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Оптимізація хірургічного лікування післяопераційних вентральних гриж великих розмірів у хворих із ожирінням: Автореф. дис… канд. мед. наук / Р.Б. Ли

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I?i?noa?noai ioi?iie caei?ia’y Oe?a?ie

Ee?anueea iaaee/ia aeaaeai?y i?neyaeeieiiii? ina?oe ?i. I.E.Ooieea

Eenaiei ?oneai Ai?eniae/

OAeE 616.55-007.43-089

IIOEI?CAOe?ss O??O?A?*IIAI E?EOAAIIss I?NEssIIA?AOe?EIEO AAIO?AEUeIEO
A?EAE AAEEEEO ?ICI???A

O OAI?EO ?C IAEE??IIssI

14. 01. 03 – o??o?a?y

Aaoi?aoa?ao

aeena?oaoe?? ia caeiaoooy iaoeiaiai nooiaiy

eaiaeeaeaoa iaaee/ieo iaoe

Ee?a – 1999

Aeena?oaoe??th ? ?oeiien.

?iaioa aeeiiaia a Oe?a?inuee?e iaaee/i?e noiiaoieia?/i?e aeaaeai??

IIC Oe?a?ie (i. Iieoaaa).

IAOEIAEE EA??AIEE:

aeieoi? iaaee/ieo iaoe E?aiiaiei Ieaen?e A?eoi?iae/,

caa?aeoaa/ eaoaae?e caaaeueii? o??o?a?? Oe?a?inueei? iaaee/ii?

noiiaoieia?/ii? aeaaeai?? IIC Oe?a?ie.

IO?Oe?EI? IIIIAIOE:

aeieoi? iaaee/ieo iaoe Neii?io Ieeiea ?aaiiae/, i?ioani? eaoaae?e

iaoieia?/ii? oa oiiia?ao?/ii? aiaoii?? Ee?anueei? iaaee/ii?

aeaaeai?? i?neyaeeieiiii? ina?oe ?i. I.E.Ooieea IIC Oe?a?ie.

aeieoi? iaaee/ieo iaoe *a?aiueei Iaea? Iao?iae/, i?ioani? eaoaae?e

o??o?a?/ieo caoai?thaaiue Iaoe?iiaeueiiai iaaee/iiai oi?aa?neoaoo

?i. I.I.Aiaiiieueoey IIC Oe?a?ie.

I?IA?AeIA ONOAIIAA:

?inoeooo ee?i?/ii? oa aenia?eiaioaeueii? o??o?a?? AII Oe?a?ie,

i. Ee?a.

Caoeno aeena?oaoe?? a?aeaoaeaoueny “____” ______________1999 ?. i
___aiae.

ia can?aeaii? niaoe?ae?ciaaii? a/aii? ?aaee Ae 26. 613. 02 i?e
Ee?anuee?e iaaee/i?e aeaaeai?? i?neyaeeieiiii? ina?oe ?i. I.E.Ooieea IIC
Oe?a?ie

(254112, i. Ee?a, aoe. Aei?iaiaeeoeueea, 9).

C aeena?oaoe??th iiaeia iciaeiieoenue a a?ae?ioaoe? Ee?anueei? iaaee/ii?
aeaaeai?? i?neyaeeieiiii? ina?oe ?i. I.E.Ooieea IIC Oe?a?ie

(254112, i. Ee?a, aoe. Aei?iaiaeeoeueea, 9).

Aaoi?aoa?ao ?ic?neaiee “____” _______________ 1999 ?ieo.

A/aiee nae?aoa?

niaoe?ae?ciaaii? a/aii? ?aaee

e.i.i., aeioeaio
Aaicaeye I.I.

CAAAEUeIA OA?AEOA?ENOEEA ?IAIOE

Aeooaeuei?noue oaie. Iacaaaeath/e ia iaai? oni?oe a aa?i?ieia?? ca
inoaii? ?iee, i?iaeaia i?neyiia?aoe?eieo aaio?aeueieo a?eae (IIAA) ua
inoaoi/ii ia ae??oaia. Aiie oneeaaeiththoue 5-10% on?o eaia?ioii?e, ui
cia/ii iia??oo? aaaeai? ?acoeueoaoe oni?oii aeeiiaieo iia?aoe?e
(I.O.Ca?ea/aoeeee, A.O.ssaiaeei, 1996, E.A.Eaieineee, 1996, E.Ae.
Oineei, A.A.AEaa?ianeee, 1990). *anoi IIAA aaeeeeo ?ici???a aeeeeeathoue
o oai?eo cia/ii a?eueoa no?aaeaeaiue, i?ae oa caoai?thaaiiy, c i?eaiaeo
yeiai aiie aoee ia?aeiii iia?iaai?. Oai?? c IIAA neeaaeathoue
aeinoaoiuei aaaaoi/enaeueiee oa iino?eiee eiioeiaaio iaoe??io?a
o??o?a?/ieo a?aeae?eaiue. E?euee?noue oai?eo aeineoue aaeeea, iino?eii
ca?eueoo?oueny ieoiia aaaa na?aae a?eaeiiin??a, aeinyaath/e 30,9%; IIAA
oaea caeiathoue ae?oaa i?noea i?ney iaoiaeo a?eae (A.A.AEaa?ianeee e
niaao., 1996, O.A.Ia?oeennia, A.I.A?aaeiaa, 1991, I.I.*a?aiueei e
niaao., 1995).

Iacaaaeath/e ia cia/io e?euee?noue o??o?a?/ieo niinia?a ei?aeoe??
/a?aaii? no?iee, ?acoeueoaoe o??o?a?/iiai e?eoaaiiy IIAA ua aeoaea
aeaeae? a?ae caaeia?eueieo, ia ui aeacothoue aeniea /anoioa ?aoeeaeea?a
(4,5-42%) (A.A.3aieyieei, 1991, TH.E.Eaeeo e niaao., 1998, V.J.Hesselink
et al., 1993) oa cia/ia (a?ae 3 aei 12,5%) i?neyiia?aoe?eia
eaoaeuei?noue (A.A.AEaa?ianeee e niaao., 1996, I.I.*a?aiueei e niaao.,
1995, R.W.Luijendijk et al., 1993). ?c caaaeueii? e?eueeino? IIAA a?ey
20% – ?aoeeaeeai? (I.A.Aaoaoeeei e niaao., 1990, Oaoee Aaaan Oaaeaeue,
1997). Iaea?eueo ?iciianthaeaeai? niiniae ieanoeee IIAA ca Iaei oa
Naiaaeeii ia caaaeaee aei?aaaeiaothoue naaa, ai iiaeooue ca?eueooaaoe
aioo??oiuei/a?aaiee oene, iaoya oeaiei, ia oe??ieththoue neaae? i?noey
aiiiaa?ica. Oiio a iaaii? e?eueeino? oai?eo ? aeooaeueiith ieanoeea
aeaoaeo?a ca aeiiiiiaith o?ainieaioao?a, ?ic?iaea iiaeo niinia?a
ieanoeee.

Cia/ia e?euee?noue iaoe??io?a (a?ae 48 aei 78%) ?c IIAA aaeeeeo ?ici???a
oai??? iaee??iiyi (I.A.Aio?iiiaa, A.O.Yeue-Naeae, 1990, I.N.Aea?thaeia,
1997, A.A.AEaa?ianeee e niaao., 1996, ss.I.Oaeaooeineee, 1990), ui
aaaiii aieeaa? ia iaoiaaiac, ia?aa?a oai?iae oa i?neyiia?aoe?eiiai
ia??iaeo, ia’?i, o?aaiaoe/i?noue oa niin?a iia?aoe??, ui iaei aena?oeaii
a e?oa?aoo??.

Aei oeueiai /ano na?aae e?ea??a caeeoa?oueny iaaaoeaiei a?aeiioaiiy aei
o??o?a?/iiai e?eoaaiiy IIAA aaeeeeo ?ici???a, iniaeeai o oai?eo ?c
cia/iei nooiaiai iaee??iiy. *anoi o??o?ae a?aeiiaeythoue oaeei oai?ei a
iia?aoe?? /a?ac aenieee ?ecee inoaiiuei?, a?aenooi?noue aeinoaoi?o
aeina?aeo oa iaae/ie uiaei ?? aeeiiaiiy aai iia?othoue aac iaeaaeii?
ia?aaeiia?aoe?eii? i?aeaioiaee, aai aac o?aooaaiiy iniaeeainoae
iaoieia??, ui i?ecaiaeeoue aei iacaaeia?eueieo ?acoeueoao?a e?eoaaiiy.

I?aaiaiiy aea/eoe iniaeeaino? ao?ieia??, iaoiaaiaco, ia?aa?ao ee?i?/iiai
oa i?neyiia?aoe?eiiai ia??iae?a o oai?eo ?c IIAA aaeeeeo ?ici???a oa
iaee??iiyi, a oaeiae ?ic?iaeoe a?eueo aoaeoeaio ia?aaeiia?aoe?eio
i?aeaioiaeo, iioeiaeueio o??o?a?/io oaeoeeo oa iia? niiniae o??o?a?/iiai
e?eoaaiiy ?o aecia/eee iaoo oa caaaeaiiy iaoiai aeine?aeaeaiiy.

Ca’ycie ?iaioe c iaoeiaeie ieaiaie. Aeena?oaoe?eia ?iaioa aeeiioaaeanue
ia eaoaae?? o??o?a?/ieo oai?ia ca?aeii c iniiaiei ieaiii IAe?
Oe?a?inueei? iaaee/ii? noiiaoieia?/ii? aeaaeai?? (OINA) ? ? o?aaiaioii
eiiieaenii? ?i?oe?aoeaii? aeaaeai?/ii? iaoeiai-aeine?aeii? ?iaioe:
“Caiaeuei? oa iacaiaeuei? oai?iae i?aai?a ? nenoai ethaeeie, ui
oi?iothoueny i?ae aieeaii aeieia?/ieo, no?aniaeo, ?ioiieo, iaoaaie?/ieo
oa ?ioaeoe?eieo oaeoi??a” (? aea?ae?a?no?aoe?? 0198U000134).

Iaoa ? caaaeaiiy aeine?aeaeaiiy. Iioei?coaaoe o??o?a?/ia e?eoaaiiy
oai?eo ?c IIAA oa iaee??iiyi oeyoii ?ic?iaee aoaeoeaii? eiiieaenii?
ia?aaeiia?aoe?eii? i?aeaioiaee, iiaeo niinia?a ieanoeee aeaoaeo?a
/a?aaii? no?iee oa i?io?eaeoeee ?aoeeaeea?a a?eae.

Aeey aeinyaiaiiy cacia/aii? iaoe aoee aenoioo? ianooii? caaaeaiiy:

1. Aea/eoe iniaeeaino? ee?i?/iiai ia?aa?ao IIAA o oai?eo ?c iaee??iiyi.

2. Aaeineiiaeeoe eiiieaenio ia?aaeiia?aoe?eio i?aeaioiaeo aeaii?
eaoaai??? oai?eo.

3. ?ic?iaeoe niin?a aoaeoeaii? i?io?eaeoeee iaaii?iiy i?neyiia?aoe?eii?
?aie o oai?eo ?c iaee??iiyi.

4. Ai?iaaaeeoe aeei?enoaiiy iioeiaeueieo ?ic??c?a o eiiieaeniiio
o??o?a?/iiio e?eoaaii? oai?eo ?c IIAA oa iaee??iiyi.

5. ?ic?iaeoe niiniae aa?i?iieanoeee, ui iai?aaeai? ia oe??ieaiiy neaaeeo
i?noeue aiiiaa?ica oa ciaioothoue e?euee?noue ?aoeeaeea?a.

Iaoeiaa iiaecia iaea?aeaieo ?acoeueoao?a. Aia?oa i?iaaaeaii eiiieaenia
aeine?aeaeaiiy IIAA o oai?eo ?c iaee??iiyi, ui aeeth/a? aea/aiiy
iniaeeainoae ao?ieia??, iaoiaaiaco, ee?i?/iiai ia?aa?ao oa ?ic?iaeo
iaea?eueo ?aoe?iiaeueii? e?eoaaeueii? oaeoeee.

O oai?eo ?c IIAA oa noiooi?i iaee??iiyi aeiaaaeaii iaiao?aei?noue
ii?aeiaiiy aa?i?iieanoeee c iaia’yceiaei aeaeaeaiiyi iniiaiiai aeaii
aee?o, ui iaaeae? ciaioo? iaaaioaaeaiiy ia ciio ieanoeee, iie?auo?
?acoeueoaoe e?eoaaiiy.

Aeiaaaeaii iaiao?aei?noue aeeiiaiiy o oai?eo ?c IIAA oa iaee??iiyi
aaaeii?iiieanoeee c aeei?enoaiiyi ?icoe?aieo iia?aoeaieo aeinooi?a ca
Oa?iaiaeanii, Aa?niiii oa Aaooeaeai, ui ia?aaeaa/athoue
aea?iaoie?iaeoii?th a cii? ieanoeee, ei?aeoe?th aeny/iai aee?iaiai
”oa?oooa” aeeaioa.

Cai?iiiiiaaii iiaee niin?a i?io?eaeoeee iaaii?iiy ?aie o oai?eo ?c
noiooi?i iaee??iiyi, ui caaacia/o?oueny oeyoii iine?aeiaiiai aeeiiaiiy
i?io?eaeoe/ieo caoiae?a aei, i?ae /an oa i?ney iia?aoe??.

?ic?iaeaia, ia aac? niiniao Naiaaeea, iiaeeo?eaoe?y aaio?iieanoeee
i?noeaaeie oeaieiaie, yea ia?aaeaa/a? aeaeaeaiiy neaaeeo ia?a?icoyaiooeo
oeaiei oeyoii V-iiae?aiiai ae??caiiy eoo?a ii na?aaei?e e?i?? aeaoaeoa,
iaeeaaeaiiy eenaoieo oa?a ia aiiiaa?ic o eooao ieanoeee,
?icaaioaaeoaaeueieo oa?a e aeicaiey? aoaeoeaii oe??iethaaoe neaae?
i?noey aiiiaa?ica oa ciaioeoe iaoya oeaiei.

Aeey ieanoeee aeaoaeo?a aiiiaa?ica aaeeeeo ?ici???a cai?iiiiiaaii niin?a
aooiaea?iaeueii? ieanoeee a?eaeiaeo ai??o ca aeiiiiiaith
“aeaiiiaa?oiaiai oio?oaaiiy” ?c niaoe?aeueieie o?enoth/eie caieaie
(iaoaio Oe?a?ie ia aeiao?ae ?12544 A), ui caaacia/o? ciaioaiiy
iaaaioaaeaiiy ia iniiaiee oia, aoaeoeaia oe??ieaiiy neaaeeo i?noeue o
ae?eyioe? ieanoeee, ciaioo? e?euee?noue ?aiiaeo oneeaaeiaiue.

I?aeoe/ia cia/aiiy iaea?aeaieo ?acoeueoao?a. Aeae?eaiiy IIAA o oai?eo ?c
iaee??iiyi ?c caaaeueii? iane i?neyiia?aoe?eieo a?eae iaoe?eth? o??o?aa
ia eiiieaeniee aeeoa?aioe?eiaaiee i?aeo?ae aei e?eoaaiiy aeaii?
eaoaai??? oai?eo.

Canoinoaaiiy a o??o?a?/ieo caeeaaeao eiiieaenii? ia?aaeiia?aoe?eii?
i?aeaioiaee oai?eo ?c IIAA oa iaee??iiyi, ii/eiath/e ?c aiaoeaoi?iiai
?aaeeio, aeicaiey? iie?aueoe ?acoeueoaoe ?o o??o?a?/iiai e?eoaaiiy oa
ciaioeoe /an ia?aaoaaiiy o noaoe?iia??.

Ai?iaaaeaeaiiy iaoiaeeee i?io?eaeoeee iaaii?iiy ?aie o oai?eo ?c
noiooi?i iaee??iiyi oeyoii iine?aeiaiiai aeeiiaiiy i?io?eaeoe/ieo
caoiae?a aei, i?ae /an oa i?ney iia?aoe?? aeicaieeei ciaioeoe
e?euee?noue iaaii?iue ?aie aei 2,1% (a iaoeo niinoa?aaeaiiyo), ui a
oe?eiio caiia?aa? ?icaeoeo ?aoeeaeeao.

Canoinoaaiiy niinia?a ieanoeee aeaoaeo?a /a?aaii? no?iee a caeaaeiino?
a?ae ?ici???a IIAA, noaio /a?aaii? no?iee, nooiaiy iaee??iiy oa
caaaeueiiai noaio oai?iai, ui ia?aaeaa/athoue oe??ieaiiy neaaeeo i?noeue
aiiiaa?ica, aeicaiey? ciaioeoe e?euee?noue ?aoeeaeea?a.

Aeei?enoaiiy eiiieaeniiai o??o?a?/iiai e?eoaaiiy oai?eo ?c IIAA oa
iaee??iiyi caaacia/o? ciaioaiiy iane o?ea a na?aaeiueiio ia 14,5% a?ae
iiia?aaeiuei?, iie?auaiiy ?o caaaeueiiai noaio oa i?aoeacaeaoiino?.

?ic?iaeaiee eiiieaen caoiae?a ii e?eoaaiith oe??? eaoaai??? oai?eo
ai?iaaaeaeaiee aei i?aeoeee a o??o?a?/ieo noaoe?iia?ao IEE ?1, IEE ?2,
Iaeanii? ee?i?/ii? e?ea?i? i.Iieoaae, i?nueeeo e?ea?aiue ?1 oa ?2
i.E?aiai/oea, Oeaio?aeueieo ?aeiiieo e?ea?aiue i.Aeiaeii, i.Ie?ai?iaea
oa i.Ea?e?aee Iieoaanueei? iaeano?.

Iniaenoee aianie caeiaoaa/a. Aaoi? a?ae?a?aa oa e?eoe/ii i?iaiae?coaaa
iayaio e?oa?aoo?o ca oaiith aeena?oaoe??; cai?iiiioaaa aieiaio iaoo e
?ic?iaea i?ia?aio aeine?aeaeaiiy. Aena?oeai? a ?iaio? aeai? io?eiai? a
?acoeueoao? naiino?eii aeeiiaieo aeena?oaioii ee?i?/ieo,
ooieoe?iiaeueieo ? a?io?i?/ieo aeine?aeaeaiue. Iniaenoi i?iiia?iaaii 28
oai?eo ?c IIAA oa iaee??iiyi, a?aa o/anoue o 105 iia?aoe?yo ye anenoaio.
Aaoi? iniaenoi i?iaiaeea a?aea?? ee?i?/iiai iaoa??aeo, iiaeaeueoa
e?eoaaiiy oai?eo oa ca?? a?aeaeaeaieo ?acoeueoao?a; noaoenoe/ii ia?iaea
io?eiai? aeai?, i?ia?a aiae?c oa ?ioa?i?aoaoe?th ?acoeueoao?a
aeine?aeaeaiiy ca aeiiiiiaith niaoe?aeueieo i?ia?ai ia ia?niiaeueiiio
eiii’thoa?? Pentium-200. On? iieiaeaiiy, aeniiaee e i?aeoe/i?
?aeiiaiaeaoe?? ?ic?iaeai? aaoi?ii.

Ai?iaaoe?y ?acoeueoao?a aeena?oaoe??. Ai?iaaoe?y aeena?oaoe?eii? ?iaioe
i?iaaaeaia ia can?aeaii? ai?iaaoe?eii? ?aaee OINA 16 aa?aciy 1999 ?ieo.
Iniiai? iieiaeaiiy aeena?oaoe?? aeiiia?aeaeenue oa iaaiai?thaaeenue ia
can?aeaiiyo eaoaae?e o??o?a?? noiiaoieia?/iiai oaeoeueoaoo OINA,
o??o?a?/iiai oiaa?enoaa Iieoaanueei? iaeano?, 11-e tha?eaei?e
iaa/aeueii-i?aeoe/i?e eiioa?aioe?? caa?aeoaa/?a eaoaae? o??o?a?/ieo
oai?ia noiiaoieia?/ieo oaeoeueoao?a iaaee/ieo aoc?a Oe?a?ie (Iieoaaa,
1998).

Ioae?eaoe??. Ca iaoa??aeaie aeena?oaoe?? iioae?eiaaii 15 iaoeiaeo ?ia?o:
o oaoiaeo ia??iaee/ieo aeaeaiiyo, ui ?aeiiaiaeiaai? AAE Oe?a?ie, – 4
noaoo?, a oiio /ene? 3 naiino?eieo; 1 naiino?eia noaooy o ca??ieeo
iaoeiaeo i?aoeue oa 10 ?ia?o o iaoa??aeao iaoeiaeo eiioa?aioe?e o
aeaeyae? oac; io?eiaii 1 iaoaio Oe?a?ie ia aeiao?ae.

No?oeoo?a aeena?oaoe??. Aeena?oaoe?y neeaaea?oueny c? anooio, iaeyaeo
e?oa?aoo?e, 4-o ?icae?e?a aeanieo niinoa?aaeaiue, iaaiai?aiiy
?acoeueoao?a aeanieo niinoa?aaeaiue, aeniiae?a, i?aeoe/ieo
?aeiiaiaeaoe?e, nieneo aeei?enoaieo aeaea?ae oa 2-o aeiaeaoe?a.

Caaaeueiee ianya aeena?oaoe?? neeaaea? 162 noi??iee, ?c ieo: 132 –
iniiaiee oaeno, 26 noi??iie – nienie e?oa?aoo?e, 4 noi??iee –
aeiaeaoee. Nienie e?oa?aoo?e i?noeoue 175 ?ia?o a?o/eciyieo oa 97 –
?iicaiieo aaoi??a. ?iaioa ?ethno?iaaia 17 iaethieaie (ia 12 noi??ieao)
oa 13 oaaeeoeyie (ia 7 noi??ieao).

INIIAIEE CI?NO ?IAIOE

Iaoa??ae oa iaoiaee aeine?aeaeaiiy. ?iaioa ? ?acoeueoaoii ee?i?/iiai
aeine?aeaeaiiy 140 oai?eo ?c IIAA aaeeeeo ?ici???a oa iaee??iiyi, ui
aoee iia?iaai? i?ioyaii 1989-1996 ?ie?a o o??o?a?/ieo ee?i?eao
i.Iieoaae, oa ye? noaiiaeee 58% a?ae caaaeueii? e?eueeino? iia?iaaieo c
i?eaiaeo IIAA oai?eo. *ieia?e?a aoei 13 (9,3%), ae?iie – 127 (90,7%).
A?e oai?eo eieeaaany a?ae 27 aei 85 ?ie?a.

On? oai?? iaee iaee??iiy ??ciiai nooiaiy ae?aaeaiino?. O a?eueoino?
oai?eo anoaiiaeaia ae?iaioa?ii-eiinoeoooe?eia iaee??iiy, caaeainiaaiee
oei. Iana o?ea neeaaeaea a?ae 80 aei 165 ea, a na?aaeiueiio 110 ± 3 ea,
?iaeaen iane o?ea (?IO) – a?ae 27,6 aei 57 ea/i2. Nooi?iue iaee??iiy
aecia/aee ca i?ioeaioiei a?aeiioaiiyi ca?eueoaiiy ae?enii? aaae aei
iaeaaeii?, yeo aecia/aee ca oi?ioeith Eio?aina.

Iaie aeei?enoiaoaaeanue eeaneo?eaoe?y IIAA, cai?iiiiiaaia Oaoe? Aaaan
Oaaeaeue, ui aeicaiey? a?aoiaoaaoe ia o?eueee aaee/eio a?eae? oa ??
eieae?caoe?th, a e ee?i?/i? iciaee: ai?aaeia, iaai?aaeia, cauaieaia,
iaeeii/ia, iiiaeeiia, ?aoeeaeeaia, aaaaoi?aciai ?aoeeaeeaia, c yaeuaie
/anoeiai? aai iiaii? ceoeiai? eeoeiai? iai?io?aeiino?. Noiniaii oai?eo
?c iaee??iiyi ie ua aeiaeaoeiai aeacoaaee ia nooi?iue iaee??iiy, oa
iayai?noue aee?iaiai “a?aeaeneiai aeeaioa” (cia/ii ae?aaeaiee o 44
oai?eo). On? oe? iciaee aeicaieythoue a?eueo aeineiiaei a?aooaaoe
iniaeeaino? iaoieia?? o eiiieaen? e?eoaaiiy aeey eiaeiiai eiie?aoiiai
aeiaaeeo oa aecia/eoe niin?a oa ia’?i iia?aoe??.

Aaee/eio a?eae? aecia/aee ca iaoiaeii E.Ae.Oine?ia oa
A.A.AEaa?ianueeiai.

Uia nei?ioeoe no?ie ia?aaoaaiiy oai?iai a noaoe?iia?? aei iia?aoe??,
?ic?iaeaia noaia ieaiiaiai ianoaaeaiiy oai?eo a aiaoeaoi?ieo oiiaao.
Oai?ei, ui aoee ieaiiai iaeyioo? c i?eaiaeo IIAA oa yeei cai?iiiiiaaia
iia?aoe?y, oey noaia aeaeaaaeany a?ae?aco ia ?oee ?acii ?c iai?aaeaiiyi
ia aini?oae?caoe?th aei ee?i?ee. Oaeiae aeaeaaaee ?ic?iaeaio iaie
“Iai’yoeo” ?c ?aeiiaiaeiaaieie caniaaie ii i?aeaioiaoe? aei iia?aoe??
ai?iaeiaae 3-4 oeaei?a. Oiio a?eueo?noue ieaiiaeo oai?eo iinooiaei aei
a?aeae?eaiiy iiai?noth aai /anoeiai ianoaaeaieie (a iaaeao iiaeeeainoae
e?eoaaeueiiai caeeaaeo ca i?noeai i?iaeeaaiiy) oa i?aeaioiaeaieie aei
iia?aoe??.

Ca aeiiiiiaith aeaiiai eiiieaeno ianoaaeaiiy iiaeeeai a?eueo aeineiiaei
ioe?ieoe noai oai?iai oa aeyaeoe noiooith iaoieia?th. Oaeiae ca
iieacaiiyie canoiniaoaaeenue o?a?iaano?ineii?y, ?aioaaiia?ao?y oiiei? oa
oianoi? eeoee. Noai ciai?oiueiai aeeoaiiy aeine?aeaeoaaee ca aeiiiiiaith
ni??ia?aoa “Iaoaoano-1“, ui o?enoaaa aeeoaeueiee ia’?i (AeI), /anoioo
aeeoaiiy (*Ae), oaeeeiiee ia’?i aeeoaiiy (OIAe), aeeoo?ao ?ii?noue
eaaai?a (AEAE), iaeneiaeueio aaioeeyoe?th eaaai?a (IAE), ?aca?aiee ia’?i
aaeeoo (?Iaae), ?aca?aiee ia’?i aeaeeoo (?Iaeae), i?iae Ooaiaa, Aai/a,
O?oii (OAEAE). An? oai?? aoee eiinoeueoiaai? oa?aiaaoii oa
aianoac?ieiaii.

Aeey ioe?ithaaiiy aoaeoeaiino? eiiieaenii? i?aeaioiaee oai?eo
i?iaiaeeeenue eiio?ieueia ni??iiao??y, AEA, cai??thaaiiy a?oa??aeueiiai
oeneo, ioeueno, /anoioe aeeoaiiy oa iane o?ea.

Aeey ioe?ithaaiiy aoaeoeaiino? e?eoaaiiy iaee??iiy aecia/aee iieaciee
ciaioaiiy iane o?ea ca ia??iae e?eoaaiiy (a).

Noaoenoe/io ia?iaeo io?eiaieo ?acoeueoao?a aeine?aeaeaiiy cae?enithaaee
ca caaaeueiii?eeiyoeie iaoiaeaie iaoaiaoe/ii? noaoenoeee c canoinoaaiiyi
iaoiaeo aa??aoe?eii? noaoenoeee oa iaia?aiao?e/ieo iaoiae?a ia
ia?niiaeueiiio eiii’thoa?? Pentium MMX 200.

Caaaeueia oa?aeoa?enoeea ee?i?/ieo niinoa?aaeaiue. Ieaiiai i?iiia?iaaii
113 (80,7%), i?e/iio ai?aaei? a?eae? aoee a?aecia/ai? o 73 (52,1%)
oai?eo, iaai?aaei? – o 40 (28.6%), oa o?aaioii c i?eaiaeo cauaieaiiy
a?eae? aai niaeeiai? eeoeiai? iai?io?aeiino? o a?eaeiaiio i?oeo – 27
(19,3%) oai?eo.

Iaee??iiy 1 no. anoaiiaeaia o 19 oai?eo (13,6%), 2 no. – o 55 (39,3%), 3
no. – o 46 (32,8%), 4 no. – o 20 (14,3%) oai?eo.

O 72 (52,9%) oai?eo aeyaeaia ?ioa noiooiy iaoieia?y, ia?aaaaeii:
oeoe?iaee ae?aaao, ?oai?/ia oai?iaa na?oey, a?ia?oii?/ia oai?iaa,
i?e/iio o 8 c ieo niinoa??aaeeny caoai?thaaiiy i?aai?a /a?aaii?
ii?iaeieie, a oiio /ene? o 3 – o?a?ii?iia iaoee, o 2 – o?ii?/iee
aiiaiaeeoeeo, o 2 – e?noa y?/ieea, o 1 – aeia/ii-eai’yia oai?iaa c
o?ii?/iei oieaoeenoeoii. Iaea?eueo ?iciianthaeaeaia niieo/aiiy – a?eaea,
iaee??iiy oa na?oeaai-noaeeiia iaoieia?y. IIAA cono??/aeeny /ano?oa
(69,3%) i?ney o?aaioieo eaia?ioii?e.

O a?eueoino? oai?eo (72,3%) IIAA aeieeea ca ia?o? i?a?ieo i?ney
ia?aeiii? iia?aoe??.O?eaae?noue a?eaeiiin?iiy – a?ae 2-3 i?nyoe?a aei 40
?ie?a

O 44 (31,4%) oai?eo a?aecia/aia ?aoeeaeeaia IIAA i?ney ?? iia?aoeaiiai
e?eoaaiiy a ?ioeo e?eoaaeueieo caeeaaeao, i?e/iio o 18 (12,8%) ?c ieo –
aaaaoi?aciai (aei 11 ?ac?a) ?aoeeaeeaoth/a a?eaea. Iaea?eueo /anoith
eieae?caoe??th a?eaeiaeo ai??o aoee iaciaano??e (iaaeieiioieiaa
ae?eyiea) – 46 (32,8%) niinoa?aaeaiue oa a?iiaano??e (na?aaeeii?) – 36
(25,7%). O 24 (17,2%) oai?eo aeyaeaii 2 oa a?eueoa a?eaeiaeo aeaoaeo?a,
i?e/iio o a?eueoino? c ieo – o?eueee i?ae /an iia?aoe?? ?c ?icoe?aiiai
aeinooia, ui caaacia/o? a?eueo aaeaeaaoio ?aa?c?th aiiiaa?ica.

Iaeaea an? oai?? c a?iiaano?aeueiith eieae?caoe??th a?eaeiaeo ai??o oa
cia/ia /anoeia – iaciaano?aeueiith iaee i?aeaeuaia a?aeeeaaeaiiy
aee?iai? ee?oeiaeie a ieaei?e /anoei? aeeaioa, ui iaei oi?io aeny/iai
“oa?oooa”.

?ici??e a?eae? eieeaaeeny a?ae 10 aei 40 ni ii aeiaaeei? iaea?eueoiai
ae?aiao?o. Ia??aeei ?ici??e a?eaeiaiai aeaoaeoo ia ni?aiaaeaee c
aaee/eiith a?eaeiaiai aeieiaiiy, oiaoi aaee/eia a?eaeiaiai i?oea ?ieiee
cia/ii ia?aa?eueooaaea ?ici??e aeaoaeoo ia?aaeiuei? /a?aaii? no?iee, oa
iaaiaee.

O a?eueoino? oai?eo (81,4%) niinoa??aaee a?noea?i-a?noea?aeuei?,
a?noea?i-ia???oaeuei? ceoee oa ceoee aioo??oi?o i?aai?a ?c a?eaeiaei
i?oeii.

Ca oeiii iiia?aaeiuei? iia?aoe?? iaea?eueoo e?euee?noue IIAA aeaee
a?iaeieia?/i? iia?aoe?? – 44 (31,4%) niinoa?aaeaiue, oa ia?aeiia
aa?i?iieanoeea ioieiai? a?eae? – 35 (25,0%).

*anoeiaa aai iiaia iaaii?iiy i?neyiia?aoe?eii? ?aie i?ney ia?aeiii?
iia?aoe?? aeieeei o 61 oai?eo (43,6%).

Aiae?c i?e/ei aeieeiaiiy IIAA o oai?eo ?c iaee??iiyi aeyaea, ui
aieiaieie c ieo aoee: iaaii?iiy i?neyiia?aoe?eii? ?aie oa ?aii? o?ce/ia
iaaaioaaeaiiy.

Ia?aaeiia?aoe?eia i?aeaioiaea oai?eo ?c IIAA aaeeeeo ?ici???a oa
iaee??iiyi, aecia/aiiy nooiaiy iia?aoe?eiiai ?eceeo. ?iaeea?aeoaeueii a
eiaeiiai oai?iai iaie i?iaiaeeeinue ioe?ithaaiiy nooiaiy iia?aoe?eiiai
?eceeo, ui ia? aaaeeeaa cia/aiiy i?e ae??oaii? ieoaiiy uiaei iieacaiue
oa i?ioeiieacaiue aei ?o iia?aoeaiiai e?eoaaiiy, o??o?a?/ii? oaeoeee oa
ia’?io iia?aoeaiiai ao?o/aiiy, i?e i?iaiicoaaii? aeieeiaiiy
oneeaaeiaiue.

Aecia/aiiy nooiaiy iia?aoe?eiiai ?eceeo iaie i?iaiaeeeinue a oiiaao
noaoe?iia?o oa aacoaaeiny ia aiae?c? oa ioe?ithaaii? oaeeo oaeoi??a: a?e
oai?eo, nooi?iue iaee??iiy, oa?aeoa? oa oyaee?noue ?ioi? noiooiuei?
iaoieia??, ia’?i oa o?aaiaoe/i?noue iia?aoe??, ui ieaio?oueny,
iniaeeaino? o??o?a?/ii? iaoieia?? (eieae?caoe?y, aaee/eia a?eaeiaiai
aeieiaiiy oa a?eaeiaeo ai??o, neeaaei?noue aoaeiae a?eaeiaiai i?oea,
iayai?noue oa ae?aaeai?noue ceoeiaai i?ioeano ca ee?i?/ieie aeaieie oa
o.ae.), e?euee?noue ?aoeeaeea?a o aiaiiac?, oa?i?iia?noue iia?aoe??.

Eiiieaenia ioe?ithaaiiy ii?aeiaiiy e?eoa???a oeeo oaeoi??a o aaeao
aeicaieeei iai aeae?eeoe 4 nooiai? iia?aoe?eiiai ?eceeo. Na?aae
iia?iaaieo iaie oai?eo 1 nooi?iue iia?aoe?eiiai ?eceeo aeyaeaiee o 20
(14.3%) oai?eo, 2-ee – o 59 (42,1%), 3-?e – o 47 (33,6%), 4-ee – o 14
(10%) oai?eo.

Oai?ei ?c aaeeeeie IIAA oa iaee??iiyi 2-4 no, ui iia?othoueny ieaiiai,
iaiao?aeia ia o?eueee caaaeueia, aea e niaoe?aeueia ia?aaeiia?aoe?eia
i?aeaioiaea, ui iai?aaeaia ia iiia?aaeaeaiiy cia/iiai i?aeaeuaiiy
aioo??oiuei/a?aaiiai oeneo oa eiai iaaaoeaiiai aieeao ia
na?oeaai-noaeeiio, aeeoaeueio oa ?io? nenoaie a ?aiiueiio
i?neyiia?aoe?eiiio ia??iae?. An?i oai?ei i?ecia/aee niaoe?aeueio eaaeo
aacoeaeiao ae??oo, ui ia?aaeaa/aea ciaioaiiy aaeeaaiiy aenieieaei??eieo
oa?/iaeo i?iaeoeo?a; aeio?eioaaiiy ?aaeeio 5-6 ?aciaiai oa?/oaaiiy aac
i?aeaeuaiiy aia?aaoe/ii? oe?iiino? ?ae?; nenoaiaoe/ia eiio?iethaaiiy
e?eueeino? aaeeaaii? ?ae? oa ??aeeie (ia a?eueoa 1,5 e/aeiao);
iaiaaeaiiy e?eueeino? aaeeaaiiy aoaeaaiae?a aei 100-120 a/aeiao,
oaa?eiieo aee??a aei 80-90 a/aeiao, nie? aei 5 a/aeiao; i?aeaeuaiiy
aaeeaaiiy a?ee?a (a?eueoa ca ?aooiie ?ineeiiiai iioiaeaeaiiy, iai?eeeaae
ni?) aei 120-160 a/aeiao, ?ineeiieo aee??a, a?oai?i?a, i?e?iaeaiaio?a;
i?eieiaiiy iae?iiy oa aaeeaaiiy aeeiaieth; canoiniaoaaiiy 1-2 ?ace ia
oeaeaeaiue ?icaaioaaeoaaeueieo aei?a (yaeo/i?, ne?i?, a?eeia?). Oaeiae
i?ecia/aee EOE, ui aeeth/aea ?aieiao a?a??i?/io a?iianoeeo, e?eoaaeueio
a?iianoeeo, aeiciaaia oiae?iiy ii no?aeoeyo oeio oa?aieo?a,
aioeaa?aaaioe, iie?a?oai?ie, i/eni? ee?cie. O eiiieaen?
ia?aaeiia?aoe?eii? i?aeaioiaee oai?eo ?c IIAA oa iaee??iiyi iniaeeao
oaaao i?eae?eyee iaeneiaeueii iiaeeeaiio i/euaiith eeoa/ieea oa
ciaioaiith eiai ia’?io, ui i?iaiaeeeinue ai?iaeiaae 6-7 aei?a aei
iia?aoe?? oa ia? aaaeeeaa cia/aiiy a aaeaioaoe?? oai?iai aei cai?aaeaiiy
a /a?aaio ii?iaeieio ai?noo a?eaeiaiai i?oea, cia/ii ciaioo? iaaaciaeo
iioeiaeaeaiiy eeoee i?e ?ic’?aeiaii? ceoe i?ae /an iia?aoe??, a oaeiae
i?aeoe/ii iiai?e e?ea?aeaoe?? yaeu aiaeiaaiii? ?ioieneeaoe??.

An?i oai?ei ?c ai?aaeieie IIAA canoiniaoaaee aa??aioe aeiciaaii?
iiaaiieiii?an?? c EOE. Oai?ei ?c iaai?aaeieie IIAA aeei?enoiaoaaee
aeiciaaia aeiooaaiiy aeeaioa i?ney iiia?aaeiueiai /anoeiaiai cai?aaeaiiy
ai?noo a?eae? aei /a?aaii? ii?iaeieie. Ca iieacaiiyie i?iaiaeeee
ei?eaoth/o oa?ai?th noiooiuei? iaoieia??.

O ?acoeueoao? i?iaaaeaiiy eiiieaenii? ia?aaeiia?aoe?eii? i?aeaioiaee
iie?auoaaany caaaeueiee noai oai?eo, AEAE, IAE, ?iaeaen O?oii
ca?eueooaaeenue o na?aaeiueiio ia 11-14% a?ae ii/aoeiaiai ??aiy,
noaa?e?coaaany ioeuen, a?oa??aeueiee oene, ciaiooaaeenue *Ae oa iana
o?ea ia 5-6%.

Iia?aoeaia e?eoaaiiy. Ii??aiyii c ?ioeie aeiaaeeaie, IIAA o oai?eo ?c
iaee??iiyi iathoue aeaye? iniaeeaino?, ui aieeaathoue ia ia’?i,
o?aaiaoe/i?noue oa niin?a iia?aoe??. Oae, ia’?i oa o?aaiaoe/i?noue
ao?o/aiiy aecia/aeenue ia o?eueee aaee/eiith a?eae?, a e nooiaiai
iaee??iiy, iniaeeainoyie a?aeeeaaeaiiy aee?iai? ee?oeiaeie, iayai?noth
“a?aeaeneiai aeeaioa”, nooiaiai ?oaoeaaeo ci?i o oeaieiao /a?aaii?
no?iee oa ae?aaeai?noth ceoeiaiai i?ioeano, iaiao?aei?noth canoinoaaiiy
?icoe?aiiai aeinooio, aeeiiaiiy neioeueoaiii? iia?aoe??.

Iniaeeao oaaao i?eae?eyee i?io?eaeoeoe? iaaii?iiy ?aie. Iiia?aaeaeaiiy
aeieeiaiiy iaaii?iiy ?aie o oai?eo ?c iaee??iiyi, ui iia?othoueny c
i?eaiaeo IIAA aaeeeeo ?ici???a, caaacia/oaaee oeyoii iine?aeiaiiai
aeeiiaiiy i?io?eaeoe/ieo caoiae?a aei, i?ae /an oa i?ney iia?aoe??
(na?aeioeoai ia ?aoei?iiiceoe?th ?1866 a?ae 09.12.1998., aeaeaia OINA).
Ca 2-3 aei? aei iia?aoe?? oe??o aeeaioa oa iaoia? neeaaeee ieee i?ae
aeooai u?oeaie c ieeii, i?ney /iai ia?iaeyee aioenaioeeii. Ca 20-30
oaeeei aei iia?aoe?? aioo??oiueiaaiii aaiaeeee iiaea?eio ?aciao aeico
aioea?ioeea oe?ieiai niaeo?o ae??. Iniaeeaei iiiaioii ? caoeno
iia?aoe?eii? ?aie a?ae ?io?eoaaiiy i?ae /an iia?aoe??, ui aeinyaa?oueny
iioa?iaei iaeeaaeaiiyi ?? iaethoeaie oa na?aaoeaie ca iaoith
iaoiaeeeith. I?aeoe??io ee?oeiaeio caoeaaee i?ae eooii, a?aee?eoei aei
ieaeiueiai eooa ?aie, aeey e?auiai ae?aioaaiiy. ?aio caaaeaee ae?aioaaee
nee?eiiiaeie ae?aiaaeaie ?c aeoeaiei ani??oaaiiyi aeae?eaiue ?aie.

Ia iaoo aeoieo, iia?aoeaiee aeinooi aecia/a? cia/io /anoeio oni?oo
iia?aoe??. O 42 oai?eo (30,0%) ?c iaci- oa a?iiaano?aeueiith
eieae?caoe??th a?eaeiaeo ai??o aeei?enoaiee ?ic??c ca Oa?iaiaeanii, oa o
2 oai?eo (1,4%) ?c iecueeith a?iiaano?aeueiith (iaaeeiaeiaith)
eieae?caoe??th a?eaeiaeo ai??o – ca Aa?niiii, ui aeeth/aee
aea?iaoie?iaeoii?th c aeaeaeaiiyi noa?iai i?neyiia?aoe?eiiai ?oaoey oa
iaaeeeoeo ia?a?icoyaiooi? oe??e, i?aeoe??ii? ee?oeiaeie oa aee?iaiai
“aeny/iai oa?oooa”. Aeinooi ca Aa?niiii ii noo? – oea iiaeeo?eiaaiee
aeinooi ca Oa?iaiaeanii. Iniaeea?noth eiai ? iayai?noue V-iiae?aiiai
?ic??co aeiaaeeiith 4-5 ni a ieaei?e /anoei? ii na?aaeeii?e e?i??,
aino?ee eoo yeiai ii/eia?oueny c?aco iaae eiiii.

O oai?eo aac iayaiino? cia/ieo ?ici???a “a?aeaeneiai aeeaioa” oa
na?aaeeiiith iaciaano?aeueiith eieae?caoe??th a?eae? (38 niinoa?aaeaiue
– 27,1%), iniaeeai i?ney iiia?aaeiuei? aa?i?iieanoeee ioieiai? a?eae?,
canoiniaoaaee iia?aoeaiee aeinooi ?c aea?iaoie?iaeoii??th ca Aaooeaeai.
Acaaae? a?aeaeaaaee ia?aaaao iiia?a/iei ?ic??cai.

Oe? ?ic??ce caaacia/othoue: 1) a?eueo oe?ieee iia?oeaiee aeinooi aei
an?o a?aeae?e?a ia?aaeiuei? /a?aaii? no?iee, ui aeicaiey? aeeiiaoe
iioeiaeueio ?aa?c?th aiiiaa?ico; 2) ?cieyoe?th a?eaeiaeo ai??o a?ae
oe??e ?aie ia anueiio i?ioyc?, ui ciaioo? ?ecee aoi?eiiiai ?io?eoaaiiy;
3) caiia?aaiiy aeieeiaiiy ?aoeeaeea?a caaaeyee aeaeaeaiith “aeny/iai
oa?oooa”, yeee ? aaaeeeaei ao?iiaoiaaiaoe/iei oaeoi?ii ?icaeoeo a?eae?;
4) cia/iee einiaoe/iee aoaeo; 5) o iaai?e i???, nioe?aeueio
?aaa?e?oaoe?th oe??? eaoaai??? oai?eo.

Ie aaaaea?ii, ui aaaeeeaei oaeoi?ii i?io?eaeoeee aeieeiaiiy ?aoeeaeeao
a?eae? ? aeaeaeaiiy “aeny/iai oa?oooa” aeeaioa. Inoaii?e o oai?eo ?c
iaee??iiyi /anoi ia? cia/i? ?ici??e ?, a?aeiia?aeii, aaao (i?ae /an
iia?aoe??, i?e aea?iaoie?iaeoii??, aeaeaey?oueny oe??ii-i?aeoe??iee
eeaiioue aei 8-10 ea). sseui a oe??? a?oie oai?eo iia?aoe?th iaiaaeoaaoe
o?eueee aa?i?iieanoeeith oa caeeoaoe “aeny/ee oa?ooo” aeeaioa, oi neea
oyae?iiy (?1), ui ae?? ia iueiai, cae/aeii aeiaea?oueny aei neee
aioo??oiuei/a?aaiiai oeneo (?2), e oei naiei noia?ia neea (?3), ui ae??
ia i?neyiia?aoe?eiee ?oaaoeue, cia/ii ca?eueoo?oueny (?3=?1+?2), a oea
iiaea i?ecaanoe aei ?aoeeaeeao. Cia/i? ?ici??e aeny/iai oa?oooa (?ieiee
aeinyaath/iai na?aaeeie noaaii) ??cei iaiaaeoaaee o?ce/io aeoeai?noue,
oiio aeaeaeaiiy inoaiiueiai iiaeia aaaaeaoe iaeiei ?c oaeoi??a
nioe?aeueii? ?aaa?e?oaoe?? oe??? eaoaai??? oai?eo.

*anoi a a?eaeiaiio i?oeo o?eno?oueny /anoeia aaeeeiai naeueieea, ui
?oaoeaai ci?ith?oueny, ?ieiee caiaeaia, oiio a a?eueoino? (76,4%)
aeiaaee?a aeeiioaaee ?acaeoe?th a?eueii? /anoeie aaeeeiai naeueieea.
Aaeeeee naeueiee, a eiie?aoii – eiai /anoeia ieae/a iiia?a/ii? iaiaeiai?
eeoee, ui a?eueii caena? o aeaeyae? “oa?oooa” oa i?noeoue cia/io
e?euee?noue a?aeeeaaeaiue aee?iai? oeaieie, ? iniiaiei aeaii aee?o
/a?aaii? ii?iaeieie, ? o oai?eo ?c iaee??iiyi (iniaeeai 3-4 no) ia?
cia/i? ?ici??e (aei 30 ni aeiaaeeie oa aei 45 ni oe?eie), e a?aeiia?aeii
ia’?i oa aaao. sse a?aeiii, iaeiei ?c iaoiae?a o??o?a?/iiai e?eoaaiiy
oai?eo ?c iaee??iiyi ? aeaeaeaiiy aeaii aee?o. Aeaeaeyth/e aaeeeee
naeueiee o oai?eo ?c iaee??iiyi oa IIAA, ie aeinyaa?ii a?ae?aco aea?
iaoe: e?ea?aeo?oueny iaeia ?c iniiaieo aeaii aee?o, ui ia? nooo?aa
cia/aiiy aeey oai?eo ?c iaee??iiyi, oa cia/ii ca?eueoo?oueny a?eueiee
i?ino?? /a?aaii? ii?iaeieie, ui aeicaiey? ciaioeoe iaoya oeaiei i?e
ieanoeoe? oa e?euee?noue i?neyiia?aoe?eieo oneeaaeiaiue. Oiio aaaaea?ii
iniaeeai aeioe?eueiei aeaeaeaiiy aeny/iai “oa?oooa” aaeeeiai naeueieea o
oai?eo ?c IIAA aaeeeeo ?ici???a oa cia/iei nooiaiai iaee??iiy ye
i?io?eaeoe/iee can?a uiaei i?aeaeuaiiy aioo??oiuei/a?aaiiai oeneo a
?aiiueiio oa i?ciueiio (iniaeeai i?e i?ia?anoaaii? iaee??iiy)
i?neyiia?aoe?eiiio ia??iae?.

Iaia’yceiaei aoaiii iia?aoe?? aaaaea?ii ?icae?eaiiy ceoe iii?ae i?aaiaie
a a?eaeiaiio i?oeo oa eiai no?ieaie ? e?ayie a?eaeiaeo ai??o, a oaeiae
?ic’?aeiaiiy ceo/aieo i?ae niaith i?aai?a /a?aaii? ii?iaeieie aeey
onoiaiiy iciae o?ii?/ii? eeoeiai? iai?io?aeiino?.

I?e o?eaaeiio iai?ioethaaii? a ?ai? i?ae /an ?ic’?aeiaiiy ceoeiaiai
i?ioeano, aeeiiaii? iniiaiiai aoaio neioeueoaiii? iia?aoe?, ?iooaaoe??
eeoee aeeaaeaee 2 ia?eaa? na?aaoee ca oiaeii ?aie, o?enoth/e ?o aeiaaeie
ieoeaie ca i/a?aaeio oa aiiiaa?ic. On? ieoee a?aee ia caoenea/? (ii 3
ieoee ia 1 caoenea/) c iaio noi??i ?aie (i?e iaiao?aeiino? ?icoe?aiiy
e?a?a ?aie iii??ii i?aeoyaoaaee ca a?aeiia?aei? caoenea/?). Oaeei /eiii,
ciia iaeaooiuei? ieanoeee a?aeiaaeiaoaaeany a?ae /a?aaii? ii?iaeieie ua
iaeiei oa?ii na?aaoie, ui ciaiooaaei o?aaioaaiiy e?a?a ?aie e eeoa/ieea
caoenea/aie oa ?ecee aoi?eiiiai ?io?eoaaiiy

O 42 oai?eo (30,7%) aeeiiaia ieanoeea ca Iaei, o 60 (43,9%) – oeio
Naiaaeea a iiaeeo?eaoe?? ee?i?ee (i?e na?aaeeii?e eieae?caoe??
aeaoaeoo), o 2 oai?eo (1,4%) ?c cia/iei noiooi?i ae?anoacii i?yieo
i’yc?a aeeaioa – ca Iaiaeeiaei, o 16 oai?eo (11,4%) c IIAA i?ney
aiaiaeaeoii?? oa o 2 oai?eo (1,4%) i?ney oieaoeenoaeoii?? ?c ?ic??co ca
Oaaei?iaei – eina i’yciai-aiiiaa?ioe/ia ieanoeea ?c oi?ioaaiiyi
aeoae?eaoo?e oeio Naiaaeea a iiaeeo?eaoe?? ee?i?ee, o 18 oai?eo ?c
?aoeeaeeaiith oa a?aaionueeith IIAA (12,8%) – ca iaoiaeeeith ssiiaa: o
10 – oeiiaa c aeei?enoaiiyi “eaoee”, o 8 – i?ea?iaeueiei niiniaii.

Aaaaeath/e, ye ? aeaye? ?io? aaoi?e, ui aeieeiaiiy IIAA aieiaiei /eiii
caeaaeeoue a?ae iani?iiiaeiino? aiiiaa?ioe/iiai oa?o ia?aaeiuei?
/a?aaii? no?iee, i?e o??o?a?/ieo ao?o/aiiyo iaiaaaeenue oe??iethaaoe
aiiiaa?ic. Cia/io oaaao i?eae?eyee oe??ieaiith neaaeeo i?noeue
aiiiaa?ica, ui aeinyaaee aeei?enoaiiyi ieanoee oeio Naiaaeea oa ssiiaa a
iiaeeo?eaoe?? ee?i?ee.

?ic?iaeaiee iaie niin?a aaio?iieanoeee i?noeaaeie oeaieiaie (na?aeioeoai
ia ?aoei?iiiceoe?th ?1865 a?ae 09.12.1998., aeaeaia OINA) aeicaiey?
oe??ieoe neaae? i?noey aiiiaa?ica a eooao aeaoaeoa oa ciaioeoe iaoya
oeaiei i?e ieanoeoe? a?eaeiaeo ai??o oeio Naiaaeea oeyoii V-iiae?aiiai
ae??caiiy ii na?aaei?e e?i?? aeaoaeoo eoo?a ?c aeaeaeaiiyi neaaeeo
ia?a?icoyaiooeo oeaiei oa iaeeaaeaiiyi eenaoieo oa?a ia aiiiaa?ic o
eooao ieanoeee, ? ? aoaeoeaiei caniaii i?io?eaeoeee ?aoeeaeeao. Aeey
ciaioaiiy iaoyao, i?i??coaaiiy iniiaieo oa?a ca ?aooiie ?icoyaoth/i?
neee aieiaeo i’yc?a aeeaioa i?ae /an iia?aoe?? o 4-o oai?eo, i?e
ieanoeoe? oeio Naiaaeea a iao?e iiaeeo?eaoe??, ie iicaeiaaeiuei
i?iaiaeeee aeiaeaoeia? 2 oiano? eaanaiia? ieoee (ia iaae? ciai?oi?o oa
na?aaeiuei? o?aoei aeaoaeoa) c? ne?aeoth/ei i?aeoiieaiiyi ?o i?e
iaeeaaeaii? iiia?a/ieo aoceiaeo oa?a (aeei?enoaiiy iaoiaeeee oeio
A.A.Ea?aaaiiaa, ?.A.C?iia’?aa), ui ciaiooaaei iaoya oeaiei oa
iaaaioaaeaiiy ia iniiai? oae.

Cae?eooy aeaoaeoo ca aeiiiiiaith oi?ioaaiiy aeoae?eaoo?e ?c i?noeaaeo
oeaiei o oai?eo ?c a?aaionueeith oa aaaaoi?aciai?aoeeaeeaoth/ith,
aeiaaee /an ?nioth/ith IIAA iaiiaeeeaa aac cia/iiai iaoyao oeaiei,
i?aeaeuaiiy aioo??oiuei/a?aaiiai oeneo. Oiio oae? aeaoaeoe caaaeaee
cae?eaaee oeyoii u?eueiiai c’?aeiaiiy ?o e?a?a ca aeiiiiiaith oio?oaaiiy
aooiaea?iaeueiith nioaith. I?e canoinoaaii? aeey ieanoeee aeaoaeo?a
aiiiaa?ica aaeeeeo ?ici???a oeiiai? iaoiaeeee ssiiaa c aeei?enoaiiyi
aooiaea?iaeueii? “eaoee” aoei iii?/aii, ui a i?neyiia?aoe?eiiio ia??iae?
c i?aeoe??ii? ee?oeiaeie a cii? ieanoeee aeiaaee /an naoea?ioaaea
na?icia ??aeeia. Oea ni?eyei aeieeiaiith ?aiiaeo oneeaaeiaiue (na?iie,
oiia?eueiaiiy i?e?iuaiiy eeaioy aei aiiiaa?ica oa ?io?). Iaie
cai?iiiiiaaiee, caiaoaioiaaiee oa aeei?enoiao?oueny niin?a ieanoeee
a?eaeiaeo ai??o ca aeiiiiiaith “aeaiiiaa?oiaiai oio?oaaiiy”
aooiaea?iaeueiith nioaith ?c niaoe?aeueieie o?enoth/eie caieaie.
Iniaeea?noth oeueiai niiniao ? oe??ieaiiy neaaeeo i?noeue aiiiaa?ica oa
ia?oiai ?yaeo ieanoeee ca aeiiiiiaith oio?oaaiiy ae?oaei ?yaeii
aooiaea?iaeueii? nioae, eiaeai e?ie yei? o?eno?oueny a iaoyaiooiio noai?
ca aeiiiiiaith niaoe?aeueieo caie?a.

?acoeueoaoe o??o?a?/iiai e?eoaaiiy oai?eo ?c IIAA oa iaee??iiyi.
Neioeueoaii? iia?aoe?? i?e ii?aeiaii? IIAA oa caoai?thaaiue i?aai?a
/a?aaii? ii?iaeieie, aeyaeaieo i?e iiia?aaeiueiio eiiieaeniiio
ianoaaeaii?, aeeiiai? o 8 (5,7%) oai?eo. Iaeii/anii ?c ?aaeeeaeueiith
iia?aoe??th c i?eaiaeo IIAA oieaoeenoaeoii?y c i?eaiaeo o?ii?/iiai
eaeueeoeueiciiai oieaoeenoeoo aeeiiaia 1 oai??e, iaaei?oaiaa aiiooaoe?y
iaoee c i?eaiaeo ?? o?a?ii?iie – 2, aiaiaeaeoii?y c i?eaiaeo o?ii?/iiai
aiaiaeeoeeoo – 2, aeaeaeaiiy e?noe y?/ieea c i?eaiaeo ?? e?noiie – 3
oai?ei. Niaoeeo?/ieo oneeaaeiaiue i?ney aeeiiaieo neioeueoaiieo
iia?aoe?e ia niinoa??aaee. Ie aaaaea?ii aeioe?eueiei aeeiiaiiy
neioeueoaiieo iia?aoe?e o oai?eo ?c IIAA oa iaee??iiyi i?e anaa?/iiio
ianoaaeaii? aei iia?aoe?? oa a?aenooiino? oneeaaeiaiue. Oea a
iiaeaeueoiio aeeeth/a? iaiao?aei?noue a?aeno?i/aieo iia?aoeaieo
ao?o/aiue o oai?eo ?c caa?icith aeieeiaiiy ?aoeeaeeao a?eae?.

O i?neyiia?aoe?eiiio ia??iae? cia/io oaaao i?eae?eyee i?io?eaeoeoe?
eaaaiaai-na?oeaaeo oa o?iiaiaiaie?/ieo oneeaaeiaiue, ?aii?e
ii?iae?caoe?? ooieoe?? eeoa/ieea oa aeaeaeaiith na?icii-aaii?aa?/ii?
??aeeie c ?aie, ui caaacia/oaaeiny ai?iaeiaae ia?oeo 2-3 aei?a aaeooiiei
ae?aioaaiiyi, a iio?i ioieooaaiiyi i?aeoe??ii? ee?oeiaeie ca
iieacaiiyie, oa i?iieaaiiyi aeyaeaieo ii?iaeiei aioenaioeeii.

O ?aiiueiio i?neyiia?aoe?eiiio ia??iae? a 3 (2,1%) oai?eo ?c iaee??iiyi
3-4 no. aeieeea aino?a eaaaiaai-na?oeaaa iaaeinoaoi?noue, aino?ee
o?iiaioeaa?o aai ieaei?o e?ioe?aie – o 2 (1,4%), aeeiai?/ia eeoeiaa
iai?io?aei?noue – o 1 (0,7%), ui ?aa?anoaaee i?ney i?iaaaeaii?
aeiiii?aeii? eiina?aaoeaii? oa?ai??. Iaaii?iiy i?neyiia?aoe?eii? ?aie
aeieeei a 3-o oai?eo (2,1%), i?aeoe??ia na?iia – o 6-e (4,3%), aaiaoiia
– o 2 (1,4%) oai?eo. Iiia?ei 2 (1,4%) oai?eo iioeeiai a?eo a?ae
o?iiaiaiaie?? eaaaiaai? a?oa???.

Na?aaei?e e?aeei-aeaiue aei iia?aoe?? – 4,5 aei?a, aeaye? oai??
ianoaaeoaaeeny oa aiooaaeeny aei iia?aoeaiiai ao?o/aiiy ca iieacaiiyie
aei 14 aei?a; na?aaeiy o?eaae?noue ia?aaoaaiiy oai?eo o ?aai?iaoe?eiiio
a?aeae?eaii? neeaaeaea 2,5 e?aeei-aei?; na?aaei?e i?neyiia?aoe?eiee
e?aeei-aeaiue neeaaeaa 13,5 aei?; na?aaei? caaaeueia ia?aaoaaiiy a
noaoe?iia?? – 18,5 aei?.

Caaaeyee i?iaaaeaiiio eiiieaeniiio o??o?a?/iiio e?eoaaiith oai?eo ?c
IIAA oa iaee??iiyi iana o?ea ciaiooaaeanue o na?aaeiueiio ia 14,5% a?ae
iiia?aaeiuei?, iie?auoaaany ?o caaaeueiee noai oa i?aoeacaeaoi?noue.

A?aeaeaeai? ?acoeueoaoe o??o?a?/iiai e?eoaaiiy (no?ieii a?ae 1 aei 5
?ie?a) ca aeaieie aieaooaaiiy oa iaeyae?a aea/ai? o 92 oai?eo. ?aoeeaeea
a?eae? aeiee o 3 (2,1%) c ieo, iia?iaaieo ca iaoiaeeeith Iaei ia aoaiao
noaiiaeaiiy e?ioeaaiai aeai?eoia iia?aoeaiiai e?eoaaiiy.

AENIIAEE

1. Iaee??iiy cono??/a?oueny o 58% oai?eo, iia?iaaieo c i?eaiaeo IIAA,
ye? /ano?oa aeieeathoue: o ae?iie, ethaeae iioeeiai a?eo, iniaeeai c
iayai?noth a?aeaeneiai aeeaioa, i?ney o?aaioieo iia?aoeaieo ao?o/aiue,
a?iaeieia?/ieo iia?aoe?e, iaaii?iiy i?neyiia?aoe?eii? ?aie.

2. Eiiieaenia ia?aaeiia?aoe?eia i?aeaioiaea oai?eo ?c IIAA oa iaee??iiyi
iiaeiia aeeth/aoe caoiaee, ui iai?aaeai? ia ciaioaiiy iane o?ea,
i?aeaeuaiiy oiiono i’yc?a, aaeaioaoe?th aeeoaeueii? oa
na?oeaai-noaeeiii? nenoai aei i?aeaeuaiiai aioo??oiuei/a?aaiiai oeneo,
iaeneiaeueia i/euaiiy eeoa/ieea, e?eoaaiiy noiooiuei? iaoieia?? e
ii/eiaoeny c aiaoeaoi?iiai ?aaeeio, aei aini?oae?caoe??, ui iie?auo?
?acoeueoaoe ?o o??o?a?/iiai e?eoaaiiy oa nei?i/o? /an ia?aaoaaiiy o
noaoe?iia??.

3. O oai?eo ?c IIAA oa iaee??iiyi aa?i?iieanoeeo iaiao?aeii ii?aeioaaoe
?c aeaeaeaiiyi iniiaieo aeaii aee?o (aeny/iai “oa?oooa” aaeeeiai
naeueieea oa aeny/iai aee?iaiai “oa?oooa” aeeaioa), ui ciaioo? iaoya
oeaiei i?e aeeiiaii? ieanoeee, iaaaioaaeaiiy ia ciio ieanoeee oa
i?aeaeuaiiy aioo??oiuei/a?aaiiai oeneo a ?aiiueiio oa i?ciueiio
i?neyiia?aoe?eiiio ia??iae?.

4. Canoinoaaiiy aaaeii?iiieanoeee c aea?iaoie?iaeoii??th o oai?eo ?c
IIAA aaeeeeo ?ici???a oa iaee??iiyi ?c aeei?enoaiiyi iia?aoeaieo
aeinooi?a ca Oa?iaiaeanii oa Aa?niiii caaacia/o?: a?eueo oe?ieee
iia?aoeaiee aeinooi, ui aeicaiey? aeeiiaoe iioeiaeueio ?aa?c?th
aiiiaa?ica, ?cieyoe?th a?eaeiaeo ai??o a?ae oe??e ?aie ia anueiio
i?ioyc?, ui ciaioo? ?ecee aoi?eiiiai ?io?eoaaiiy, caiia?aaiiy aeieeiaiiy
?aoeeaeea?a caaaeyee aeaeaeaiith aeny/iai “oa?oooa” aeeaioa, cia/iee
einiaoe/iee aoaeo, o iaai?e i??? nioe?aeueio ?aaa?e?oaoe?th oe???
eaoaai??? oai?eo.

5. Niiniae ieanoeee a?eaeiaeo aeaoaeo?a IIAA ca i?iiiiiaaieie
iaoiaeeeaie caaacia/othoue ciaioaiiy iaaaioaaeaiiy ia iniiaiee oia,
aoaeoeaia oe??ieaiiy neaaeeo i?noeue o ae?eyioe? ieanoeee oa a oe?eiio
ni?eythoue ciaioaiith /anoioe aeieeiaiiy ?aoeeaeea?a.

6. I?io?eaeoeea iaaii?iiy ?aie oeyoii iine?aeiaiiai aeeiiaiiy
cai?iiiiiaaieo i?io?eaeoe/ieo caoiae?a aei, i?ae /an oa i?ney iia?aoe??
aeicaiey? cia/ii ciaioeoe e?euee?noue ?aiiaeo ai?eieo oneeaaeiaiue.

7. Aeioe?euei?noue aeeiiaiiy neioeueoaiieo iia?aoe?e o oai?eo ?c IIAA
oa iaee??iiyi aei?aaaeiao?oueny aeeeth/aiiyi a?aeno?i/aieo iia?aoeaieo
ao?o/aiue ia i?aaiao /a?aaii? ii?iaeieie i?e caa?ic? aeieeiaiiy
?aoeeaeeao a?eae? oa iie?ioaiiyi yeino? aeeooy oai?eo.

8. ?ic?iaeai? o??o?a?/ia oaeoeea oa niiniae iia?aoeaiiai e?eoaaiiy
oai?eo ?c IIAA oa iaee??iiyi iiaeooue aooe ?aeiiaiaeiaai? aei
canoinoaaiiy a o??o?a?/i?e i?aeoeoe?.

NIENIE IIOAE?EIAAIEO I?AOeUe CA OAIITH AeENA?OAOe??

1. Eenaiei ?.A. O??o?a?/ia e?eoaaiiy i?neyiia?aoe?eieo aaio?aeueieo
a?eae aaeeeeo ?ici???a o oai?eo ?c iaee??iiyi // Eeiii/ia oi?o?aiy. –
1999. – ? 4. – C. 26-29.

2. Eenaiei ?.A. Iia?aoeaiee aeinooi i?e o??o?a?/iiio e?eoaaii?
i?neyiia?aoe?eieo aaio?aeueieo a?eae aaeeeeo ?ici???a o oai?eo ?c
iaee??iiyi // A?niee i?iaeai a?ieia?? ? iaaeeoeeie. – Iieoaaa-Oa?e?a,
1998. – ? 25. – N. 26 -28.

3. Eenaiei ?.A. I?neyiia?aoe?ei? aai?aeuei? a?eae? o oai?eo ?c
iaee??iiyi // A?niee i?iaeai a?ieia?? ? iaaeeoeeie. – Iieoaaa-Oa?e?a,
1998. – ? 25. – N. 23-25.

4. Eenaiei A.I., Eenaiei ?.A. Iaeiiiiiaioia o??o?a?/ia e?eoaaiiy
a?aaionueei? aaaaoieaia?ii? ?aoeeaeeaii? iaai?aaeii? i?neyiia?aoe?eii?
aaio?aeueii? a?eae?, ioieiai? a?eae? oa o?a?ii?iie iaoee o oai?i? c
iaee??iiyi // Iaoeiaee a?niee Oaeai?iaenueeiai oi?aa?neoaoo (na??y
iaaeeoeeia). – Oaeai?iae, 1999. – Aeione 8. – N. 28-30.

5. Iao. ? 12544 A Oe?a?ia, UA A61A17/00. Niinia aooiaea?iaeueii?
ieanoeee iineyiia?aoeieii? aaio?aeueii? a?eaei / Eenaiei A.I., Eenaiei
?.A., Oaeei A.Ae. – ? 94010206; Cayae. 10.09.93.; Iioae. 28.02.97; Athe.
– 1997. – ?1. – N. 3.1.54.

6. Eenaiei ?.A. Iaoiaeeea i?io?eaeoeee iaaii?iiy ?aie o oai?eo c
i?neyiia?aoe?eieie aaio?aeueieie a?eaeaie oa iaee??iiyi // Aeooaeueiua
aii?inu iaioeiaeiie oe?o?aee i?aaiia a?thoiie iieinoe: Nai?iee ?aaio
iao/ii-i?aeoe/aneie eiioa?aioeee, iinayuaiiie 15-eaoeth eaoaae?u
oe?o?ae/aneeo aieaciae. – Oa?ueeia, 1998. – N. 190-191.

7. Eunaiei A.O., Iyeioa A.A., Eunaiei ?.A. Ieanoeea aieueoeo e
aeaaioneeo aaio?aeueiuo a?uae iaoiaeii aooiaea?iaeueiie iieinee ii
A.I.ssiiao // Oacenu aeieeaaeia iaeanoiie iao/ii-i?aeoe/aneie
eiioa?aioeee “Ooiaeaiaioaeueiua e i?eeeaaeiua aii?inu iaaeeoeeiu e
aeieiaee”. – Iieoaaa. – 1990. – N. 203.

AIIOAOe?ss:

Eenaiei ?.A. Iioei?caoe?y o??o?a?/iiai e?eoaaiiy i?neyiia?aoe?eieo
aaio?aeueieo a?eae aaeeeeo ?ici???a o oai?eo ?c iaee??iiyi. – ?oeiien.

Aeena?oaoe?y ia caeiaoooy iaoeiaiai nooiaiy eaiaeeaeaoa iaaee/ieo iaoe
ca niaoe?aeuei?noth 14.01.03 – o??o?a?y. – Ee?anueea iaaee/ia aeaaeai?y
i?neyaeeieiiii? ina?oe ?i. I.E.Ooieea IIC Oe?a?ie, Ee?a, 1999.

Aeena?oaoe?th i?enay/aii ieoaiiyi ao?iiaoiaaiaco, iniaeeainoae
ee?i?/iiai ia?aa?ao i?neyiia?aoe?eieo aaio?aeueieo a?eae aaeeeeo
?ici???a o oai?eo ?c iaee??iiyi ? ?ic?iaoe? ia oe?e iniia? iaea?eueo
?aoe?iiaeueii? oaeoeee ?o o??o?a?/iiai e?eoaaiiy. Iniaeeaa oaaaa
i?eae?ey?oueny ia?aaeiia?aoe?ei?e i?aeaioiaoe?, ui ii/eia?oueny c
aiaoeaoi?iiai ?aaeeio, aeeth/a? eiiieaen ae??oe/iiai oa?/oaaiiy, ai?aae
c EOE. Cai?iiiiiaaii iiaee niin?a i?io?eaeoeee iaaii?iiy ?aie a oai?eo
?c iaee??iiyi. Ai?iaaaeaeaii aeei?enoaiiy ?icoe?aieo iia?aoeaieo
?ic??c?a, ui ia?aaeaa/athoue aaaeii?iiieanoeeo. O oai?eo ?c iaee??iiyi
2-4 no aa?i?iieanoeea ii?aeio?oueny c aeaeaeaiiyi iniiaiiai aeaii aee?o
(aeny/iai “oa?oooa” aaeeeiai naeueieea). ?ic?iaeaii iiaeeo?eiaaiee
niin?a aaio?iieanoeee i?noeaaeie oeaieiaie, iiaee niin?a
aooiaea?iaeueii? ieanoeee, ui aeicaieythoue aoaeoeaii oe??iethaaoe
neaae? i?noey aiiiaa?ica a cii? ieanoeee, ciaioothoue iaaaioaaeaiiy ia
iniiaiee oia. ?acoeueoaoe aeine?aeaeaiue ai?iaaaeaeai? a i?aeoeeo –
io?eiai? iiceoeai? ?acoeueoaoe.

Eeth/ia? neiaa: aaio?aeueia a?eaea, iaee??iiy, o??o?a?/ia e?eoaaiiy,
aaaeii?iiieanoeea, aa?i?iieanoeea.

SUMMARY:

R.B. Lyssenko. Optimization of the surgical treatment of postoperative
ventral hernias of large sizes in patients with obesity. – Manuscript.

The thesis to the scientific degree of Candidate of Medical Sciences by
speciality 14.01.03 – surgery. The Kiev Medical Academy for
Post-Graduate Education of Ministry of Health of Ukraine, Kiev, 1999.

The thesis presented deals with the problems surgical treatment of
postoperative ventral hernias in patients with obesity. Wich concern the
study of the problems of ethiopathogenesis, peculiarities of the
clinical course of postoperative ventral hernias in patients with
obesity and the development on this basis of the most rational tactics
of their surgical treatment. Special attention is given to the
preoperative preparation, which starts with an out-patient regimen,
includes a complex diet, exercises of therapeutic physical culture. The
new method of the wound suppuration prevention in patients with obesity
is offered. The use of extended operating slits is introduced it
providing abdominoplasty. The modified method of ventroplasty with the
help of local tissues and the new method of autodermal plasty developed
allow in the course of research to strengthen effectively aponeurosis
weak points in the area of the plasty, reduce the load on the main
suture. The results of the research are being implemented into practice.

Key words: ventral hernia, surgical treatment, obesity, abdominoplasty,
hernioplasty.

AIIIOAOeEss:

Eunaiei ?.A. Iioeiecaoeey oe?o?ae/aneiai ea/aiey iineaiia?aoeeiiiuo
aaio?aeueiuo a?uae aieueoeo ?acia?ia o aieueiuo n iaee?aieai. –
?oeiienue.

Aeenna?oaoeey ia nieneaiea iao/iie noaiaie eaiaeeaeaoa iaaeeoeeineeo
iaoe ii niaoeeaeueiinoe 14.01.03 – oe?o?aey. – Eeaaneay iaaeeoeeineay
aeaaeaiey iineaaeeieiiiiai ia?aciaaiey ei. I.E.Ooieea IIC Oe?aeiu, Eeaa,
1999.

Aeenna?oaoeeiiiay ?aaioa yaeyaony ?acoeueoaoii eeeie/aneiai
enneaaeiaaiey 140 aieueiuo n iineaiia?aoeeiiiie aaio?aeueiie a?uaeae
aieueoeo ?acia?ia (IIAA) e niioonoaothuei iaee?aieai, eioi?ua auee
iia?e?iaaiu a oa/aiea 1989-1996 aiaeia a oe?o?ae/aneeo eeeieeao
a.Iieoaau, eiee/anoai eioi?uo ninoaaeyei 58% io iauaai eiee/anoaa
aieueiuo, iia?e?iaaiiuo ii iiaiaeo IIAA ca yoe aiaeu.

Aeenna?oaoeey iinayuaia eco/aieth aii?inia yoeiiaoiaaiaca, iniaaiiinoae
eeeie/aneiai oa/aiey IIAA o aieueiuo n iaee?aieai e ?ac?aaioea ia yoie
iniiaa iaeaieaa ?aoeeiiaeueiie oaeoeee eo oe?o?ae/aneiai ea/aiey.

Iniaia aieiaiea oaeaeaii eiiieaeniie i?aaeiia?aoeeiiiie iiaeaioiaea,
eioi?ay ia/eiaaony n aiaoeaoi?iiai ?aaeeia, aeeth/aao ?aaeei
aeeaoe/aneiai ieoaiey, oi?aaeiaiey n EOE, iai?aaeaia ia
i?aaeoi?aaeaeaiea cia/eoaeueiiai iiauoaiey aioo?ea?thoiiai aeaaeaiey e
aai iaaaoeaiia aeeyiea ia na?aea/ii-ninoaeenooth, aeuoaoaeueioth e
ae?oaea nenoaiu a ?aiiai iineaiia?aoeeiiiii ia?eiaea. ?ac?aaioaia
niaoeeaeueiay “Iaiyoea” aeey aieueiuo n IIAA e iaee?aieai, eioi?ui
i?aaeeiaeaii iia?aoeaiia ea/aiea, ni noaiie ieaiiaiai ianeaaeiaaiey e
?aeiiaiaeoaiuie ia?ii?eyoeyie ii iiaeaioiaea e iia?aoeee a aiaoeaoi?iuo
oneiaeyo, /oi iicaieyao oiaiueoeoue n?ie i?aauaaiey a noaoeeiia?a aei
iia?aoeee aei 4,5 aeiae.

I?aaeeiaeai iiaue niinia i?ioeeaeoeee iaaiiaiey ?aiu o aieueiuo n
iaee?aieai. I?aaeoi?aaeaeaiea aicieeiiaaiey iaaiiaiey ?aiu o aieueiuo n
iaee?aieai, eioi?ua iia?e?othony ii iiaiaeo IIAA aieueoeo ?acia?ia,
iaania/eaaeinue iooai iineaaeiaaoaeueiiai auiieiaiey i?ioeeaeoe/aneeo
ia?ii?eyoee aei, ai a?aiy e iinea iia?aoeee. Iniaia aieiaiea oaeaeyee
caueoa iia?aoeeiiiie ?aiu io eioeoee?iaaiey ai a?aiy iia?aoeee, /oi
iaania/eaaeinue iineieiui iaeeaaeuaaieai aa iaeaieaie e naeoaoeaie ii
iaoiaeeea eeeieee.

Aeieacaia iaiaoiaeeiinoue auiieiaiey o aieueiuo n IIAA e iaee?aieai
aaaeiieiiieanoeee n eniieueciaaieai ?anoe?aiiuo iia?aoeaiuo ?ac?acia ii
Oa?iaiaeano, Aa?niio e Aaooeaeth, eioi?ua i?aaeoniao?eaatho
aea?iaoieeiyeoiieth a ciia ieanoeee, ei??aeoeeth aeny/aai aee?iaiai
”oa?oooa” aeeaioa e iaania/eaatho aieaa oe?ieee iia?aoeaiue aeinooi e
a?uaeaaui ai?ioai aeey iioeiaeueiie ?aaecee aiiiaa?ica, cia/eoaeueiue
einiaoe/aneee yooaeo, a iaeioi?ie noaiaie nioeeaeueioth ?aaaeeeoaoeeth
yoie eaoaai?ee aieueiuo.

O aieueiuo n iaee?aieai 2-4 no aa?ieiieanoeea ni/aoaaony n oaeaeaieai
iniiaiiai aeaii aee?a (aeny/aai “oa?oooa” aieueoiai naeueieea), /oi
iicaieyao oiaiueoeoue iaoyaeaiea oeaiae i?e auiieiaiee ieanoeee,
iaa?oceo ia ciio ieanoeee e iiauoaiea aioo?ea?thoiiai aeaaeaiey a ?aiiai
e iicaeiai (iniaaiii i?e i?ia?anne?iaaiee iaee?aiey) iineaiia?aoeeiiiii
ia?eiaea.

I?e ni/aoaiee IIAA e caaieaaaiee i?aaiia a?thoiie iieinoe o aieueiuo n
iaee?aieai, auyaeaiiuo i?e i?aaeaa?eoaeueiii ianeaaeiaaiee e
ioaeaeathueony a oe?o?ae/aneie ei??aeoeee, auiieiyeenue neioeueoaiiua
iia?aoeee. N/eoaai oeaeaniia?aciui auiieiaiea neioeueoaiiuo iia?aoeee o
aieueiuo n IIAA e iaee?aieai i?e ananoi?iiiai ianeaaeiaaiee aei
iia?aoeee e ionoonoaee i?ioeaiiieacaiee. Yoi a aeaeueiaeoai eneeth/aao
iaiaoiaeeiinoue ion?i/aiiuo iia?aoeaiuo aiaoaoaeuenoa o aieueiuo n
oa?icie aicieeiiaaiey ?aoeeaeeaa a?uaee.

Iaycaoaeueiui yoaiii iia?aoeee n/eoaai ?acaeaeaiea niaae iaaeaeo
i?aaiaie a a?uaeaaii iaoea e aai noaieaie e e?ayie a?uaeaauo ai?io, a
oaeaea ?acuaaeeiaiea n?auaiiuo iaaeaeo niaie i?aaiia a?thoiie iieinoe
aeey eeeaeaeaoeee i?iyaeaiee o?iie/aneie eeoa/iie iai?ioiaeeiinoe.

N/eoay, /oi aicieeiiaaiea IIAA a iniiaiii caaeneo io neaainoe
aiiiaa?ioe/aneiai neiy ia?aaeiae a?thoiie noaiee, i?e oe?o?ae/aneeo
aiaoaoaeuenoaao noa?aeenue oe?aieyoue aiiiaa?ic. Cia/eoaeueiia aieiaiea
oaeaeyee oe?aieaieth neaauo iano aiiiaa?ica, /oi aeinoeaaeinue
eniieueciaaieai ieanoee oeia Naiaaeei e ssiiaa a iiaeeoeeaoeee eeeieee.

?ac?aaioaiiay, ia aaca niiniaa Naiaaeei, iiaeeoeeaoeey aaio?iieanoeee
ianoiuie oeaiyie, eioi?ay i?aaeoniao?eaaao oaeaeaiea neaauo
ia?a?anoyioouo oeaiae iooai V-ia?aciiai au?acaiey ii n?aaeiae eeiee
aeaoaeoa, iaeiaeaiea eenaoiuo oaia ia aiiiaa?ic a oaeao ieanoeee,
?aca?oci/iuo oaia, iicaieyao yooaeoeaii oe?aieyoue neaaua ianoa
aiiiaa?ica a ciia ieanoeee, oiaiueoaao iaa?oceo ia iniiaiie oia.

I?aaeeiaeai caiaoaioiaaiiue niinia aooiaea?iaeueiie ieanoeee a?uaeaauo
ai?io n iiiiuueth “aeaooyoaaeiiai oio?iaaiey” ni niaoeeaeueiuie
oeene?othueie caieaie, eioi?ue iaania/eaaao oiaiueoaiea iaa?ocee ia
iniiaiie oia, oiaiueoaao eiee/anoai ?aiaauo ineiaeiaiee.

?acoeueoaou enneaaeiaaiee aiaae?aiu a i?aeoeeo – iieo/aiu oi?ioea
?acoeueoaou: iaaiiaiea iineaiia?aoeeiiiie ?aiu aicieeei o 3-o aieueiuo
(2,1%), ?aoeeaeea a?uaee aiciee o 3 (2,1%) aieueiuo, ianna oaea
oiaiueoaeanue a n?aaeiai ia 14,5% io enoiaeiie. Eaoaeueiinoue ninoaaeea
1,4%.

Eeth/aaua neiaa: aaio?aeueiay a?uaea, iaee?aiea, oe?o?ae/aneia ea/aiea,
aaaeiieiiieanoeea, aa?ieiieanoeea.

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