rak tolstoy kishki

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yugon ichak saratoni rak tolstoy kishki rak tolstoy kishki obodochnaya kishka 1. sigmovidnaya (lateralnaya stenka) 2. slepaya kishka (zadnyaya stenka) 3. rektosigmoidniy ugol 4. praviy ugol 5. vosxodyashe-obodochnaya (medialnaya stenka) 6. poperechno-obodochnaya 7. nisxodyashe-obodochnaya (medialnaya stenka) 8. leviy ugol pryamaya kishka verxne-ampulyarniy (10-15 sm) sredne-ampulyarniy (5-10 sm) nijne-ampulyarniy (5 sm) analniy kanal regionar-nie limfati-cheskie uzli tolstoy kishki. regionarnie limfaticheskie uzli pryamoy kishki epidemiologicheskie dannie sredi zotk 99%- rak, 1%- sarkomi i dr. zlokachestvennie opuxoli rtk - 4 mesto (obodochnaya-17%,pryamaya-10%, v ekonomicheski razvitix stranax -2 mesto) ejegodno v mire diagnostiruetsya okolo 1 mln. bolnix rtk i u 50% letalniy isxod epidemiologicheskie dannie ssha (konnektikut) daniya velikobritaniya rossiya sng uzbekistan (djizak, kashkadarya) 15-17 / 100 tis. 10 / 100 tis. 7 /100 tis. 3 /100 tis. epidemiologicheskie dannie rtk chashe vstrechaetsya v 40-60 letnem vozraste rak obodochnoy kishki v 2-3 raza chashe vstrechaetsya u jenshin rak pryamoy kishki v 3-4 raza chashe …

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atsiya gub i shek) nyak (risk v 30 vishe) sindrom olfrida (polipoz tk+ateromatoz) sindrom tyurko (polipoz tk+opuxoli tsns) polipi tk bolezn krona (im-15%) endometrioz tk xronicheskiy paraproktit, treshini leyomioma tk morfologicheskaya xarakteristika rtk makroskopicheski 1.endofitnaya (68%)-levaya polovina 2.ekzofitnaya (28%)-poperechnaya i pravaya 3.smeshanniy rost (4%) mikroskopicheski 1.tubullyarniy 2.perstnevidno-kletochniy 3.plosko-kletochniy 4.adenokartsinoma 5.slizistiy 6.melko-kletochniy 7.adeno-plosko-kletochniy metastazirovanie pri rtk regionarnoe pravaya polovina ok- l/u verxne-brizjeechnoy arterii levaya polovina ok – l/u nijne-brizjeechnoy arterii verxnyaya 1/3 pryamoy kishki – tazovie l/u nijne-ampulyarniy otdel i analniy kanal – paxovie l/u otdalennoe pechen legkie zabryushinnoe prostranstvo selezenka golovnoy mozg klassifikatsiya rtk tnm t1- slizistaya t2- mishechniy sloy t3- seroznaya obolochka t4- sosednie tkani n1- 1-3 l/u n2 - 4 i bolee l/u m1- otdalenniy metastaz 0- net opuxoli x- nedostatochno dannix d'yuk a (t1-2n0m0) b (t3-4n0m0) c (t0-4n1-2m0) d (t0-4n0-4m1) osnovnie klinicheskie simptomi pri rtk obshie simptomi (anemiya, asteniya, intoksikatsiya, depressiya) mestnie simptomi a) svyazannie s pervichnim …

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, sliz v stule boli v levom podrebere v levoy podvzdoshnoy oblasti klinicheskie simptomi pri rake pryamoy kishki izmeneniya ritma defekatsii zapori tenezmi izmeneniya formi stula primes krovi, gnoya, slizi, op.mass v stule bol (usilivaetsya pri defekatsii) kishechnaya neproxodimost oslojneniya raka tolstogo kishechnika krovotecheniya (75-90%) ostraya, xronicheskaya, chastichnaya, polnaya kishechnaya neproxodimost perforatsiya - peritonit - flegmona zabryushinnogo prostranstva - flegmona malogo taza penetratsiya (formirovanie svishey) tromboticheskie oslojneniya (12-15%) problemi diagnostiki rtk diagnosticheskie oshibki – pri pervichnom osmotre u 10-15% bolnix rtk pravilno ustanavlivaetsya diagnoz pozdnee obrashenie k spetsialistu – pri poyavlenii pervix priznakov -30%,cherez 6 mes. - 30% i cherez 1 god - 40% patsientov pri pervichnom obrashenii ustanavlivaetsya: u 42% lokalnaya opuxol, u 38% regionarnie metastazi, u 20% otdalennie metastazi, prichem v 80-85% sluchaev v pecheni metodi diagnostiki rtk osmotr i palpatsiya analnoy zoni palpatsiya paxovix oblastey paltsevoe issledovanie pryamoy kishki (65-80%) vaginalnoe issledovanie rektoskopiya biopsiya kontrastnoe rentgen obsledovanie …

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sigmovidnoy kishki. destsendostoma. sigmorektoanastomoz. operatsiya gartmana xirurgicheskoe lechenie raka pryamoy kishki perednyaya rezektsiya pryamoy kishki. sigmostomiya. sigmorektoanastomoz. bryushinno-promejnostnaya rezektsiya. sigmostomiya. sigmorektoanastomoz. bryushinno-promejnostnaya eksterpatsiya. sigmostomiya. sigmoanal anastomoz. bryushno-promejnaya ekstipratsiya pryamoy kishki s formirovaniem sigmostomi perednyaya ili chrezbryushinnaya rezektsiya pryamoy kishki bryushno-analnaya rezektsiya pryamoy kishki s nizvedeniem sigmovidnoy kishki i soxraneniem sfinktera ximioterapiya v lechenii rtk preparati ftoruratsil doksorubitsin oksaliplatin kseloda leykovorin mitomitsin tsisplatin irinotekan (kampto) avastin puti vvedeniya v venu v arteriyu ximioembolizatsiya intraabdominalno endolimfalno intralimfalno (d. thoracicus) luchevaya terapiya v lechenii rtk predoperatsionnaya (neoad'yuvantnaya) dtgt posleoperatsionnaya (ad'yuvantnaya) dtgt palliativnaya dtgt braxiaterapiya vibor taktiki lecheniya rtk pokazateli 5-letney vijivaemosti pri rtk obshaya 46-62% lokalnaya forma 92% regionarnie metastazi 64% otdalennie metastazi 7% profilaktika raka tolstoy kishki pervichnaya – ustranenie ili umenshenie vozdeystviya predraspolagayushix faktorov dlya raka tolstoy kishki vtorichnaya – lechenie predrakovix zabolevaniy (preduprejdenie razvitiya retsidivov i metastazov posle radikalnogo lecheniya) rak obodochnoy kishki (zaklyuchenie) chastota rok vozrastaet, na 5 meste, …

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v sredney i nijney chasti ampuli do 90%-adenokartsinoma pri porajenii nijney treti i analnogo kanala porajayutsya l/u paxovix oblastey luchevaya terapiya: radikalnaya - i-ii st. analnogo raka palliativ - iii st + radikalnaya operatsiya ctadii taktika lecheniya i op+xt(4 kurs) ii lt(30gr)+op+xt(4-6) iii lt(40gr) (xt)+op+xt (lt(40-60gr)) iv palliativnaya op palliativnaya xt palliativnaya lt simptomaticheskoe iv ctadii taktika lecheniya i op+xt(4 kurs) ii lt(30gr)+op+xt(4-6) iii lt(40gr) (xt)+op+xt (lt(40-60gr)) iv palliativnaya op palliativnaya xt palliativnaya lt simptomaticheskoe iv

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yugon ichak saratoni rak tolstoy kishki rak tolstoy kishki obodochnaya kishka 1. sigmovidnaya (lateralnaya stenka) 2. slepaya kishka (zadnyaya stenka) 3. rektosigmoidniy ugol 4. praviy ugol 5. vosxodyashe-obodochnaya (medialnaya stenka) 6. poperechno-obodochnaya 7. nisxodyashe-obodochnaya (medialnaya stenka) 8. leviy ugol pryamaya kishka verxne-ampulyarniy (10-15 sm) sredne-ampulyarniy (5-10 sm) nijne-ampulyarniy (5 sm) analniy kanal regionar-nie limfati-cheskie uzli tolstoy kishki. regionarnie limfaticheskie uzli pryamoy kishki epidemiologicheskie dannie sredi zotk 99%- rak, 1%- sarkomi i dr. zlokachestvennie opuxoli rtk - 4 mesto (obodochnaya-17%,pryamaya-10%, v ekonomicheski razvitix stranax -2 mesto) ejegodno v mire diagnostiruetsya okolo 1 mln. bolnix rtk i u 50% letalniy isxod epidem...

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