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},
"code": "N87",
"name": "Дисплазия шейки матки",
"icd_name": "Дисплазия шейки матки",
"gender": 2,
"age_min": 10,
"age_max": 100,
"cause": [
3,
2,
8
],
"periodicity": 1,
"slug": "n87_displaziya_sheyki_matki",
"lead": "Нарушение здоровья, относящееся к группе невоспалительные болезни женских половых органов",
"description": "Дисплазия шейки матки (цервикальная дисплазия) – это состояние покрывающего шейку матки эпителия, которое характеризуется изменением числа слоев и строения образующих его клеток. При этом в процесс не вовлекается базальная мембрана и самые верхние клеточные слои. Дисплазия относится к заболеваниям, которые при стечении обстоятельств могут стать причиной развития злокачественной опухоли шейки матки.",
"etiology": "<p>Основной причиной считают инфицирование вирусом папилломы человека (ВПЧ). Заражение ВПЧ происходит только половым путем. Риск инфицирования повышен в следующих случаях:</p>\r\n<ul>\r\n<li>иммунодефицит – подавление иммунной реактивности хроническими заболеваниями, стрессами, лекарственными препаратами, неправильным питанием и т. д.;</li>\r\n<li>табакокурение активное и пассивное – увеличивает вероятность развития дисплазии шейки матки в 4 раза;</li>\r\n<li>затяжные хронические воспаления половых органов;</li>\r\n<li>нарушения гормонального фона, вызванные менопаузой, беременностью, употреблением гормоносодержащих лекарств;</li>\r\n<li>ранняя половая жизнь и роды;</li>\r\n<li>травматические повреждения шейки матки.</li>\r\n</ul>",
"pathogenesis": "<p>При формировании патологического процесса происходит нарушение слоев эпителия, поверхностные и переходные эпителиоциты содержат делящиеся (митотически активные) клетки, которых в норме быть не должно. Это приводит к гиперплазии (увеличение количества эпителиоцитов) слизистой. Механизмом формирования дисплазии шейки матки является нарушение регуляции митоза клеток, вследствие которого происходит их деление в тех слоях слизистой, в которых этого не должно быть.</p>",
"diagnostics": "<p>Диагностика дисплазии шейки матки включает:</p>\r\n<ul>\r\n<li>осмотршейки матки при помощи влагалищных зеркал – с целью обнаружения видимых глазом, клинически выраженных форм дисплазии (изменение окраски слизистой, блеск вокруг наружного зева, пятна, разрастание эпителия и др.);</li>\r\n<li>кольпоскопия – осмотр шейки матки специальным оптическим аппаратом, увеличивающим изображение более чем в 10 раз и одновременное проведение диагностических проб - обработки шейки матки раствором Люголя и уксусной кислоты;</li>\r\n<li>ПАП-мазок ф– при дисплазии шейки матки исследование под микроскопом соскоба, полученного с разных участков, позволяет выявить атипичные клетки. Также с помощью ПАП-мазка обнаруживаются клетки-маркеры папилломавирусной инфекции, имеющие сморщенные ядра и ободок, являющиеся местом локализации вируса папилломы человека;</li>\r\n<li>гистологического исследованиябиоптата – фрагмента ткани, взятого в ходе биопсии шейки матки из зоны, подозрительной на дисплазию. Является наиболее информативным методом выявления дисплазии шейки матки;</li>\r\n</ul>\r\n<p>иммунологических ПЦР-методов – для выявления ВПЧ-инфекции, установления штаммов вируса и вирусной нагрузки (концентрации вируса папилломы в организме). Выявление наличия или отсутствия онкогенных типов ВПЧ позволяет определить выбор метода лечения и тактику ведения пациентки с дисплазией шейки матки.</p>",
"treatment": "<p>Медикаментозное лечение включает в себя препараты для повышения иммунитета в виде иммуномодуляторов, а также средств интерферона. Применяют их при обширных поражениях и рецидивирующей форме дисплазии.</p>\r\n<p>К хирургическому лечению прибегают в случае двукратного положительного результата анализа на дисплазию. Перед любой оперативной методикой назначаются противовоспалительные препараты для санации очага. Очень часто после предоперационного лечения степень поражения дисплазией уменьшается в размерах или полностью исчезает. Операции всегда выполняют в первую фазу месячного цикла, а именно на 6-10 день, при условии отсутствия воспалительного процесса во влагалище и матке, а также беременности.</p>\r\n<p>Современные хирургические методики лечения дисплазии шейки матки следующие:</p>\r\n<ul>\r\n<li>Лазерная хирургия(лазерная вапоризация, лазерная конизация, лазерное прижигание). Это способ воздействия на патологические ткани посредством пучка лазера с низкой интенсивностью. Благодаря этому участки дисплазии нагреваются и разрушаются, на их месте образуется некроз.</li>\r\n<li>Холодовая деструкция(криодеструкции, криоконизация).</li>\r\n<li>Электрическая эксцизия(диатермокоагуляция, процедура петлевой электрической эксцизии).</li>\r\n<li>Конизация шейки матки. При ней специальным ножом в виде петли удаляют участок шейки конусовидной формы.</li>\r\n<li>Криотерапия.Данная технология предусматривает ликвидацию очага на шейке жидким азотом.</li>\r\n<li>Радиоволновая хирургия.</li>\r\n<li>Ампутация шейки матки. Радикальное удаление шейки при невозможности проведения или неэффективности других методов.</li>\r\n</ul>\r\n<p> </p>",
"prevention": "<p>Для профилактики дисплазии шейки матки и ее рецидивов рекомендуется:</p>\r\n<ul>\r\n<li>включение в рацион питания всех микроэлементов и витаминов, в особенности витаминов А, группы В, селена;</li>\r\n<li>своевременная санация всех очагов инфекций;</li>\r\n<li>отказ от табакокурения;</li>\r\n<li>применение барьерной контрацепции (при случайных половых контактах);</li>\r\n<li>регулярное наблюдение гинеколога(1-2 раза в год) с исследованием цитологического соскоба с шейки матки</li>\r\n</ul>\r\n<p> </p>",
"clinical_picture": "<p>Типичная клиническая картина провялятся в большинстве случаев уже в тяжелой степени дисплазии шейки матки и присоединении вторичной инфекции с развитием воспаления (цервицит, кольпит). </p>\r\n<p>Пациентка с дисплазией шейки матки может предъявлять следующие жалобы:</p>\r\n<ul>\r\n<li>бели (выделения) – обильные, с неприятным запахом;</li>\r\n<li>кровянистые выделения (часто контактные, то есть после полового акта, гинекологического осмотра);</li>\r\n<li>зуд;</li>\r\n<li>чувство жжения;</li>\r\n<li>боль, возникающая во время секса.</li>\r\n</ul>\r\n<p> </p>",
"image": null,
"image_alt": null,
"standard_type": 3,
"danger": 76,
"published": 2,
"parent": null,
"block_rubric": 156,
"standards": [
4892
]
}
]
}
