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"lead": "Область медицины, включающая в себя лечение 851 заболевания. В 696 клиниках России оказывается помощь по этому направлению медицины.",
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"lead": "Область медицины, включающая в себя лечение 335 заболеваний. В 180 клиниках России оказывается помощь по этому направлению медицины.",
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"lead": "Область медицины, включающая в себя лечение 145 заболеваний. В 181 клинике России оказывается помощь по этому направлению медицины.",
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"lead": "Область медицины, включающая в себя лечение 34 заболеваний. В 23 клиниках России оказывается помощь по этому направлению медицины.",
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"lead": "Область медицины, включающая в себя лечение 984 заболеваний. В 69 клиниках России оказывается помощь по этому направлению медицины.",
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"lead": "Область медицины, включающая в себя лечение 211 заболеваний. В 341 клинике России оказывается помощь по этому направлению медицины.",
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"lead": "Область медицины, включающая в себя лечение 376 заболеваний. В 728 клиниках России оказывается помощь по этому направлению медицины.",
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"lead": "Область медицины, включающая в себя лечение 351 заболевания. В 523 клиниках России оказывается помощь по этому направлению медицины.",
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},
"code": "C25",
"name": "Рак поджелудочной железы",
"icd_name": "Рак поджелудочной железы",
"gender": 0,
"age_min": 55,
"age_max": 100,
"cause": [
3,
0
],
"periodicity": 1,
"slug": "c25_rak_podzheludochnoy_zhelezy",
"lead": " злокачественное новообразование, исходящее из эпителия железистой ткани или протоков поджелудочной железы.",
"description": "Рак поджелудочной железы является одним из самых агрессивных типов онкологии. Наиболее распространенной формой рака поджелудочной железы является аденокарцинома.\r\n\r\n",
"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>",
"pathogenesis": "",
"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>",
"image": "http://api.symptomd.ru/storage/9b68be57089b1e9e313f2e6ee9412850_qVHAHyN.jpg",
"image_alt": "Поджелудочная железа",
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4675,
4683,
5187,
5209,
5212,
5343
]
},
{
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{
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