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"lead": "Гемангио́ма ( — доброкачественная опухоль, состоящая из самостоятельно инволюционирующих эндотелиальных клеток",
"description": "<p>Гемангиома появляется у детей как родимое пятно. Такое изменение является результатом порока развития сосудов. Частота обнаружения гемангиом у новорожденных достигает 3%. В 10% проблему выявляют на первом году жизни ребенка. Данные статистики подтверждают, что это самая распространенная доброкачественная опухоль мягких тканей в педиатрии. Частота обнаружения достигает 50% случаев. Проблема в 3-5 раза чаще выявляется у девочек. Гемангиома у взрослых проявляется в исключительных случаях при неполноценном лечении в детском возрасте.</p>\r\n<p> </p>\r\n<p>Доброкачественная опухоль быстро прогрессирует. Она стремительно разрастается на поверхности кожи и в глубину. По мере роста, дефект способен разругать окружающие ткани, приводить к нарушению функций зрения, слуха, дыхания. При травмировании гемангиомы возникает риск инфицирования и образования язвенных деформаций на поверхности.</p>\r\n<p> </p>\r\n<p> </p>",
"etiology": "<p>Точных причин возникновения гемангиом выявить пока не удалось; принято считать, что их появление может спровоцировать нарушение внутриутробного развития плода из-за вирусной болезни матери либо кислородного голодания. Дополнительные факторы риска образования врожденной гемангиомы:</p>\r\n<ul>\r\n<li>многоплодная и/или поздняя беременность;</li>\r\n<li>повышенное количество эстрогена у матери;</li>\r\n<li>ее малоподвижный образ жизни;</li>\r\n<li>несбалансированный рацион;</li>\r\n<li>алкогольная или никотиновая интоксикация плода;</li>\r\n<li>его низкий вес при рождении.</li>\r\n</ul>\r\n<p>У взрослых причиной новообразования могут стать наследственная предрасположенность, заболевания сердечно-сосудистой системы, избыточное ультрафиолетовое облучение, повышенный уровень женских гормонов эстрогенов.</p>",
"pathogenesis": "<p>Гемангиома представляет собой красное пятно, в центре которого расположена точка, а из неё исходит сеть небольших сосудов. Обычно новообразование гладкое, может выступать на 1-2 см над кожей. При нажатии становится бледным, но быстро возвращается к своему обычному виду. Характерный симптом – неравномерность температуры: при пальпации гемангиома заметно теплее окружающих участков тела. Клинически может никак себя не проявлять и обнаруживаться случайно при осмотре.</p>\r\n<p>Заболевание протекает фазами – рост, стабилизация, опционально – спонтанный регресс. В фазах роста и стабилизации гемангиомы возможны осложнения. Если новообразование растет около функционального органа, его работа может ухудшаться – например, в периорбитальной зоне оно может способствовать снижению зрения, а на слизистой гортани – обструкции дыхания.</p>\r\n<p>Если гемангиома локализована около нервного окончания, при ее росте возможны слабость и онемение конечностей, нарушение работы мочевого пузыря и ЖКТ. Крупные гемангиомы позвоночника могут вызывать боль и повышать риск компрессионных переломов. Новообразования легко травмируются, поэтому могут вызывать кровотечения</p>",
"diagnostics": "<div class=\"accordion__content\">\r\n<p class=\"paragraph b6C6nEQ unit_text_m\">Диагностика гемангиомы осуществляется врачом-хирургом с использованием следующих методик:</p>\r\n<ul class=\"list list_unordered b6C6nEQ unit_text_m\">\r\n<li class=\"list__item list__item_paragraph\">Осмотр</li>\r\n<li class=\"list__item list__item_paragraph\">Лабораторная диагностика</li>\r\n<li class=\"list__item list__item_paragraph\">Ультразвуковое исследование (определение глубины распространения опухоли и расчет объема образования; определяются особенности расположения, структура опухоли, измерение скорости кровотока в сосудах).</li>\r\n<li class=\"list__item list__item_paragraph\">Ангиография (обязательна при обследовании больных с обширными и глубокими гемангиомами)</li>\r\n</ul>\r\n</div>",
"treatment": "<p class=\"paragraph b6C6nEQ unit_text_m\">Лечение гемангиом в большинстве случаев необходимо начинать как можно раньше, сразу после постановки диагноза. Наиболее результативно лечение в первые недели и месяцы жизни ребенка.</p>\r\n<p class=\"paragraph b6C6nEQ unit_text_m\">Хирургическое лечение показано при глубоко расположенных сосудистых гемангиомах, когда можно удалить образование целиком, в пределах здоровых тканей, без значительного косметического ущерба. Оперативный метод лечения целесообразно использовать и в тех случаях, когда применение других способов терапии представляется заведомо неэффективным. Успех лечения достигается в 90% случаев. Послеоперационные осложнения редки.</p>\r\n<p class=\"paragraph b6C6nEQ unit_text_m\">Лучевому лечению подлежат гемангиомы сложных месторасположений, в первую очередь таких областей, где другие методы лечения невозможно использовать, например область глазницы. Лучевая терапия показана также при простых гемангиомах большой площади. Облучение проводится отдельными фракциями с интервалами от 2-4 недель до 2-6 месяцев, до исчезновения гемангиомы. Этот метод лечения относительно сложен, и эффект наступает в течение довольно длительного времени.</p>\r\n<p class=\"paragraph b6C6nEQ unit_text_m\">Диатермоэлектрокоагуляции (прижиганию) подлежат лишь небольшие, точечные гемангиомы в тех случаях, когда опухоль располагается в областях, недоступных для другого метода лечения. Электрокоагуляцию обширных и глубоких образований применять не следует. У части больных после электрокоагуляции наблюдаются косметические дефекты.</p>\r\n<p class=\"paragraph b6C6nEQ unit_text_m\">Склерозирующее лечение показано при небольших, глубоко расположенных сосудистых гемангиомах сложного месторасположения, особенно при лечении небольших кавернозных и комбинированных форм на лице и кончике носа. Для инъекций используют 70% спирт. При комбинированных гемангиомах сначала проводится криогенное или СВЧ-криогенное лечение для гибели поверхностной части опухоли, а затем склерозирующая терапия. Недостатками склерозирующей терапии являются болезненность и длительность лечения. Преимущество инъекционной терапии перед другими консервативными методами лечения заключается в ее простоте.</p>\r\n<p class=\"paragraph b6C6nEQ unit_text_m\">Одним из методов лечения обширных гемангиом наружных покровов у детей является гормональное лечение. Оно проводится гормоном <a class=\"link link-like link-like_type_turbo-navigation b9G2sAKE\" href=\"https://yandex.ru/health/pills/product/prednizolon-46443?parent-reqid=1617706803001125-1117516131332047011200135-production-app-host-vla-web-yp-322&utm_source=portal&utm_medium=diseases&utm_campaign=yamd-crosslinks&utm_content=link-from-encyclopedia-to-pills\" data-bem=\"{"link-like":{}}\" data-log-node=\"gjiq\" data-clickable=\"\">преднизолоном</a>. Суточная доза <a class=\"link link-like link-like_type_turbo-navigation b9G2sAKE\" href=\"https://yandex.ru/health/pills/product/prednizolon-46443?parent-reqid=1617706803001125-1117516131332047011200135-production-app-host-vla-web-yp-322&utm_source=portal&utm_medium=diseases&utm_campaign=yamd-crosslinks&utm_content=link-from-encyclopedia-to-pills\" data-bem=\"{"link-like":{}}\" data-log-node=\"gjir\" data-clickable=\"\">преднизолона</a> в таблетках делится на 2 приема: в 6 часов утра ребенок получает 2/3 дозы, в 9 часов утра - 1/3 дозы. Препарат принимается через день без снижения дозировки. Продолжительность курса лечения - 28 дней. При необходимости через 6-8 недель курс лечения повторяют. Данный метод останавливает рост сосудистой опухоли. Долечивание гемангиом после гормонотерапии другими методами позволяет решить косметические проблемы.</p>\r\n<p class=\"paragraph b6C6nEQ unit_text_m\">Широкое применение низкотемпературного воздействия связано с использованием специальных аппаратов и замораживающих систем, что позволяет расширить возможности метода. Благодаря таким важным свойствам, как безболезненность, отсутствие кровотечения и заметной общей реакции организма - криогенный метод широко распространен в лечении гемангиом. Криогенному лечению подлежат все простые гемангиомы небольшой площади, любого расположения и в любом возрасте ребенка. Для лечебного воздействия применяется аппаратный криогенный метод, где в качестве охлаждающего агента используется жидкий азот. Оптимальная продолжительность криовоздействия - 20-25 секунд для гемангиом, располагающихся на коже, и 7-10 секунд для гемангиом, располагающихся на слизистых оболочках. Общая площадь криовоздействия не должна превышать 10 см<sup class=\"sup\">2</sup>.</p>\r\n<p class=\"paragraph b6C6nEQ unit_text_m\">При простых гемангиомах наиболее целесообразно использовать криогенный метод.</p>\r\n<p class=\"paragraph b6C6nEQ unit_text_m\">При лечении простых гемангиом бо</p>\r\n<div class=\"accordion__item accordion__item_expanded b9G2sAKE\" data-bem=\"{"accordion__item":{}}\" data-log-node=\"gjio\">\r\n<div class=\"accordion__content\">\r\n<p class=\"paragraph b6C6nEQ unit_text_m\">льшой площади гормональная и лучевая терапия являются методами выбора.</p>\r\n<p class=\"paragraph b6C6nEQ unit_text_m\">При кавернозных и комбинированных формах наиболее эффективны склерозирующий, хирургический и СВЧ-криогенный методы.</p>\r\n<p class=\"paragraph b6C6nEQ unit_text_m\">При обширных и глубоких гемангиомах околоушной области эффективно комплексное лечение, включающее в себя обязательную ангиографию и эмболизацию гемангиомы.</p>\r\n</div>\r\n</div>",
"prevention": "<p>Гемангиомы могут становиться причиной некроза(омертвения) тканей, поэтому очаг поражения становится входными воротами для инфекции. Присоединение гнойного процесса может стать причиной сепсиса. При гемангиоме костей возможно их разрушение. Кроме этого, процесс может способствовать нарушению свертываемости крови и образованию тромбов. Возможна малигнизация –перерождение гемангиомы в рак. При своевременном обращении к врачу новообразование успешно лечится в 100% случаев<span class=\"info-note\"><a> <br /></a></span></p>",
"clinical_picture": "<p>Существует 2 вида гемангиом – врожденные – сформированные во время внутриутробного развития – и приобретенные; приобретенные в раннем детском возрасте нередко называют младенческими. По структуре различают единичные и множественные гемангиомы (гемангиоматоз), по строению – капиллярные, артериальные и венозные.</p>\r\n<p>По образованию они бывают местными и сегментарными. Местные гемангиомы растут из одной точки, отличаются ровными краями и сравнительно небольшими размерами. Сегментарные – крупные, с «рваным» краем, нередко развиваются в рамках сочетанных патологий грудной клетки, аорты, таза и крестца, пороков сердца и т. д.</p>\r\n<p>По локализации выделяют гемангиомы:</p>\r\n<ul>\r\n<li>простую – образована на поверхности кожи;</li>\r\n<li>кавернозную– растет под кожей;</li>\r\n<li>комбинированную– в процесс вовлечены поверхностные и глубокие слои дермы;</li>\r\n<li>смешанную– в процесс вовлечены не только дермальные, но также нервные и мышечные ткани.</li>\r\n</ul>\r\n<h2 id=\"ank3\"> </h2>",
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"code": "D22.9",
"name": "Доброкачественная опухоль меланоформный невус неуточненный",
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"lead": "",
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"etiology": "",
"pathogenesis": "",
"diagnostics": "",
"treatment": "",
"prevention": "",
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"image": null,
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"standard_type": 3,
"danger": 1,
"published": 1,
"parent": 8015,
"block_rubric": 37,
"standards": []
}
]
}
