадии которого наблюдаются преимущественные симптомы аллергического характера со стороны кожи и легких, в поздней стадии преобладают поражения органов пищеварительной системы. ",
"description": "Инфекционное заболевание.",
"etiology": "<p>Возбудитель стронгилоидоза — круглый гельминт Strongyloides stercoralis — кишечная угрица. Самец длиной 0,7 мм, шириной 0,04—0,06 мм. На загнутом хвостовом конце тела имеется две спикулы и рулек. Самка длиной 2,2 мм, шириной 0,03—0,7 мм. Яйца прозрачные, овальной формы, размером 0,05 х 0,03 мм. Развитие паразитов протекает со сменой свободноживущих и паразитических поколений. Половозрелые самки паразитического поколения локализуются в организме человека в толще слизистой оболочки, главным образом в либеркюновых железах двенадцатиперстной кишки, при интенсивной инвазии проникают в желудок, слизистую тонкого кишечника, панкреатические и желчные ходы. Оплодотворенные самки откладывают яйца, из которых выходят личинки, достигающие в длину 0,2—0,3 мм.</p>\r\n<full></full>\r\n<p>Личинки выделяются с фекалиями во внешнюю среду, где либо превращаются в филяриевидные личинки (гомогения), либо в свободноживущих половозрелых самцов и самок (гетерогония), способных откладывать яйца. Филяриевидные личинки способны инвазировать человека, проникая через кожные покровы или через рот с водой и пищей. При перкутантном заражении личинки совершают миграцию, подобно личинкам аскарид и анкилостомид, и достигают кишечника через дыхательные пути, глотку, пищевод. Источник инвазии — больной стронгилоидозом человек. Заражение происходит из зараженной почвы. Особенно благоприятные условия имеются в странах с жарким и влажным климатом, а также в сырых с высокой температурой шахтах и туннелях. Распространен, в основном, в странах тропического и субтропического пояса. Спорадические случаи возможны на территории России.</p>",
"pathogenesis": "",
"diagnostics": "<p>Паразитологический диагноз устанавливается по обнаружению личинок (реже яиц) в дуоденальном содержимом и в кале, обработанных по методу Бермана, в миграционной стадии иногда удается выявить личинки и половозрелых паразитов в мокроте. Исследованию на стронгилоидоз подлежат все больные с высокой эозинофилией крови.</p>",
"treatment": "<p>Больные стронгилоидозом подлежат лечению в стационаре. Наиболее эффективными препаратами является минтезол (тиабендазол) и ивермектин (мектизан). Минтезол назначают из расчета 25-50 мг/кг массы тела в сутки в 3 приема 2 дня подряд. Ивермектин (мектизан) - по 200 мг/кг/сут в течение 2 дней. Могут быть использованы вермокс, альбендазол. Больным назначают десенсибилизирующие средства, при интоксикации проводят инфузионную терапию. Контроль эффективности лечения через 2 нед и затем ежемесячно в течение З меc.</p>",
"prevention": "<p>Профилактические мероприятия при стронгилоидозе направлены на выявление и оздоровление инвазированных и на охрану окружающей среды от загрязнения фекалиями. <br /><br />Обязательному обследованию на стронгилоидоз подлежат больные, страдающие заболеваниями органов пищеварения, гепатобилиарной системы, особенно при наличии у них эозинофилии или крапивницы, т. е. при наличии характерных для инвазии клинических показаний.</p>\r\n<full></full>\r\n<p><br /><br />Учитывая особенности эпидемиологии стронгилоидоза, наличие групп профессий повышенного риска заражения, обследованию методом Бермана подлежат землекопы, шахтеры, рабочие очистных сооружений, строители дорог, парниковых хозяйств, овощных баз и др., а также лица, находящиеся в больницах, интернатах, колониях для психических больных. <br /><br />Выявленные инвазированные подлежат дегельминтизации лучше в условиях стационара или полустационара с последующим диспансерным наблюдением на протяжении одного года: с обследованием специальным методом Бермана один раз в месяц в течение 6 месяцев и один раз в квартал следующие полгода. С диспансерного учета снимают через год после трехкратного обследования с интервалом 2-3 дня при получении отрицательных результатов анализов. <br /><br />Важным и решающим методом профилактики стронгилоидоза является охрана внешней среды от фекальных загрязнении и обеззараживание загрязненной почвы. Это, прежде всего меры по санитарному благоустройству населенных мест, организация плановой очистки дворовых туалетов, запрещению удобрение почвы огородов необезвреженными фекалиями.</p>",
"clinical_picture": "<p>В ранней миграционной стадии (до 10 суток) стронгилоидоза возникает <a title=\"Перейти на страницу симптома Высокая температура 38-42° \" href=\"../../../symptom/vysokaya_temperatura_38-42/\">лихорадка</a>, кожный <a title=\"Перейти на страницу симптома Зуд\" href=\"../../../symptom/zud/\">зуд</a>, крапивница или папулезные <a title=\"Перейти на страницу симптома Сыпь\" href=\"../../../symptom/syp/\">высыпания</a>, местные отеки, в легких появляются эозинофильные инфильтраты. В поздней фазе инвазии, когда гельминты достигают половой зрелости, иногда могут наблюдаться тяжелые, летально заканчивающиеся клинические прояв-ления. В легких случаях течения заболевания отмечаются <a title=\"Перейти на страницу симптома Тошнота\" href=\"../../../symptom/toshnota/\">тошнота</a>, тупые боли в эпигастрии. Стул, как правило, не изменен, иногда запоры или чередование запоров с легкими поносами. Иногда ведущим синдромом является ал-лергический. При выраженных проявлениях <a title=\"Перейти на страницу симптома Тошнота\" href=\"../../../symptom/toshnota/\">тошнота</a> нередко сопровождается рвотой, возникают острые боли в эпигастрии или по всему животу.</p>\r\n<full></full>\r\n<p>Периодически появляются поносы до 5—7 раз в сутки. Печень у некоторых больных увеличена и уплотнена. В периферической крови у большинства боль-ных выявляется эозинофилия до 70—80%, при длительных инвазиях возникает вторичная анемия, обычно умеренно выраженная. При тяжелых формах стронгилоидоза поносы становятся постоянными, стул приобретает гнилостный запах и содержит много остатков непереваренной пищи. Наступает обезвоживание организма, тяжелая вторичная анемия, <a title=\"Перейти на страницу симптома Кахексия\" href=\"../../../symptom/kaheksiya/\">кахексия</a>. Со стороны нервной системы отмечаются <a title=\"Перейти на страницу симптома Головная боль\" href=\"../../../symptom/golovnaya_bol/\">головная боль</a>, головокружения, повышенная умственная <a title=\"Перейти на страницу симптома Утомляемость\" href=\"../../../symptom/utomlyaemost/\">утомляемость</a>, неврастенические и психастенические синдромы. Наблюдаются симптомы дуоденита, энтероколита, реже ангиохолита и гепатита. При отсутствии лечения гельминтоз приобретает длительное хроническое течение.</p>",
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