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"code": "C53",
"name": "Рак шейки матки",
"icd_name": "Рак шейки матки",
"gender": 2,
"age_min": 20,
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0
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"slug": "c53_rak_sheyki_matki",
"lead": "Злокачественное новообразование шейки матки- онкологическое заболевание.",
"description": "Злокачественное новообразование шейки матки- онкологическое заболевание. В структуре онкологической заболеваемости женщин злокачественные опухоли шейки матки составляют почти 15% и среди поражений органов репродуктивной системы стабильно занимают третье место после рака молочной железы и рака эндометрия.",
"etiology": "<p>Ведущую роль в канцерогенезе рака шейки матки отводят вирусу папилломы человека как наиболее частому виду инфекций, передающихся половым путем Возбудитель вируса папилломы человека — группа ДНКсодержащих вирусов, относящихся к семейству Papavaviriade (HPV — human papilloma virus), обладающих способностью инфицировать и трансформировать эпителиальные клетки шейки матки.</p>",
"pathogenesis": "",
"diagnostics": "<p>При выяснении анамнеза необходимо обратить внимание на перенесённые заболевания, нарушения менструальной и репродуктивной функций, изменения в работе кишечника и мочевого пузыря, возраст больной, семейное положение, образ жизни.</p>\r\n<p>Шейка матки доступна для визуальных и инвазивных методов исследования, что способствует выявлению РШМ на ранних стадиях. Ранняя диагностика включает несколько различных исследований.</p>\r\n<p>Расширенная кольпоскопия позволяет изучать состояния эпителия шейки матки под 7,5–40кратным увеличением. Особое внимание уделяют зоне трансформации. Для повышения информативности исследования используют ряд специфических проб. Одна из них состоит в аппликации на шейку матки 3–5% раствора уксусной кислоты, что позволяет оценить состояние терминальной сосудистой сети, питающей эпителий шейки матки.</p>\r\n<p>В качестве опухолевого маркёра плоскоклеточного рака шейки матки в сыворотке крови пациентки определяют уровень специфического Аг — SCC. В норме он не превышает 1,5 нг/мл.</p>\r\n<p>При подозрении на предопухолевую патологию или рака шейки матки необходимо проводить углублённую диагностику (биопсия шейки матки, выскабливание цервикального канала).</p>\r\n<p>Гистологическое исследование считают заключительным и решающим методом диагностики РШМ, позволяющим определить характер морфологических и структурных изменений.</p>\r\n<p>Стадию РШМ определяют с помощью УЗИ, рентгенографии лёгких, цистоскопии, ирригоскопии. По показаниям выполняют КТ и МРТ.</p>",
"treatment": "<p>При раке шейки матки IА1 стадии (без неблагоприятных факторов прогноза) у лиц молодого, репродуктивного возраста, соматически отягощённых больных может быть выполнена высокая конусовидная ампутация шейки матки. После этой операции (в пределах здоровых тканей) показано строгое динамическое наблюдение.</p>\r\n<p>Для сохранения репродуктивной функции можно выполнить высокую конусовидную ампутацию шейки матки с забрюшинной или лапароскопической тазовой лимфодиссекцией.</p>\r\n<p>Стандартное хирургическое лечение РШМ IB1 стадии: расширенная экстирпация матки с придатками.</p>\r\n<p>У больных репродуктивного возраста яичники могут быть сохранены и выведены за пределы таза (возможно проведение послеоперационной лучевой терапии). Транспозиция яичников может быть выполнена при плоскоклеточном раке высокой и умеренной степени дифференцировки и отсутствии опухолевой сосудистой эмболии.</p>\r\n<p>Выбор метода лечения зависит от возраста, соматического статуса, мнения больной. Тактику лечения определяют на консилиуме.</p>",
"prevention": "<p>Риск заболеть раком шейки матки наиболее высок у женщин группы риска (раннее начало половой жизни, частая смена сексуальных партнеров, наличие инфекций, передающихся половым путем, первые роды в очень раннем возрасте, частые аборты). Основным способом профилактики рака шейки матки считают своевременное выявление фоновых, особенно предраковых, процессов и их лечение. Не менее важно использование барьерных средств контрацепции, препятствующих распространению инфекций, передающихся половым путем к которым относят и вирус папилломы человека, считаемый этиологическим фактором развития вируса папилломы человека. </p>",
"clinical_picture": "<p>Рак шейки матки принадлежит к опухолям, которые длительное время протекают бессимптомно. Появление клинических симптомов и жалоб говорит о далеко зашедшем опухолевом процессе. Наиболее часто больные предъявляют жалобы на обильные , кровянистые выделения и боли.</p>\r\n<p>Первые симптомы рака шейки матки. носят жидкий, водянистый характер и обусловлены лимфореей из участка опухоли, подвергшегося некрозу или распаду.</p>\r\n<p>Кровотечения — самый частый клинический симптом. Кровотечения при раке шейки матки носят характер многократно беспорядочно повторяющихся кровянистых выделений, усиливающихся в предменструальном и постменструальном периодах. В начале заболевания кровянистые выделения часто носят характер контактных, возникают после полового акта, натуживания или пальцевого исследования шейки матки.</p>\r\n<p>Боли по своему характеру, локализации, интенсивности бывают различны, бывают локализованы в поясничной области, крестце и под лоном.</p>\r\n<p>Поздние симптомы рака шейки матки. Развиваются в результате регионарного метастазирования, прорастания соседних органов, присоединения воспалительного компонента. К ним относят боли, тела, появление отёков конечностей, нарушения работы кишечника, мочевыделительной системы.</p>\r\n<p>Общие симптомы рака шейки матки. К ним относят общую , повышенную \"></a>, .</p>",
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{
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{
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{
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{
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{
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{
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{
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"code": "C54",
"name": "Рак тела матки",
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"lead": "это злокачественная опухоль слизистой оболочки (эндометрия), изнутри выстилающей тело матки (со стороны полости матки).\r\n",
"description": "Рак тела матки – одно из самых распространенных онкологических заболеваний, составляющее, по разным данным 30% всех онкогинекологических заболеваний, и находящееся на 3-4 месте среди онкологических заболеваний у женщин после рака молочной железы, толстой кишки и легких. По разным данным раком тела матки заболевают до 3% всех женщин. В среднем заболевание возникает у лиц старше 60 лет.\r\n",
"etiology": "<p>К факторам риска развития рака эндометрия относят:</p>\r\n<ul>\r\n<li>эндокриннообменные нарушения (например, , сахарный диабет, гипертоническая болезнь);</li>\r\n<li>гормональнозависимые нарушения функции женских половых органов (ановуляция, гиперэстрогенизм, );</li>\r\n<li>гормональноактивные опухоли яичников (гранулёзотекаклеточная опухоль и опухоль Бреннера в 20% случаев сопровождаются раком эндометрия);</li>\r\n<li>генетическую предрасположенность;</li>\r\n<li>отсутствие половой жизни, беременностей, родов;</li>\r\n<li>позднее наступление менархе, менопаузы (в возрасте старше 55 лет);</li>\r\n</ul>",
"pathogenesis": "<p>Предлагают три гипотезы возникновения и развития рака эндометрия.</p>\r\n<p>Первую из них (эстрогенную) характеризуют проявлением гиперэстрогенизма в сочетании с эндокринными и обменными нарушениями (, сахарный диабет, гипертоническая болезнь), что наблюдают у 70% больных.</p>\r\n<p>Вторая (эстрогеннезависимая) теория подразумевает отсутствие эндокриннообменных расстройств и нарушений овуляции, что наблюдают у 30% больных.</p>\r\n<p>В свете последних открытий в генетике рака пристального внимания заслуживает третья теория развития неоплазии — генетическая.</p>",
"diagnostics": "<p>Диагностический этап — ведущий и ответственный момент, позволяющий врачу выбрать наиболее правильную тактику лечения, ориентируясь на возраст больной, распространённость (стадию) процесса (локализация неоплазии, выраженность её инвазии в миометрий), морфологическую структуру опухоли, степень дифференцировки опухолевых клеток, потенциальную чувствительность данного вида опухоли к гормональной или лучевой терапии, выраженность экстрагенитальной патологии, выступающей противопоказанием к проведению того или иного метода лечения.</p>\r\n<p>Цитологический метод широко применяют в клинической практике благодаря его доступности и возможности многократного исследования в условиях поликлиники.</p>\r\n<p>В настоящее время ведущим диагностическим скринингтестом при массовых обследованиях населения считают ультразвуковое сканирование, позволяющее визуализировать патологические изменения в эндометрии у лиц любой возрастной категории.</p>\r\n<p>Гистероскопия позволяет не только судить о выраженности и распространённости неопластического процесса, но и производить прицельную биопсию патологически изменённого эпителия, а также оценивать качество раздельного лечебно- диагностического выскабливания и целесообразность его выполнения.</p>\r\n<p>Заключительным и решающим методом диагностики рака эндометрия является гистологическое исследование, позволяющее определить характер морфологических изменений.</p>",
"treatment": "<p>В настоящее время в России при раке эндометрия проводят комплексное лечение, включающее хирургический, лучевой и лекарственный компоненты. Последовательность и интенсивность каждого из них определяют степенью распространения заболевания и биологическими особенностями опухолевого процесса. Известны преимущества хирургического, комбинированного и комплексного лечения рака тела матки, при которых достигают высоких показателей пятилетней выживаемости (80–90%), что на 20–25% выше, чем при лучевой терапии. Лечение назначают индивидуально, что зависит от прогностических факторов.</p>\r\n<p>Хирургический метод считают основным в комплексном и комбинированном лечении.</p>\r\n<p>Один из компонентов комбинированного лечения при распространённых формах рака тела матки — лучевая терапия.</p>\r\n<p>Химиотерапию проводят лишь как компонент комплексного лечения. Наиболее распространённая схема поддерживающей химиотерапии для лечения рака тела матки — САР (цисплатин, доксорубицин, циклофосфамид).</p>",
"prevention": "<p>Специфической профилактики не существует.</p>",
"clinical_picture": "<p>На ранних стадиях заболевание протекает бессимптомно. Основными клиническими симптомами рака тела матки бывают кровянистые выделения из половых путей, водянистые и боли.</p>\r\n<p>Наиболее часто наблюдаемый симптом — атипичное маточное — непатогномоничен для рака эндометрия, поскольку характерен для многих гинекологических заболеваний (например, миома матки, аденомиоз), особенно у женщин репродуктивного и перименопаузального периодов. Больные детородного возраста чаще обращаются за помощью в женскую консультацию, где длительное время наблюдаются и лечатся у гинекологов по поводу дисфункциональных нарушений.</p>\r\n<p>Однако бывает «классическим» симптомом только в постменопаузе.</p>\r\n<p>Появление обильных серозных белей у женщин пожилого возраста без сопутствующих воспалительных заболеваний матки, влагалища, шейки матки характерно для рака тела матки. Развитие заболевания может сопровождаться обильными водянистыми выделениями (лейкореей), характерными для РМТ.</p>\r\n<p>Боли — поздний симптом заболевания. Чаще локализуются внизу живота и поясничнокрестцовой области, носят схваткообразный или постоянный характер. Значительная часть больных обращаются к врачу с опозданием, т.е. когда уже есть признаки распространения опухолевого процесса (нарушение функции мочевого пузыря, кишечника). Это связано с низким уровнем медикопросветительной работы и отсутствием профилактических осмотров, проводимых среди населения.</p>",
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},
"code": "B76",
"name": "Анкилостомидоз",
"icd_name": "Анкилостомидоз",
"gender": 2,
"age_min": 0,
"age_max": 100,
"cause": [
2,
5,
7
],
"periodicity": 1,
"slug": "b76_ankilostomidoz",
"lead": "Называются гельминтозы анкилостомоз и некатороз, обладающие большим сходством биологии возбудителей, патогенеза и клиники и часто встречающиеся совместно. ",
"description": "",
"etiology": "<p>Возбудители анкилостомидоза — круглые гельминты семейства Ancylostomatidae: Ancylostomaduodenale (Dubini, 1843), A. braziliense (de Faria,1910), Necator americanus (Stiles, 1902). Анкилостомидозы широко распространены в тропической и субтропической зонах, в областях с жарким и влажным климатом, между 450 с. ш. и 30° ю. ш., особенно в Южной и Центральной Америке, Азии и Африке. На территории России некатороз регистрируется на черноморском побережье Краснодарского края. Развитие личинок анкилостомид во внешней среде возможно при температуре от 14 до 40° (оптимальная — 27—30°) и высокой влажности почвы, лишь небольшая часть личинок способна перезимовать в глубоких слоях почвы при незначительных понижениях температуры. В субтропических зонах почва полностью очищается от личинок, поэтому заражение носит сезонный характер, в тропических районах оно может носить круглогодичный характер, усиливаясь в сезон дождей. Источником инвазии A. duodenale и N. americanus являются больные люди, A braziliense — преимущественно собаки и кошки. Заражение анкилостомозом происходит через загрязненные руки, овощи, фрукты, зелень, а некаторозом — при ходьбе босиком, лежании на земле.</p>",
"pathogenesis": "<p>Анкилостома и некатор локализуются в тонком кишечнике, главным образом в двенадцатиперстной и тощей кишках. Личинки анкилостом попадают в организм хозяина преимущественно через рот и развиваются в кишечнике без миграции. Личинки некатора обычно внедряются активно через кожу, проникают в кровеносные капилляры, мигрируют по большому и малому кругам кровообращения. Достигнув легких, через воздухоносные пути, гортань и глотку они попадают в пищевод и кишечник, где через 4—5 недель развива-ются во взрослых гельминтов. Паразитируя в кишечнике, гельминты питаются в основном кровью, нанося слизистой оболочке кишки мелкие ранения хитино-вым вооружением ротовой капсулы. В головном и шейном отделах имеются железы, которые выделяют особые антикоагулянты, которые обусловливают длительное <a href=\"/symptom/krovotechenie/\" title=\"Перейти на страницу симптома Кровотечение\">кровотечение</a>. Интенсивная инвазия, особенно в детском и молодом возрасте, может привести к задержке в физическом и умственном развитии, истощению и кахексии. Нередко в этих случаях инвазия заканчивается летальным исходом. Продолжительность жизни гельминтов, вероятно, 3—5 лет, возможно, дольше. Большинство анкилостомид погибает через 1—2 года после проникновения в тело человека.</p>",
"diagnostics": "<p align=\"justify\">В различные фазы анкилостомидоза пациент может обращаться за медицинской помощью к отоларингологу, пульмонологу, гастроэнтерологу или терапевту. При диагностике анкилостомидоза учитываются клинические и эпидемиологические данные. В периферической крови отмечается гипохромная железодефицитная анемия, увеличение СОЭ, эозинофилия, гипоальбуминемия. При исследовании общего анализа мокроты обнаруживается большое количество эозинофилов. В фазу миграции на рентгенограммах легких могут выявляться воспалительные эозинофильные инфильтраты; на ЭКГ – признаки миокардиодистрофии. Данные рентгенографии пассажа бария указывают на гипотонию кишечника, нарушение моторики с явлениями застоя каловых масс.</p>\r\n<p align=\"justify\">Решающими для подтверждения анкилостомидоза являются результаты анализа кала на яйца гельминтов или исследования содержимого</p>\r\n<full></full>\r\n<p align=\"justify\">12-перстной кишки, получаемого при дуоденальном зондировании. Кроме этого, используются серологические методы диагностики (реакции гемагглютинации и латекс-агглютинации). Поскольку яйца анкилостомид имеют одинаковое строение, идентификация гельминтов (анкилостом и некаторов) возможна лишь после проведения дегельминтизации и отхождения с калом взрослых особей.</p>",
"treatment": "<p>Этиотропная терапия анкилостомидоза проводится противогельминтными препаратами, назначаемыми врачом инфекционистом (паразитологом). Для проведения дегельминтизации используются следующие лекарственные средства: пирантел, нафтамон, левамизол, вермокс. Через 3-4 недели после антигельминтной терапии проводится контроль эффективности лечения – 3-хкратное исследование кала с интервалом в 1 месяц. Симптоматическое и патогенетическое лечение анкилостомидоза предполагает назначение препаратов железа, витамина B12, фолиевой кислоты, антигистаминных средств и др.</p>",
"prevention": "<p>Профилактические мероприятия заключаются в соблюдении норм личной гигиены - мытье рук после посещения туалета, защите кожных покровов при контакте с землей, тщательной обработке фруктов и овощей, кипячении воды перед употреблением и т. д. Важное значение имеет санитарная обработка участков почвы и объектов внешней среды, предположительно загрязненных личинками анкилостомид. Группы повышенного риска по заболеваемости анкилостомидозом должны проходить ежегодное медицинское обследование.</p>",
"clinical_picture": "<p>При проникновении через кожу возникает <a title=\"Перейти на страницу симптома Зуд\" href=\"../../../symptom/zud/\">зуд</a> и жжение кожи, различного рода <a title=\"Перейти на страницу симптома Сыпь\" href=\"../../../symptom/syp/\">высыпания</a> (эритематозные, папулезные, везикулезные, пустулезные), которые могут сохраняться в течение нескольких месяцев. Массивная инвазия приводит к отекам конечностей. При миграции личинок через дыхательные пути возможно развитие катаральных явлений, появляются <a title=\"Перейти на страницу симптома Одышка\" href=\"../../../symptom/odyshka/\">одышка</a>, <a title=\"Перейти на страницу симптома Хрипы\" href=\"../../../symptom/hripy/\">хрипы</a>, возможно развитие бронхита, плеврита, пневмонии. На более поздней стадии, при попадании в желудочно-кишечный тракт, развивается дуоденит с изжогой, отсутствием или усилением аппетита, иногда извращением вкуса (желанием есть, например, глину), тошнотой, рвотой, болями в подложечной и печеночной области, нередко сопровождающиеся диареей.</p>\r\n<full></full>\r\n<p><br /><br />Наиболее характерное проявление заболевания – гипохромная железодефицитная анемия. Анкилостома питается кровью. Зубцами она прикрепляется к стенкам слизистой оболочки кишки. На месте фиксации гельминта возникают <a title=\"Перейти на страницу симптома Изменения структуры кожи\" href=\"../../../symptom/izmeneniya_struktury_kozhi/\">эрозии</a> и язвы до 2 см в диаметре, при этом могут проявиться длительные кишечные кровотечения, которые и вызывают развитие железодефицитной анемии. Снижается белок крови (гипоальбуминемия). <br /><br />Поражается центральная нервная система, появляется <a title=\"Перейти на страницу симптома Вялость\" href=\"../../../symptom/vyalost/\">вялость</a>, отставание в умственном и физическом развитии.</p>",
"image": null,
"image_alt": null,
"standard_type": 1,
"danger": 16,
"published": 1,
"parent": null,
"block_rubric": 17,
"standards": []
}
]
}
