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"code": "D13.6",
"name": "Доброкачественная опухоль поджелудочной железы",
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"lead": "группа опухолевых заболеваний, в основе которых лежит патологический процесс бесконтрольного деления клеток тканей поджелудочной железы и ее протоков, характеризующийся доброкачественным течением",
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"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;\">Причины доброкачественных опухолей поджелудочной железы не установлены. Считается, что они развиваются под воздействием следующих факторов:</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Генетической патологии, предрасполагающей к неопластическим процессам;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Неблагоприятной экологической обстановки;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Курения табака;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Злоупотребления алкоголем.</span></li>\r\n</ul>\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;\">Большая роль в развитии доброкачественных опухолей поджелудочной железы воспалительным процессам органа, в первую очередь – хроническому панкреатиту. К факторам риска развития доброкачественных новообразований относится нерациональное питание – преобладание в рационе жирной пищи, преимущественно животного происхождения, недостаток протеинов, клетчатки, витаминов, неправильный режим питания (переедание, отсутствие регулярных приёмов пищи).</span></p>",
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"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 данной патологии основана на характерной клинической картине некоторых видов новообразований, а также результатах инструментальных и гистологических методов исследования. Консультация гастроэнтеролога позволяет предположить тип опухоли, выяснить, как давно появились симптомы и прогрессируют ли они. В анамнезе жизни пациента возможны воспалительные заболевания поджелудочной железы, злоупотребление алкоголем.</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;\">При осмотре пациента врач может определить желтушность кожных покровов и склер, свидетельствующую о механическом сдавлении опухолью панкреатического или общего желчного протока. При оценке общего анализа крови изменения выявляются крайне редко. Биохимический анализ крови в случае инсуломы и глюкагономы подтверждает изменение уровня сахара крови. Обязательно проводится определение онкомаркеров: карциноэмбрионального антигена, СА 19-9, которые в случае доброкачественной природы заболевания не повышены.</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;\">Наиболее информативными методами диагностики являются инструментальные исследования. УЗИ органов брюшной полости проводится с целью визуализации образования, определения его размеров, состояния регионарных лимфатических узлов. Однако при гормонпродуцирующих опухолях малых размерах данный метод малоэффективен. Высокоинформативны КТ и МРТ поджелудочной железы, позволяющие обнаружить новообразования небольших размеров и детально изучить их распространенность.</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;\">Для определения неоплазий с множественными очагами (это характерно для инсулом, гастрином) проводится сцинтиграфия – в организм вводятся радиофармпрепараты, которые активно накапливаются клетками опухоли, и их излучение фиксируется на снимке. При подозрении на гемангиому выполняется ангиография с целью оценки тока крови в образовании и его связи с системным кровотоком. </span></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;\">Лечение доброкачественных опухолей поджелудочной железы только хирургическое. Окончательно установить, доброкачественная или злокачественная опухоль, удается лишь после выполнения операции и проведения гистологического (изучения ткани под микроскопом) исследования удаленной опухоли.</span></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;\">На сегодняшний день к основным операциям по удалению опухоли поджелудочной железы относят:</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Резекция (удаление части поджелудочной железы). Как правило, такая операция применяется тогда, когда опухоль находится в хвосте железы.</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Удаление опухоли (вылущивание). Как правило, выполняют при гормонпродуцирующих опухолях – опухолях, продуцирующих (производящих) гормоны (например, при инсуломе вырабатывается гормон инсулин (гормон, снижающий содержание глюкозы (сахара) в крови)).</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Панкреатодуоденальная резекция — удаление опухоли вместе с 12-перстной кишкой при локализации (размещении) опухоли в головке железы.</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Селективная артериальная эмболизация (закупорка сосуда) – проводится иногда при гемангиоме (доброкачественной опухоли, растущей из кровеносных сосудов) для прекращения ее кровоснабжения.</span></li>\r\n</ul>",
"prevention": "<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;\">Чтобы снизить вероятность развития рака поджелудочной железы, врачи разработали профилактические рекомендации. Они включают в себя:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Соблюдение рационального и сбалансированного питания. В ежедневном меню необходимо ограничить количество легкоусвояемых углеводов и белков. Выбираемые продукты не должны содержать нитраты;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Активный образ жизни. Адекватная физическая нагрузка снижает риск развития ожирения;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Отказ от курения и чрезмерного употребления алкоголя. Хронические интоксикации негативно сказываются на состоянии поджелудочной железы, стимулируя рост опухолевых клеток.</span></li>\r\n</ul>",
"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;\">Доброкачественные опухоли поджелудочной железы не проявляют себя до тех пор, пока не достигают больших размеров. Диагноз зачастую устанавливается случайно, во время планового УЗИ органов брюшной полости.</span></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;\">Исключением является инсулома: даже при небольших ее размерах она вызывает нарушения в секреции инсулина, и у больных значительно снижается уровень сахара в крови, что сопровождается:</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">повышенным аппетитом и стремительным набором веса;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">слабостью;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">беспричинным чувством страха;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">повышенным потоотделением;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">учащенным сердцебиением;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">эпизодами головокружения, двоения в глазах, иногда – потерей сознания.</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\"><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 процессе роста опухоли и в результате воздействия на прилежащие структуры могут наблюдаться следующие симптомы:</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Боли с локализацией в правом или левом подреберье, эпигастрии (область под грудиной), возле пупка. Часто имеют опоясывающий характер, могут отдавать в спину. Возникают вне зависимости от приема пищи.</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Желтуха. Опухоль нарушает проходимость желчных путей, нарушается отток желчи, что сопровождается пожелтением кожных покровов и склер глаз, кожным зудом, обесцвечиванием кала, моча приобретает цвет «крепко заваренного чая».</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Кишечная непроходимость. В результате воздействия на двенадцатиперстную кишку развивается ее непроходимость. Состояние может сопровождаться тошнотой, рвотой, ощущением тяжести после приема пищи.</span></li>\r\n</ul>",
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},
"code": "D13.0",
"name": "Доброкачественная опухоль пищевода",
"icd_name": "Доброкачественная опухоль пищевода",
"gender": 0,
"age_min": 20,
"age_max": 100,
"cause": [
"0"
],
"periodicity": 1,
"slug": "d13.0_dobrokachestvennaya_opuhol_pischevoda",
"lead": "гистологически разнородные эпителиальные и неэпитальные новообразования эзофагеальной стенки с внутрипросветным или внутристеночным ростом",
"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;\">Точных причин развития онкологического процесса в пищеводе пока не установлено. Известно, что болезнь возникает из-за неправильного роста и размножения клеток в слизистой или мышечной оболочке органа. В результате хаотического и неконтролируемого разрастания тканей образуются патологические элементы.</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;\">Факторами, которые увеличивают риск возникновения доброкачественных опухолей пищевода, являются:</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;\">генетическая предрасположенность;</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;\">химические и физические повреждения пищевода;</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;\">влияние радиации;</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;\">контакт с химическими канцерогенами (лакокрасочные изделия, смолы, фенолы).</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 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;\">Известно также, что частое употребление острой и горячей пищи может выступать пусковым фактором для развития опухолей. Это обусловлено физическим и химическим раздражением слизистой оболочки рта и пищевода, что создает оптимальные условия для «поломки» механизмов, которые регулируют деление клеток.</span></p>",
"pathogenesis": "",
"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;\">Пациенты чаще всего обращаются за помощью к гастроэнтерологу, когда возникает нарушение глотания. При оценке жалоб пациента и сборе анамнеза заболевания врач может заподозрить наличие патологического новообразования в пищеводе.</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;\">Для подтверждения диагноза гастроэнтеролог может назначить:</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;\">рентгенологическое исследование пищевода с применением бария;</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;\">эзофагогастродуоденоскопию (ЭГДС) с биопсией для дальнейшего гистологического анализа тканей опухоли;</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;\">компьютерную (КТ) или магнитно-резонансную томографию (МРТ).</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;\">Все указанные методики позволяют визуализировать полость пищевода и зафиксировать наличие новообразования. При выявлении опухоли пациент направляется к онкологу для выбора дальнейшей тактики лечения.</span></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;\">Лечение доброкачественных образований пищевода проводится хирургическим путем.</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;\">Консервативное лечение</span></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;\">Эффективных консервативных методов лечения доброкачественных опухолей пищевода не существует. Медикаменты применяются временно и только для уменьшения выраженности симптомов, доставляющих дискомфорт.</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;\">Хирургическое лечение</span></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;\">Оптимальным вариантом решения проблемы остается радикальная операция, направленная на полное удаление опухоли. Доступ к патологическому участку может быть осуществлен 2 путями:</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;\">Эндоскопические операции. Через естественные отверстия в полость органа вводится оптическая система и небольшие инструменты, которыми и осуществляется иссечение опухоли. На коже разрез отсутствует.</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;\">Традиционные операции. С помощью скальпеля делается достаточно большой разрез в области шеи, грудной клетки или верхнего этажа брюшной полости (в зависимости от того, в каком отделе пищевода находится опухоль). На коже остается рубец.</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\"><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;\">С учетом размеров новообразования и степени поражения близлежащих тканей могут использоваться следующие хирургические методы лечения:</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;\">Полипэктомия. Применяется для удаления полипов, которые не прорастают вглубь стенки органа.</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;\">Энуклеация. Операция используется для удаления кистообразных опухолей и предусматривает их вылущивание с капсулой. В ходе процедуры пищевод сохраняется полностью.</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 части пищевода. При глубоком прорастании опухоли используется частичное удаление органа в пределах здоровых тканей.</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 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 проводится индивидуально в зависимости от особенностей конкретного клинического случая.</span></p>\r\n<p> </p>",
"prevention": "<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;\">Специфической профилактики опухолей пищевода не существует. Рекомендуется вести здоровый образ жизни, избегать контактов с известными канцерогенами и умеренно употреблять острую и горячую пищу.</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;\">Доброкачественные опухоли пищевода отличаются медленным темпом роста. Это обуславливает отсутствие клинической симптоматики на ранних стадиях заболевания. Пациент может годами даже не подозревать о наличии новообразования и вести обычный образ жизни.</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;\">Признаки заболевания возникают уже при больших размерах опухолей, когда они напрямую начинают мешать пищеварению или сдавливать соседние органы. Наиболее распространенными симптомами патологии являются:</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;\">Затрудненное глотание (дисфагия). Опухоль механически мешает пище пройти по пищеводу. Пациент должен запивать еду водой, ему трудно употреблять мясо, хлеб и твердые продукты.</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;\">Легкая или умеренная боль в груди в проекции пищевода. Дискомфорт вызван сдавливанием нервных окончаний опухолью.</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;\">Отрыжка, тошнота, рвота. Эти признаки являются следствием нарушения пищеварения.</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;\">Похудение, общая слабость. Обусловлены нарушением метаболизма на фоне длительного существования опухоли.</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 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;\">При больших размерах новообразований, когда они сдавливают бронхи, легкие или сердце, может возникать одышка, тахикардия, кашель, аритмии.</span></p>",
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"etiology": "<p><span id=\"docs-internal-guid-7bd64637-7fff-0e52-9c97-bafae1b1f52b\"><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;\">Причины развития данной патологии не установлены, однако доказана роль ряда факторов, повышающих риск формирования доброкачественных опухолей печени. Установлено, что заболеваемость выше среди лиц, имеющих отягощенный по онкопатологии семейный анамнез, при неблагоприятной экологической обстановке. Важная роль отводится приему гормональных препаратов, в том числе пероральных контрацептивов, а также особенностям питания: избытку в рационе животных жиров, недостатку клетчатки, витаминов, белка. Факторами риска являются вредные привычки: курение и употребление алкоголя. Индуцирует развитие опухолей печени и физиологическая гиперэстрогенемия при беременности.</span></span></p>",
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"diagnostics": "<p> </p>\r\n<p><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Анализ анамнеза заболевания и жалоб (когда (как давно) появились боли и тяжесть в животе, тошнота, с чем больной связывает возникновение этих симптомов).</span></p>\r\n<p><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Данные объективного осмотра. Врач обращает внимание, есть ли у пациента бледность кожных покровов (она может возникнуть при разрыве опухоли и кровотечении в брюшную полость).</span></p>\r\n<p><span style=\"background-color: transparent; font-size: 7pt; white-space: pre-wrap;\">Инструментально-лабораторные данные.</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Общий анализ крови. Может быть обнаружена анемия (малокровие, снижение в крови гемоглобина (белка-переносчика кислорода в крови)).</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Биохимический анализ крови. Возможно небольшое снижение печеночных ферментов (белков, ускоряющих химические реакции) в крови.</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Исследование крови на опухолевые маркеры – специфические белки, вырабатывающиеся при злокачественных новообразованиях (АФП, СЕА, СА19-9). Проводится для дифференциальной (отличительной) диагностики со злокачественными опухолями печени.</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Ультразвуковое исследование (УЗИ) органов брюшной полости для определения наличия опухоли в печени.</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Компьютерная томография (КТ) для выявления опухоли печени.</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Магнитно-резонансная томография (МРТ). Проводится для выявления опухоли в печени.</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Рентгенография органов брюшной полости. Выявление опухоли и ее кальцификации (отложения солей кальция).</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Сцинтиграфия (введение в организм радиоактивных элементов, способных испускать излучение; это используется для получения изображения, где и в каких органах эти элементы задерживаются) выявляет локализацию (расположение) опухоли, ее размеры.</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Ангиография (рентгенологическое исследование кровеносных сосудов).</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Пункционная биопсия опухоли (взятие кусочка ткани опухоли на гистологическое (тканевое) исследование).</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Эластография (сканирование ткани печени с установлением степени ее плотности (эластичности)).</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Эндоскопическая ретроградная панкреатохолангиография (ЭРПХГ) — метод исследования желчных протоков и протоков поджелудочной железы. Проводится для того, чтобы определить, сдавливает ли опухоль желчные протоки.</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Магнитно-резонансная панкреатохолангиография (МРПХГ) – метод компьютерного исследования панкреатического, внепеченочного и внутрипеченочных желчных протоков в условиях электромагнитного поля (потоков электромагнитных волн).</span></li>\r\n</ul>",
"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;\">Как правило, опухоли, протекающие без клинической симптоматики, не требуют лечения. Однако пациент должен постоянно наблюдаться у врача-гепатолога для оценки характера роста образования. При использовании гормональных препаратов (особенно контрацептивов женщинами) решается вопрос об их отмене. В некоторых случаях (при гепатоцеллюлярной карциноме) это приводит к регрессу образования, если оно является гормонозависимым.</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;\">При крупных размерах опухоли, сдавлении кровеносных сосудов или желчевыводящих путей производится ее удаление с резекцией доли печени. Также оперативному удалению подлежат кистозные образования с высоким риском разрыва и кровотечения. Доброкачественные новообразования печени часто гормонозависимые, поэтому даже при небольших размерах могут удаляться у женщин, планирующих беременность.</span></p>",
"prevention": "<p><span id=\"docs-internal-guid-be293d45-7fff-73f0-6a1f-06eba8a259a0\"><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;\">Специфической профилактики не существует. Необходимо соблюдение рационального питания, отказ от курения и употребления алкоголя, а также отсутствие бесконтрольного использования лекарственных препаратов, в особенности гормональных.</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;\">Чаще всего доброкачественные опухоли печени, не достигнув больших размеров, никак себя никак не проявляют, поэтому диагноз ставится случайно, во время выполнения планового ультразвукового исследования (УЗИ).</span></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;\"> </span></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;\">Возможны такие симптомы, как:</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">боли (возникают при механическом сдавлении опухолью соседних органов, локализуются (располагаются) в эпигастрии (верхнем отделе живота));</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">тошнота;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">отрыжка воздухом.</span></li>\r\n</ul>\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;\"> </span></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;\">Поскольку четких клинических признаков, которые отличают доброкачественные опухоли от злокачественных, нет, используют ряд признаков, позволяющих их отличить:</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">отсутствие злокачественных новообразований в прошлом;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">отсутствие опухолевой интоксикации (отравления) — общая слабость, быстрая утомляемость, снижение аппетита, тошнота, рвота, повышение температуры тела, цианоз (посинение) и бледность кожных покровов;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">нормальный уровень опухолевых маркеров (особых белков, присутствующих при злокачественных новообразованиях в повышенном количестве);</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">особенности кровоснабжения (неравномерное распределение сосудов в опухоли) при ангиографии (рентгенологическом исследовании сосудов);</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">отсутствие роста опухоли или незначительный рост в течение длительного срока.</span></li>\r\n</ul>",
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"code": "D13.9",
"name": "Доброкачественная опухоль неточно обозначенных локализаций в пределах пищевари-",
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"description": "",
"etiology": "",
"pathogenesis": "",
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"standard_type": 3,
"danger": 1,
"published": 1,
"parent": 8006,
"block_rubric": 37,
"standards": []
}
]
}