mastopatiya

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fibrozno-kistoznaya bolezn. fibrozno-kistoznaya bolezn. faktori riska, klinika, diagnostika, lechenie. mastopatiya mastopatiyu kak zabolevanie klassicheski opisal j.velpean v 1838g. mastopatiya – fibrozno-kistoznaya bolezn – eto disgormonalniy giperplasticheskiy protsess, xarakterizuyushiysya narusheniem sootnosheniya epitelialnogo i soedinitelnotkannogo komponentov, shirokim spektrom proliferativnix i regressivnix izmeneniy tkani molochnoy jelezi (voz, 1984g) okolo 30 sinonimov: disgormonalnaya displaziya, kistoznaya deskvamativnaya giperplaziya, xronicheskiy kistozniy mastit, bolezn reklyu, bolezn mintsa, makrokistozniy fibroadenomatoz i dr. v angloyazichnoy literature: mastophaty, bebd (benign epithelial breast disease), ccbd (complex cystic breast disease) (croce s, 2008, doshi dj, 2007) fkb okolo 75-80% jenshin reproduktivnogo vozrasta stradayut razlichnimi zabolevaniyami molochnix jelez, samim rasprostranennim dobrokachestvennim zabolevaniem yavlyaetsya fkb (1) risk vozniknoveniya raka molochnoy jelezi na fone fkb vozrastaet v 3-5 raz, a pri proliferativnix formax fkb v 25-30raz (2). na ambulatornom prieme onkologa do 50% patsientok sostavlyayut bolnie s fkb (3) 1.kulakov v.i., prilepskaya v.n., 2005g 2. letyagin v.p., 2000; semiglazovv.f., 2000; allred d.c., mohshin s.k., figua …

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9 11735 818 1329 602 209 5437 3,4 2008 18745 2054 7,5 12747 749 1227 595 228 5393 1,9 2009 19005 2105 7,6 12747 790 1214 688 203 5984 0,9 3,3 2010 19115 2273 8,1 13593 946 1244 828 224 6335 1,1 3,5 anatomicheskaya xarakteristika molochnoy jelezi mj sostoit iz 15-25 doley (4), kajdaya dolya sostoit iz 20-40 dolek(3), kajdaya dolka sostoit iz 10-100 alveolyarnix jelezok (1) i protokov (2). anatomicheskaya xarakteristika molochnoy jelezi epitelialnaya tkan: kubicheskiy epiteliy alveolyarnoy jelezi tsilindricheskiy epiteliy protokov ploskokletochniy orogovevayushiy epiteliy soska soedinitelnaya tkan: lojevaya- okrujaet alveolyarnie jelezki opornaya- okrujaet dolki i doli i obrazuet svyazku kupera jirovaya tkan. vozrastnie izmeneniya molochnoy jelezi fiziologicheskiy adenoz jirovaya involyutsiya molochnoy (vozrast 18-23 let) jelezi (menopauza) molochnaya jeleza kak organ- mishen fsg lg faktori rosta: egfr, ifr prolaktin insulin xorionicheskiy gonadotropin kortizol stg gormoni shitovidnoy jelezi progesteron estrogen molochnaya jeleza izmeneniya mj na protyajenii menstrualnogo tsikla epiteliy molochnoy …

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zlokachestvennix kletok) (3) 1 trimestr 2 trimestr 3 trimestr estrogeni xg xg xg prolaktin prolaktin molochnaya jeleza po vremya beremennosti progesteron progesteron fiziologicheskie effekti xg i prolaktina u jenshin xorionicheskiy gonadotropin (xg) prolaktin ugnetaet proliferatsiyu epiteliya (1, 2, 3): povishaet dnk-vosstanovleniya snijaet kantserogen-dnk svyazivaniya aktiviziruet apoptoz ugnetaet kletochniy rost 1 obespechivaet laktatsiyu: aktivniy rost epitelialnix kletok – laktotsitov; sintez proteinov, jirov, uglevodov moloka 2. podderjivaet sushestvovaniya jeltogo tela i obrazovanie im progesterona etiologicheskie momenti vozniknoveniya mastopatii dlitelniy stress (neudovletvorennost semeynim polojeniem; bitovie konflikti, konfliktnie situatsii na rabote; neblagopriyatnie seksualnie faktori) ginekologicheskiy status (vremya nastupleniya normalnogo menstrualnogo tsikla i menopauzi – rannie menarxe i pozdnyaya menopauza, vospalitelnie zabolevaniya organov malogo taza, kolichestvo iskusstvennix i samoproizvolnix abortov) sostoyanie endokrinnoy sistemi (giperestrogenemiya, giperprolaktinemiya, nedostatok gestagenov, gipotireoz, gepatopatii, privodyashie k gormonalnim narusheniyam) nasledstvennaya predraspolojennost – risk zabolet mastopatiey v 11 raz vishe u jenshin, imeyushix krovnix rodstvennits, stradayushix patologiey molochnix jelez. kak pravilo, imeet …

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rinnaya patologiya (pervichniy gipotireoz, sindrom polikistoznix yaichnikov, disfunktsiya kori nadpochechnikov), tsirroz pecheni, xpn i dr. farmakologicheskaya: neyroleptiki, opiati, n2-blokatori gistaminovix retseptorov ( tsimetidin, ranitidin, famotidin), antidepressanti, gormonalnie kontratseptivi, tserukal, verapamil i dr. idiopaticheskaya giperprolaktinemiya. faktori riska vozniknoveniya fkb 1. giperplasticheskie protsessi genitaliy (genitalniy endometrioz, mioma matki, giperplaziya endometriya). 2. faktori reproduktivnogo xaraktera (kolichestvo beremennostey, rodov, abortov, vozrast pri beremennosti i rodax, dlitelnost laktatsii, vremya poyavleniya menarxe i nastupleniya menopauzi i dr.). 3. ginekologicheskaya patologiya (xronicheskie vospalitelnie zabolevaniya, sindrom polikistoznix yaichnikov (spkya)) 4. endokrinnie formi besplodiya 5. yatrogennaya giperestrogenemiya (priem difaznix kontratseptivov, zamestitelnaya gormonoterapiya, eko). 6. zabolevaniya pecheni 7. endokrinnaya patologiya (gipotireoz, saxarniy diabet, ojirenie, adenoma gipofiza, zabolevaniya nadpochechnikov i dr) 8. psixotravmiruyushie situatsii 9. geneticheskaya predraspolojennost proyavleniya mastopatii patologicheskie izmeneniya razvivayutsya v predelax protokovo-dolkovoy edinitsi. uchastki fibroznoy tkani sochetayutsya s kistoznimi polostyami ili kisti vistlani atroficheskim epiteliem, libo epiteliem, podvergshimsya apokrinovoy metaplazii (inogda metaplaziya nosit slizistiy xarakter). stepen riska raka …

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a razvitiya raka na fone proliferativnix form mastopatii zavisit ot dlitelnosti zabolevaniya i perioda nablyudeniya za patsientkoy; osobennostey traktovki pogranichnix sostoyaniy – predraka i raka; gormonalno-immunologicheskogo statusa i i individualnix vzaimootnosheniy v sisteme «organizm – proliferativnaya tkan molochnoy jelezi» kliniko-rentgenologicheskaya klassifikatsiya fkb. (po n.i. rojkovoy, 1998) i. diffuznaya forma: - adenoz s preobladaniem jelezistogo komponenta; - mastopatiya s preobladaniem fibroznogo komponenta; - mastopatiya s preobladaniem kistoznogo komponenta; - smeshannaya forma diffuznoy kistozno–fibroznoy mastopatii. - skleroziruyushiy adenoz ii. uzlovaya (lokalizovannaya) fibrozno–kistoznaya mastopatiya. klinicheskoe razvitie mastopatii 1 faza – mastalgiya (za 5-7 dney do mesyachnix + 1-2 dnya v nachale menstruatsii). 2 faza – mastalgiya + diskomfort v molochnix jelezax + nagrubanie i otek molochnix jelez (vsya 2 faza) + faza mesyachnix. 3 faza – te je izmeneniya, kak v 1 i 2 fazax + palpatorno opredelyaemie fibrozno-uplotnennie ochagi po vsey tkani molochnix jelez prakticheski ves menstrualniy tsikl. kliniko-morfologicheskaya klassifikatsiya fkb neproliferativnaya …

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fibrozno-kistoznaya bolezn. fibrozno-kistoznaya bolezn. faktori riska, klinika, diagnostika, lechenie. mastopatiya mastopatiyu kak zabolevanie klassicheski opisal j.velpean v 1838g. mastopatiya – fibrozno-kistoznaya bolezn – eto disgormonalniy giperplasticheskiy protsess, xarakterizuyushiysya narusheniem sootnosheniya epitelialnogo i soedinitelnotkannogo komponentov, shirokim spektrom proliferativnix i regressivnix izmeneniy tkani molochnoy jelezi (voz, 1984g) okolo 30 sinonimov: disgormonalnaya displaziya, kistoznaya deskvamativnaya giperplaziya, xronicheskiy kistozniy mastit, bolezn reklyu, bolezn mintsa, makrokistozniy fibroadenomatoz i dr. v angloyazichnoy literature: mastophaty, bebd (benign epithelial breast disease), ccbd (complex cystic breast disease) (croce s, 2008, doshi dj, 200...

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