Порівняльна оцінка хірургічних методів лікування синдрому склерокістозних яєчників: Автореф. дис… канд. мед. наук / Валід Камаль Абд Ель Салам Атіа,

19

I?I?NOA?NOAI IOI?IIE CAeI?IA”ss OE?A?IE

A?IIEOeUeEEE AeA?AEAAIEE IAAeE*IEE OI?AA?NEOAO

?i. I. ?. IE?IAIAA

AAE?Ae EAIAEUe AAAe AEUe NAEAI AO?A

OAeE 618.11-006.21.55-089

Ii??aiyeueia ioe?iea o??o?a?/ieo iaoiae?a e?eoaaiiy neiae?iio
neea?ie?noicieo y?/iee?a

14.01.01- aeooa?noai ? a?iaeieia?y

Aaoi?aoa?ao

aeena?oaoe?? ia caeiaoooy iaoeiaiai nooiaiy

eaiaeeaeaoa iaaee/ieo iaoe

A?iieoey — 1999

Aeena?oaoe??th ? ?oeiien.

?iaioa aeeiiaia ia eaoaae?? aeooa?noaa ? a?iaeieia?? ? 1 E?einueeiai
aea?aeaaiiai iaaee/iiai oi?aa?neoaoo ?i. N. ?. Aai?a??anueeiai IIC
Oe?a?ie.

Iaoeiaee ea??aiee: aeieoi? iaaee/ieo iaoe, i?ioani? Aiaoie?e
Ieeieaeiae/ ?eaaeea, E?einueeee aea?aeaaiee iaaee/iee oi?aa?neoao ?i.
N.?.Aai?a??anueeiai, caaiaeoth/ee eaoaae?ith aeooa?noaa ? a?iaeieia?? ?
1.

Io?oe?ei? iiiiaioe: aeieoi? iaaee/iee iaoe, i?ioani? Ai?en Oaaei?iae/
Iaci?/oe, A?iieoeueeee aea?aeaaiee iaaee/iee oi?aa?neoao ?i.
I.?.Ie?iaiaa, caaiaeoth/ee eaoaae?ith aeooa?noaa ? a?iaeieia?? ?1.

aeieoi? iaaee/ieo iaoe, i?ioani? A?eoi?
Ieeieaeiae/ A?n?ae?i, Euea?anueeee aea?aeaaiee iaaee/iee oi?aa?neoao,
caaiaeoth/ee eaoaae?ith aeooa?noaa ? a?iaeieia?? ?1.

I?ia?aeia i?aai?caoe?y: Aei?i?iiao?ianueea iaaee/ia aeaaeai?y IIC
Oe?a?ie.

Caoeno a?aeaoaeaoueny 22 /a?aiy 1999 ?ieo i 12 aiaeei? ia can?aeaii?
Niaoe?ae?ciaaii? A/aii? ?aaee E. 05.600.01 i?e A?iieoeueeiio
aea?aeaaiiio iaaee/iiio oi?aa?neoao? ?i. I.?.Ie?iaiaa ca aae?anith:
286018 i. A?iieoey, aoe. Ie?iaiaa, 56.

C aeena?oaoe??th iiaeia iciaeiieoeny o a?ae?ioaoe? A?iieoeueeiai
aea?aeaaiiai iaaee/iiai oi?aa?neoaoo ca aae?anith:286018 i. A?iieoey,
aoe.Ie?iaiaa, 56.

Aaoi?aoa?ao ?ic?neaiee 19 o?aaiy 1999 ?ieo.

A/aiee nae?aoa? Niaoe?ae?ciaaii?

A/aii? ?aaee,

eaiaeeaeao iaaee/ieo iaoe, aeioeaio Iieeaeueei I.?.

CAAAEUeIA OA?AEOA?ENOEEA ?IAIOE

Aeooaeuei?noue oaie. I?iaeaia ia?eoiiaaeueii? iaie?aeiino? i?ney
eeeiiaeaeii? ?acaeoe?? y?/iee?a c i?eaiaeo neiae?iio neea?ie?noicieo
y?/iee?a (CNEss) ciaoiaeeoueny a oeaio?? oaaae no/anii? a?iaeieia?/ii?
aiaeie?eiieia??. Oey i?iaeaia ia? aaeeea iaaee/ia ? nioe?aeueia
cia/aiiy, oae ye aoaeoeai?noue o??o?a?/iiai e?eoaaiiy ii a?aeiioaiith
aei a?aeiiaeaiiy aaia?aoeaii? ooieoe?? neeaaea? a?ae 24 aei 63% (A. O.
Oaaoeue, 1997).

Ia aeoieo a?eueoino? aaoi??a, iaeiei ?c iaea?eueo aoaeoeaieo iaoiae?a
a?aeiiaeaiiy iaino?oaeueii? ? aaia?aoeaii? ooieoe?? i?e oeiia?e oi?i?
NEss ? iia?aoeaia e?eoaaiiy (A. E. Eoeaeia .,1997; A. A. Oiiano?eaeca
,1997; D. Paul et al.,1997).

A inoaii? ?iee c’yaeeeny aeai? i?i aeei?enoaiiy eaia?ineii?/ii?
aeaeo?iioieoo?e, oa?iieaooa?ecaoe??, eaca?ii? eaii?ecaoe?? y?/iee?a ye
iaoiae?a e?eoaaiiy oai?eo c neiae?iiii NEss, ye? aeicaieythoue oieeiooe
?icaeoeo niaeeiaiai i?ioeano a /a?aai?e ii?iaeiei? (O. A. Ao?aaa,1998;
A.O. Oaaoeue, 1998; J. Farhi et al., 1995).

Iaoai?cie e?eoaaeueiiai aoaeoo eeeiiaeaeii? ?acaeoe?? ? aeaiaaeoeyoe??
y?/iee?a, ieoaiiy i?i ee?i?/i? no?oeoo?e y?/ieea, ye? a?aeiia?aeaeuei?
ca i?aeaeuaio nae?aoe?th aiae?iaai?a, c?ooaiiy a nae?aoe??
aiiaaeio?iiieo ? noaoaaeo ai?iii?a aei oaia??oiueiai /ano ia iaea?aeaee
ae/a?iiiai iiyniaiiy.

Ii i??? iaeiie/aiiy a?aeiiinoae i?i aea/aiiy a?aeaeaeaieo ?acoeueoao?a
iia?aoeaiiai e?eoaaiiy iioae?eiaai? iia?aeiieaiiy i?i ?icaeoie
niaeeiaiai i?ioeano iaaeiei iaoeiaeo o?oa oa y?/iee?a o 58-100% ae?iie,
yeee iiaea neoaeeoe iaoai?/iei oaeoi?ii iaie?aeiino? (TH. E. Iaioaie?ia
, 1987; A. A. Aeeaaa, 1992).

Iaaeeaey/enue ia iino?eio ?ic?iaeo iiaeo iaoiae?a o??o?a?/iiai e?eoaaiiy
neiae?iio NEss, aiie ia ciaoiaeyoue oe?ieiai canoinoaaiiy i?e iia?aoe?yo
o oai?eo c aeaiith iaoieia??th. O ca’yceo c oeei aeooaeuei?noue i?iaeaie
i?io?eaeoeee ia?eoiiaaeueii? oi?ie iaie?aeiino?, iaoiiaeaii? iia?aoeaiei
ao?o/aiiyi ia y?/ieeao, iiooeo ? aaeineiiaeaiiy oaoi?ee iia?aoe?? a
oaia??oi?e /an ia aeeeeea? noii?a?a.

Ca’ycie ?iaioe c iaoeiaeie i?ia?aiaie. ?iaioa aeeiiaia a ?aieao iaoeiai?
i?iaeaie 14. 01. 01- aeooa?noai ? a?iaeieia?y E?einueeiai aea?aeaaiiai
iaaee/iiai oi?aa?neoaoo ?i. N.?.Aai?a??anueeiai. Oeo? oaie 1.27 ?
aea?ae?a?no?aoe?? 0196 EI 14531.

Iaoa ?iaioe. ?ic?iaea iaea?eueo iioeiaeueiiai, iaoiaaiaoe/ii
iaa?oioiaaiiai iaoiaeo o??o?a?/iiai e?eoaaiiy aeey i?aeaeuaiiy
aoaeoeaiino? a?aeiiaeaiiy aaia?aoeaii? ooieoe??, i?io?eaeoeee
ia?eoiiaaeueii? oi?ie iaie?aeiino? o ae?iie c neiae?iiii neea?ie?noicieo
y?/iee?a.

Caaea/? aeine?aeaeaiiy.

1. Aea/eoe ? aeae?eeoe oa?aeoa?i? ?ene ee?i?/iiai ? ai?iiiaeueiiai
i?io?eth o oai?eo c oeiiaith oi?iith neiae?iio neea?ie?noicieo y?/iee?a.

2. Aea/eoe ee?i?ei-aaiaaeia?/iee aniaeo n?iaeii? noeeueiino? aei
caoai?thaaiiy neiae?iiii neea?ie?noicieo y?/iee?a.

3. Aea/eoe iniaeea?noue ii?oieia?/ii? no?oeoo?e aeaeaeaii? oeaieie
y?/ieea.

4. I?iaanoe ii??aiyeueiee aiae?c iniaeeainoae /anoioe ooai?aiiy niaeie ?
?icaeoeo o?oaii-ia?eoiiaaeueii? iaie?aeiino? i?ney eaia?ioii?/iiai ?
eaia?ineii?/iiai aeinooi?a o oai?eo c neiae?iiii neea?ie?noicieo
y?/iee?a.

5. Aeynieoe /anoioo ? oa?aeoa? ?icaeoeo aioo??oiuei/a?aaieo c?iuaiue a
iaeano? aeiaeaoe?a iaoee o ae?iie, ye? i?iiia?iaai? iaoiaeii
aeaiaaeoeyoe?? y?/iee?a o ?aiiueiio i?neyiia?aoe?eiiio ia??iae?.

6. Ii??aiyoe a?aeaeaeai? ?acoeueoaoe aoaeoeaiino? aeaiaaeoeyoe?? ?
ae?aoa?iieiaaoeyoe?? y?/iee?a noiniaii aei a?aeiiaeaiiy iaino?oaeueii?,
aaia?aoeaii? ooieoe??.

7. I?iaanoe aoia?ao?/io ioe?ieo y?/iee?a ? ooieoe?iiaeueiee noai
iaoeiaeo o?oa iaoiaeii a?noa?inaeuei?iaia?ao?? aei ? i?ney ??cieo
o??o?a?/ieo iaoiae?a e?eoaaiiy NNEss.

8. Aeyaeoe aieea iaoiaeo aeaiaaeoeyoe?? ? ae?aoa?iieiaaoeyoe?? y?/iee?a
ia aene?aoe?th aiiaaeio?iiieo ai?iii?a, ano?iaai?a, i?iaanoa?iio,
aiae?iaai?a.

9. Aea/eoe iniaeeaino? ii?oieia?/ieo ci?i a y?/ieeao a oiiaao
aenia?eiaioo i?e aeei?enoaii? ae?aoa?iiioieoo?e.

10. ?ic?iaeoe oa iaa?oiooaaoe i?aeoe/i? ?aeiiaiaeaoe?? ii
ai?iaaaeaeaiith e?eoaaeueii? oaeoeee o oai?eo c neiae?iiii
neea?ie?noicieo y?/iee?a.

Iaoeiaa iiaecia ?iaioe. I?iaeaia aeai?o aeaeo o??o?a?/iiai e?eoaaiiy i?e
NNEss i?aaenoaaey? ia o?eueee oai?aoe/ia, aea e i?aeoe/ia cia/aiiy a
?icae?e? a?aeiiaeaiiy ?ai?iaeoeoeaii? ooieoe??.

O ?iaio? aia?oa ia no/aniiio ee?i?ei-eaai?aoi?iiio ??ai? i?iaaaeaii
ii??aiyiiy ?acoeueoao?a o??o?a?/iiai e?eoaaiiy NNEss c canoinoaaiiyi
eaia?ineii?/iiai ? eaia?ioii?/iiai aeinooi?a. Aeey aea/aiiy aoaeoeaiino?
aeaiaaeoeyoe?? y?/iee?a noai?aiee niaoe?aeueiee ?ino?oiaioa??e,
?ic?iaeaia iaoiaeeea iia?aoe??.

I?iaaaeaia eaia?ineii?/ia aeine?aeaeaiiy aeicaieeei aea/eoe caaithaaiiy
i?iiia?iaaiiai y?/ieea, iienaoe noai /a?aaii? ii?iaeieie, ia?aa?a
?aiiueiai i?neyiia?aoe?eiiai ia??iaeo.

Aeaeaeaiiy iiceiaiai oa?o y?/ieea ca aeiiiiiaith o?oa/anoiai iiaea c
iaeeaaeaiiyi aaiinoaoe/iiai, i?aeiaiei/iiai, caaeeaiiai, ia?ao?aniiai
oaa aeiaciey? cieceoe ??aaiue aiae?iaai?a, iaeneiaeueii caa?aaoe
ei?eiaee oa? y?/ieea, yeee i?noeoue oie?eoee, ciaioeoe ca?eueoai?
y?/ieee aei ii?iaeueieo ?ici???a.

Aia?oa aeiaaaeaii, ui canoinoaaiiy aaeineiiaeaiiai iaoiaeo o??o?a?/iiai
e?eoaaiiy noi?iaiaeaeo?oueny cia/iei ciaioaiiyi aioo??oiuei/a?aaieo
c?iuaiue iaaeiei aeiaeaoe?a iaoee, aeicaiey? cieceoe /anoioo oaeiai
oneeaaeiaiiy, ye ia?eoiiaaeueia ? o?oaia iaie?aei?noue. Iieacaia
aacoiiaii a?eueo aeniea aoaeoeai?noue aeaiiai iaoiaeo a ii??aiyii? c
cae/aeiith eeeiiaeaeiith ?acaeoe??th y?/iee?a.

Aeyniaia ea?oeia ii?oieia?/ieo ci?i a y?/ieeao i?ney aeaeo?e/ii? ae??.
Cieaeaiiy caiaeueii? ?aaeoe?? o a?aeiia?aeue ia ae?th, a ??
aace?iaiino?, anaioe/iino?, aeicaiey? aeei?enoaoe ae?aoa?iiioieoo?o a
yeino? aeueoa?iaoeaiiai niiniao e?eoaaiiy NNEss.

Iaeii/ania aeei?enoaiiy no/aniiai eiiieaeno ee?i?/ieo, ai?iiiaeueieo,
oeueo?acaoeiaeo ? ii?oieia?/ieo iaoiae?a aeine?aeaeaiiy aeiacieeei
ooi/ieoe e?eoa??? ae?aaiinoeee oeiiai? oi?ie NNEss ? iieacaiiy aei
o??o?a?/iiai e?eoaaiiy.

Iaoeiai- i?aoe/ia cia/aiiy ?iaioe. Aiae?c o??o?a?/iiai e?eoaaiiy oai?eo
c NNEss c aeei?enoaiiyi eeeiiaeaeii? ?acaeoe?? y?/iee?a iieacaa
iaaaoeaio ?ieue inoaiiuei? o ?icaeoeo o?oaii-ia?eoiiaaeueii?
iaie?aeiino?.

Cai?iiiiiaaiee niin?a aeaiaaeoeyoe?? y?/iee?a o?oa/anoei iiaeai c
iaeeaaeaiiyi aaiinoaoe/iiai, i?aeiaiei/iiai, caaeeaiiai, ia?ao?aniiai
oaa.

Ee?i?ei-eaia?ineii?/ia iaa?oiooaaiiy a o??o?a?/i?e i?aeoeoe?
iiaeeo?eiaaiiai iaoiaeo aeaiaaeoeyoe?? ? eaia?ineii?/ii?
ae?aoa?iieiaaoeyoe?? y?/iee?a aeicaiey? ??cei ciaioeoe niaeeiooai?aiiy a
iaeano? aeiaeaoe?a iaoee, cieceoe /anoioo ?icaeoeo
o?oaii-ia?eoiiaaeueii? iaie?aeiino?, a?aeiiaeoe aiaeie?eiio ooieoe?th
i?aai?cio.

I?aeoaa?aeaeaii, ui a ?acoeueoao? ?ic?iaeaii? oaoi?ee iia?aoe?? ?
eaia?ineii?/ii? ae?aoa?iieiaaoeyoe?? y?/iee?a aeoea?co?oueny
aiiaaeio?iiia ooieoe?y a?iio?co, ??aaiue oanoinoa?iio cia/ii
cieaeo?oueny. Eiio?ieueia eaia?ineii?y aeicaiey? a?eueo aeaoaeueii
aea/eoe noai i?ioean?a, ca’ycaieo ?c niaeeiooai?aiiyi, eiai
i?io?eaeoeeith ? e?eoaaiiyi. Oai?aoe/ia cia/aiiy ?iaioe iieyaa? a oiio,
ui aiia ? i?iaeiaaeaiiyi aeine?aeaeaiiy a iiooeo iiaeo niinia?a
o??o?a?/iiai e?eoaaiiy ? oeyo?a cieaeaiiy ia?eoiiaaeueii? oi?ie o?oaii?
iaie?aeiino?, a oaeiae o aeyniaii? niaaeeiaiai oaeoi?o a ao?ieia??
?icaeoeo NNEss.

Iniaenoee aeeaae caeiaoaa/a. Iaea?aeai? aeai? ? ?acoeueoaoii naiino?eii?
?iaioe aeena?oaioa.

Iniaenoi caeiaoaa/ai i?iaaaeaii 107 a?iaeieia?/ieo iia?aoe?e ia y?/ieeao
o oai?eo c neiae?iiii NEss, ai?iiiaeuei? aeine?aeaeaiiy,
iao?inaeuei?iaia?ao??, a oaeiae aenia?eiaioaeueia /anoeia ?iaioe ia
i?aeaeine?aeieo oaa?eiao.

Ii cae?i/aii? ee?i?/ieo aeine?aeaeaiue aeena?oaioii i?iaaaeaiee aiae?c
?acoeueoao?a ? c?iaeai? i?aeoe/i? aeniiaee. Iaoa??ae aeena?oaoe??
ciaeoia nai? a?aeia?aaeaiiy a iaoeiaeo noaooyo, ye? iaienai? ye
naiino?eii, oae ? a ni?aaaoi?noa?, ?aoe?iiae?caoi?nueeeo i?iiiceoe?yo,
iaoiaee/ieo ?aeiiaiaeaoe?yo ca oaiith aeena?oaoe??.

Ai?iaaoe?y ?iaioe. Iniiai? iieiaeaiiy aeena?oaoe?? iia?aeiieai? oa
iaaiai?ai? ia: ee?i?/i?e eiioa?aioe?? e?ea??a 2-ai iieiaiaiai aoaeeieo
i. N?ioa?iiiey 1997 ?ieo; ?anioae?eainuee?e eiioa?aioe??
aeooa??a-a?iaeieia?a Aaoiiiiii? ?anioae?ee E?ei 1998 ?.; i?iaeaii?e
eii?n?? E?einueeiai iaaee/iiai oi?aa?neoaoo c o??o?a?/ieo
niaoe?aeueiinoae ? 4 a?ae 02. 10. 98 ?.; ni?eueiiio can?aeaii? eaoaae?e
aeooa?noaa ? a?iaeieia?? ? 1 ? eaoaae?e aeooa?noaa ? a?iaeieia?? ? 2
a?ae 26. 01. 99 ?.

Ioae?eaoe??. Ca iaoa??aeaie aeena?oaoe?? iioae?eiaaii 5 iaoeiaeo ?ia?o
? 4 ?aoe. i?iiiceoe??.

Ia’?i ? no?oeoo?a ?iaioe. Aeena?oaoe?y aeeeaaeaia ia 143 noi??ieao
iaoeiiieniiai oaenoo, neeaaea?oueny ?c aaaaeaiiy, iaeyaeo e?oa?aoo?e,
?icae?e?a, ye? i?enay/ai? iaoa??aeai ? iaoiaeai iaoaaeaiiy, aeanieo
aeine?aeaeaiue, iaaiai?aiiy ?acoeueoao?a, aeniiae?a, i?aeoe/ieo
?aeiiaiaeaoe?e ? iieaae/eea e?oa?aoo?e, yeee i?noeoue 211 aeaea?ae, ?c
ieo: 88 — ia ?iicaiieo iiaao. ?iaioa ?ethno?iaaia 13 oaaeeoeyie , 10
iaethieaie.

Iaoa??ae ? iaoiaee aeine?aeaeaiiy.

A iniiao iaoeo aeine?aeaeaiue aoee iieeaaeai? niinoa?aaeaiiy ca 395
oai?eie c oeiiaith oi?iith neiae?iio NEss, yeei i?iaaaeaii o??o?a?/ia
e?eoaaiiy. A ia?oo a?oio aa?eoee 48 oai?eo, yeei i?iaaaeaia
aeaiaaeoeyoe?y y?/iee?a ca aeiiiiiaith o?oa/anoiiai iiaea c ianooiiei
iaeeaaeaiiyi iaaeaiiai, ia?ao?aniiai, caaeeaiiai , i?aeiaiei/iiai oaa.

O?oa/anoei iiaeai iaa?oaeueieie ?ooaie iaaeiei iicaeiaaeii? in?
oee?eoey?ii ?icn?ea?oueny eainoea a iaeano? iaoeiaiai a?aeae?eo y?/ieea
? i?aeeyaath/a oeaieia aac ?icn?eaiiy a?ei/ii? iaieiiee aei o?oaiiai
a?aeae?eo. Aee?i?io iiceiao ?a/iaeio y?/ieea, yea a?aeiia?aeia
aioo??oiueiio ae?aiao?o o?oa/anoiiai iiaea ? aeiaaeei? y?/ieea,
aeaeaeythoue c?aiooeie iiaeieoeyie. Iaaeaiei, ia?ao?anoiei, caaeeaiei,
i?aeiaiei/iei oaii i?iaiaeeoueny aaiinoac ooai?aiiai ooiaeth c iaoith
caiia?aaiiy ooai?aiiy caeeoeiaeo ii?iaeiei ? aaiaoii o i?iiia?iaaiiio
y?/ieeo. Oee?eoeyoi?iee iiaa?oiaaee ?ic??c a iaeano? iaoeiaiai e?ioey
y?/ieea i?ee?eaa?oueny aeoae?eaoo?ith c eainoee y?/ieea ca aeiiiiiaith
2 a?aee?eeiaeo oa?a.

Aeey cae?eniaiiy iinoaaeaieo caaea/ aoee aea/ai? a?aeaeaeai? ?acoeueoaoe
o??o?a?/iiai e?eoaaiiy o 295 oai?eo 2-i? a?oie, yeei aoea i?iaaaeaia
aeaia?/ia eeeiiaeaeia ?acaeoe?y y?/iee?a.

Anoaiiaeaia /anoioa ? a?aenioie oai?eo, ye? i?iaeiaaeothoue no?aaeaeaoe
iaie?aei?noth a ca’yceo c ?icaeoeii niaeeiaiai i?ioeano i?ney
o??o?a?/iiai e?eoaaiiy. I?iaaaeaiee aiae?c iiaoi?ieo eaia?ioii?e o 82
ae?iie, ye? ia?aianee o ieioeiio iia?aoe?th eeeiiaeaeii? ?acaeoe?? ? o 5
aeaiaaeoeyoe?? y?/iee?a.

O?aoth a?oio neeaee 52 ae?iee, yeei i?iaaaeaia eaia?ineii?/ia
ae?aoa?iieiaaoeyoe?y y?/iee?a.

I?e anoaiiaeaii? ae?aaiico aoee aeei?enoai? ne?aeoth/? iaoiaee
aeine?aeaeaiiy: ee?i?ei-aaiaaeia?/ia ianoaaeaiiy, yea aeeth/aei
aeieeaaeiee aiae?c, aeai? caaaeueiiai ? a?iaeieia?/iiai noaoono. Aeey
ioe?iee a??nooecio aeei?enoiaoaaee oeaeo D. Ferriman et al. (1961) ,c
aecia/aiiyi na?aaeiueiai a??nooiiai ai?iiiaeueiiai oa ?iaeeoa?aioiiai
iaee??iiy, yea ioe?ithaaeiny ca aaee/eiith ?iaeaeno Eaoea. On?i ae?ieai
i?iaiaeeee iaeyaeiao ?aioaaiia?ao?th /a?aio a aeaio i?iaeoe?yo,
aoia?ao?th y?/iee?a, iaaeie?eiai? caeice. Aeey ae?aaiinoeee i?io?aeiino?
iaoeiaeo o?oa aeei?enoiaoaaee ?aioaaiia?noa?inaeuei?iaia?ao?th.
Aeeeth/aee /ieia?/ee oaeoi? iaie?aeiino?. Aeey ioe?iee noaio
?aia?aoeaieo i?ioean?a a y?/ieeao ? ieoaiiy ?aiiueiai niaeeiooai?aiiy a
?aiiueiio i?neyiia?aoe?eiiio ia??iae? i?iaiaeeeany eaia?ineii?y.
Nooi?iue ?icaeoeo niaeie iaaeiei y?/iee?a ioe?ithaaee ca?aeii I. Hulka
et al. (1978), a?aeiia?aeii 4 -i noaae?yi.

Aeey ooi/iaiiy oi?ie neiae?iio NEss ? eiio?ieth o??o?a?/iiai e?eoaaiiy
i?iaiaeeee ai?iiiaeueia aeine?aeaeaiiy: aecia/aiiy aene?aoe??
17-eaoinoa?i?ae?a ? 17-ieneeaoinoa?i?ae?a o aeiaia?e na/?; aecia/aiiy a
ieaci? e?ia? ethoa?iacoth/iai (EA), oie?eoeinoeioethth/iai (ONA)
ai?iiia, oanoinoa?iio (O), oe?ieneio (O4), ei?oecieo (E), i?ieaeoeio
(I?E), i?iaanoa?iio (I), ano?aae?ieo (A2). E?ia ? na/o aeey
aeine?aeaeaiiy a?aee ia 7-8 ? 20-21 aei? iaino?oaeueiiai oeeeeo,
aiaeia?/i? aeine?aeaeaiiy i?iaaaeai? ia 7 ? 20 aeaiue i?ney o??o?a?/iiai
ao?o/aiiy.

I?iaaaeai? ooieoe?iiaeuei? i?iae- i?iaanoa?iiiaa, aeaenaiaoaciiiaa,
eeii?oaiiaa. Ooieoe?iiaeueiee noai y?/iee?a aecia/aee ca aeiiiiiaith
oano?a ooieoe?iiaeueii? ae?aaiinoeee, aeaieo a?noieia?/iiai
aeine?aeaeaiiy cne?aae?a neeciai? iaoee.

?aca?eoiaaia oeaieia y?/iee?a o oai?eo c neiae?iiii NEss, a oaeiae a
oiiaao aenia?eiaioo ia oaa?eiao i?aeaeaaaeany a?noieia?/iiio
aeine?aeaeaiith. A?noii?aia?aoe caaa?aethaaee aaiaoienee?i-aiceiii,
i??iooeneiii ii AAI — A?ciio. ?acoeueoaoe aeine?aeaeaiue i?aeaeaaaeeny
noaoenoe/i?e ia?iaoe?, ca?aeii ?aeiiaiaeaoe?yi A. E. Aaneeueaaie ? A. N.
E?enaae/a (1989).

?acoeueoaoe aeine?aeaeaiiy oa ?o iaaiai?aiiy

Aei ii/aoeo ia??iaeo ianoaaeaiiy ? e?eoaaiiy a?e oai?eo c neiae?iiii
NEss eieeaaany a?ae 16 aei 39 ?ie?a, a na?aaeiueiio a?i neeaa o oai?eo
1-? a?oie — 26,4±0,12 ?ie?a, 2-? — 26,25±0,14, 3-? a?oie — 26,9±1,6
?ie?a. ?o iniiaieie nea?aaie aoee ii?ooaiiy iaino?oaeueiiai oeeeeo,
iaie?aei?noue, iaoieia?/iee ??no aieinny ia iaee//? ? o?e?. On? oai??
aoee ae?ii/ieie, aoi?eii? noaoaa? iciaee o ieo aoe? aeinoaoiuei
?icaeiooeie.

Aea/aiiy n?iaeiiai aiaiiaco iieacaei, ui o iaeaeeae/eo ?iaee/?a ( 1-a
a?oia- 18,7%, 2-a- 32,2%, 3-y- 24,4%) a?aei?/aeeny ii?ooaiiy
iaino?oaeueii? oa ?ai?iaeoeoeaii? nenoaie ? i?iyae a??nooecio. O 56,7%
aeiaaeeao NEss oa?aeoa?eco?oueny niaaeeiaith noeeuei?noth. Aeaia
caoai?thaaiiy cono??/aeiny a eiaeii? ae?oai? aei/ee, ui ia?iaeeeany a?ae
iaoa??, yea no?aaeaeaea neiae?iiii NEss.

Aeyaeaii aenieee ?ioaeoe?eiee ?iaeaen o ia??iaeao aeeoeinoaa ? noaoaaiai
aeic??aaiiy (e??, o?ii?/iee oiicee?o, ?aaiaoeci, ia?ioeo, aaiaoeo). Ca
a?eiaei neeaaeii ( ?< 0,05) ? ia?aianaieie a ia??iaeao aeeoeinoaa ? noaoaaiai aeic??aaiiy ?ioaeoe?eieie ? caiaeueieie caoai?thaaiiyie, ianoaaeai? ae?iee iaeaea ia a?ae??ciyeeny o an?o 3 a?oiao. Na?aaei?e a?e ianoaiiy iaia?oa o oai?eo neeaa 13,8± 0,94 ?ie?a (1-a a?oia), 12,8±0,27 (2-a a?oia), 13,0±0,6 ?iee (3-y a?oia). Aeey oai?eo c neiae?iiii NEss oa?aeoa?ii ii?ooaiiy iaino?oaeueii? ooieoe?? c iaia?oa aai i?ney a?aeiinii iaaaeeeiai ia??iaeo ianooiieo ?aaoey?ieo iaino?oaoe?e. Ii?ooaiiy oeeee?/iino? iaino?oaoe?? c iiiaioo ?o iiyae niinoa??aa?oueny a?aeiia?aeii o 66,6%, 82,1%, 25,0% oai?eo. O 68,7% ae?iie (1-a a?oia), o 80,3% (2-a a?oia), o 73% (3-y a?oia) oai?eo niinoa??aaeanue iiniiaii?ay. A?aeiia?aeii o 22,9%, 14,2%, 15:3% ae?iie aeyaeaia aoi?eiia aiaii?ay o?eaae?noth a?ae 6 i?nyoe?a aei 1,5 ?iee. O 4,1%, 3,0%, 7,6% oai?eo a?aeiia?aeii 1, 2, 3 a?oie aoee aeenooieoe?iiaeuei? iaoeia? e?iaioa/?. O 4,17%, 1,3%, 3,8% ae?iie ?aaoey?iee ?eoi iaino?oaoe?? aoa caa?aaeaiee, aea i?e oeueiio aoa aeyaeaiee aiiaoeyoi?iee ?eoi. Ne?ae a?aei?oeoe, ui iiniiaii?ay aeyaeeany iniiaiei oeiii ii?ooaiiy iaino?oaeueii? ooieoe?? o a?eueoino? ianoaaeaieo oai?eo c neiae?iiii NEss. Iaie?aei?noth no?aaeaeaee 91,6% ae?iie (1 a?oia), 84,4% (2 a?oia), 88,4% oai?eo (3 a?oia). ?c ieo ia?aeiiith a?aeiia?aeii- 87,5%, 79,3%, 61,5%. Na?aaeiy o?eaae?noue iaie?aeiino? neeaea 5,55±0,8; 4,45±0,7; 6,2±0,4 ?ie?a. A?eueo?noue ae?iie aei iia?aoe?? ia i?ioyc? o?eaaeiai /ano iaea?aeoaaea ??cio ai?iiiaeueio oa?ai?th, a oiio /ene? noeioeyoe?th iaoeyoe?? eeii?oaiii a?ae 2 aei 4 eo?n?a. Ia?o? ee?i?/i? i?iyae caoai?thaaiiy o a?eueoino? oai?eo (66,6%, 82,1%, 25,0%) a?aeiia?aeii 1, 2, 3 a?oie ni?aiaee c ii/aoeii iaia?oa. A ?ioeo oai?eo iciaee caoai?thaaiiy aeyaeeeny a a?eueo i?ci? no?iee ? aoee ca’ycai? c ??cieie no?aniaeie neooaoe?yie. Iaaei??iee ?iaeaen iane o?ea a na?aaeiueiio 27,6± 1,12 (1 a?oia), 30,34± 1,08 (2 a?oia), 24,4± 0,4 (3 a?oia) a?aei?/aiee a?aeiia?aeii o 41,6%, 33,8%, 26,9% oai?eo. A??nooeci a?aei?/aiee o 62,5% oai?eo 1 a?oie, na?aaei? a??nooia /enei neeaei 11,3± 1,14; o 44% -2 a?oie, a??nooia /enei 11,2±0,6; o 32,6% ae?iie 3 a?oie, a??nooia /enei 10,7, oiaoi, iaeaea a 1,5- 2 ?ace aeua a ii??aiyii? ?c caei?iaeie ae?ieaie. I?e a?iaeieia?/iiio aeine?aeaeaii? o an?o oai?eo ciai?oi? noaoaa? i?aaie ?icaeioo? i?aaeeueii, o 60,4% (1 a?oia), 37,9% (2 a?oia), o 59% (3 a?oia) aeyaeaia a?iiieac?y iaoee. Ca?eueoaiiy y?/iee?a iaio noi??i aai iaeiiai y?/ieea aecia/aeeny, a?aeiia?aeii, o 77%, 65,7%, 69,2% oai?eo. Ca?eueoaiiy ?ici???a y?/iee?a aoei i?aeoaa?aeaeaii i?e oeueo?acaoeiaiio aeine?aeaeaii? o 85,4% oai?eo 1 a?oie, o 78,9: - 2 a?oie, o 82,6% - 3 a?oie. Iaiao?aeii iiaiaeeoeny c aeoieith TH. E. Iaioaie?iaa (1981) i?i a?aeiinia cia/aiiy iciaee aeainoi?iiiueiai ca?eueoaiiy y?/iee?a. I?e aeaoaeueiiio ianoaaeaii? o an?o oai?eo c neiae?iiii NEss ca oanoaie ooieoe?iiaeueii? ae?aaiinoeee aoea aeyaeaia aiiaoeyoe?y. I?e aea/aii? aeaieo eieueiioeeoieia?/ieo aeine?aeaeaiue o 66,6% ( 1 a?oia), 34% (2 a?oia), 69,2% (3 a?oia) oai?eo aeyaeai? aenieii?ie?oa?iaai? oeie iace?a. Iieacieee EAe aoee aenieeie ? eieeaaeeny a iaaeao 70- 85%. O 33,3% (1 a?oia) oai?eo, o 57,9% ( 2 a?oia), 32% ( 3 a?oia) a?aei?/aeeny na?aaei? ? iecuee? nooiai? i?ie?oa?aoe?? aaa?iaeueiiai ai?oae?th. Caaaeueiith aeey ianoaaeaieo aeyaeeany iiiioiii?noue eieueiioeeoieia?/ii? ea?oeie ia i?ioyc? ia??iaeo ianoaaeaiiy. O 86,1% oai?eo (1 a?oia), o 67,6% (2 a?oia), o 83,3% ( 3 a?oia) niinoa??aaeeny a?ia?ieanoe/i? i?ioeane a aiaeiiao??th, ui i?aeoaa?aeaeo? i?eiouaiiy i?i iiaeeeaee aenieee ?ecee ?icaeoeo ?aeiaiai i?ioeano i?e aeaiiio caoai?thaaii?. O ee?i?/i?e i?aeoeoe? anoaiiaeaiiy ae?aaiico oeiiai? oi?ie neiae?iio NEss ca’ycaii c iaaieie o?oaeiiuaie, ye? iaoiiaeai? ?icaeoeii ??cieo iaoiaaiaoe/ieo aa??aio?a. O ca’yceo c oeei iaeio ?c caaea/ aeaiiai aeine?aeaeaiiy neeaei i?iaaaeaiiy aiae?co canoinoaaiiy eeii?oaio c a?aeaeaeaieie ?acoeueoaoaie o??o?a?/iiai e?eoaaiiy. O i?ioean? canoinoaaiiy eeii?oaio o an?o oai?eo iaee i?noea ?aaoey?i? iaoeyoi?i? iaino?oaeueii-iiae?ai? iaino?oaeuei? ?aaeoe?? /a?ac 24-33 aeiy. Canoinoaaiiy eeii?oaio i?e neiae?ii? NEss aeicaieeei a cia/i?e i??? ooi/ieoe nooi?iue aoyaiaiiy a iaoieia?/iee i?ioean a?iioaeaii-a?iio?ca?ieo no?oeoo?, a oaeiae aeei?enoiaoaaoe a yeino? ooieoe?iiaeueiiai ae?aaiinoe/iiai oanoo ? iane?aeea iia?aoeaiiai e?eoaaiiy. C oe??th ae iaoith aoea aea/aia nae?aoe?y aiiaaeio?iiieo ai?iii?a aei ? i?ney o??o?a?/iiai ao?o/aiiy ia y?/ieeao. I?iaaaeai? iaie aeine?aeaeaiiy aei iia?aoe?? aacaeueiiai ??aiy EA iieacaee noaoenoe/ii aeinoia??ia ca?eueoaiiy (?<0,001) ai?noo oeueiai ai?iiio ( oaae.1). Aeey oai?eo c oeiiaith oi?iith NEss aeyaeeany oa?aeoa?iith iino?eii aeniea nae?aoe?y EA, yea ? iaeiei ?c oaeoi??a, ui iaoiiaeththoue o?ii?/io aiiaoeyoe?th o oeeo oai?eo. ??aaiue ONA aeinoia??ii aoa ieae/a ??aiy ONA caei?iaeo ae?iie. Aiae?c iaea?aeaieo aeaieo iieacaa, ui ni?aa?aeiioaiiy EA/ONA aoa aeua 2,0. Iaoeie aeine?aeaeaiiyie ia anoaiiaeaii aoaeue-yeeo a?aeoeeaiue a?ae ii?ie a ??aiyo nae?aoe?? i?ieaeoeio, ei?oecieo, oe?ieneio. Ca?aeii iaoeo aeine?aeaeaiue, ai?no ano?iaai?a o oai?eo c neiae?iiii NEss aeyaeany cieaeaiei a 1,2 ?ace ii a?aeiioaiith aei in?a eiio?ieueii? a?oie (?<0,001) ? neeaa o na?aaeiueiio 0,38± 0,25 iiieue/e. Naia aene?aoe?y ano?iaai?a a?ae??ciyeany iiiioiii?noth. Aeae?eaiiy ano?iaai?a aeyaeeiny i?aeaeuaiei o?eueee o oai?eo c aeenooieoe?iiaeueiith iaoeiaith e?iaioa/ath.. Iaeiei ?c i?ia?aeieo ii?ooaiue o ai?iiiaeueiiio noaoon? i?e neiae?ii? NEss aaaaea?oueny a?ia?aiae?iaai?y. sse iieacaee iao? aeine?aeaeaiiy, i?aeaeuaiiy ??aiy oanoinoa?iio iaei i?noea o 91,6% ae?iie 1 a?oie, o 66,1% (2 a?oia) ? o 46,1% (3 a?oia) (oaae.1). I?iaaaeaiee aiae?c ooieoe?iiaeueiiai noaio oa y?/iee?a iieacaa, ui o an?o oai?eo c neiae?iiii NEss o?ueio a?oi ii?ooaia ye aiiaaeio?iiia ooieoe?y a?iio?co, oae ? ooieoe?iiaeueiee noai y?/iee?a. Oea i?iyaeeiny ci?iith ni?aa?aeiioaiiy EA, ONA ? noaoaaeo ai?iii?a, a?aenooi?noth oeeee?/iino? ?o aeae?eaiiy. A caeaaeiino? a?ae oa?aeoa?o ? nooiaiy ee?i?/iiai i?iyao, a oaeiae aiaeie?eiieia?/iiai aeine?aeaeaiiy ? a?aeiia?aeieo ?aaeoe?e neea?ie?noicieo y?/iee?a ia noeioeyoe?th eeii?oaio, oai?ei c onoaiiaeaiei ae?aaiicii oeiiai? oi?ie neiae?iio NEss aoei i?iaaaeaii o??o?a?/ia e?eoaaiiy. O ca’yceo c ?ica?aei?noth aeaieo i?i aoaeoeai?noue canoinoaaiiy ??cieo o??o?a?/ieo iaoiaeee e?eoaaiiy neiae?iio NEss iaie i?iaaaeaia ii??aiyeueia ioe?iea aoaeoeaiino? aeaiaaeoeyoe?? y?/iee?a, eaia?ineii?/ii? ae?aoa?iieiaaoeyoe?? ? eeeiiaeaeii? ?acaeoe??. Aea/aiiy iniaeeainoae aeaiaaeoeyoe?? y?/iee?a c iaeneiaeueiei aeaeaeaiiyi a?ia?ieaciaaii? no?iie iaaeoey?iiai oa?o a ?aiiueiio i?neyiia?aoe?eiiio ia??iae? aeicaieeei anoaiiaeoe, ui aeaiaaeoeyoe?y y?/iee?a i?eaiaeeoue aei cia/iiai cieaeaiiy ??aiy oanoinoa?iio (?<0,001), i?aeaeuaiiy ??aiy i?iaanoa?iio. Niinoa??aa?oueny aeoeaaoe?y aiiaaeio?iiii? ooieoe?? a?iio?co, yea i?iyaey?oueny a cieaeaii? ??aiy EA, ca?eueoaii? ONA a e?ia? ? aeieeiaii? i?e?a nae?aoe?? oeeo ai?iii?a. Aaee/eia iaoeyoi?iiai i?eo EA neeaea 30,5 ±1,8 iIA/e. Iaea?aeai? iaie aeai? aeicaieythoue i?eionoeoe, ui aoaeo iia?aoe?? aeaiaaeoeyoe?? y?/iee?a ca’ycaiee c aeaeaeaiiyi a?eueoi? /anoeie a?ineioaco iaaei??ii? e?eueeino? oanoinoa?iio, aeeth/aiiyi iaoai?cio iiceoeaiiai cai?ioiiai ca’yceo oa aeoeaaoe?? nae?aoe?? ONA. ??aaiue ano?aae?ieo i?ney iia?aoe?? caeeoaany oaeei aea, ye ? aei iia?aoe??, aene?aoe?y iaaoaaea oeeee?/iiai oa?aeoa?o. I?e aecia/aiiyo ai?noo aiiaaeio?iiieo ai?iii?a, ano?aae?ieo ? i?iaanoa?iio o ae?iie /a?ac 2 i?nyoey i?ney o??o?a?/iiai e?eoaaiiy a?aei?/a?oueny ii?iae?caoe?y o ai?noo EA, ONA, ano?aae?ieo, i?iaanoa?iio c oa?aeoa?iei i?eii aeeeaeo EA. OCAe a i?neyiia?aoe?eiiio ia??iaeo iieacaei ciaioaiiy na?aaeiuei? aaee/eie y?/iee?a oa ?o ia’?io: aeiaaeeia 3,6 ± 0,7 ni, oe?eia 2,4 ± 1,1 ni, oiaueia 1,9± 0,9, ia’?i 8,2 ±1,3 ni3. A?eueo cia/ii ciaioeeany oe?eia ? oiaueia y?/iee?a (?<0,05). I?e aeaiaaeoeyoe?? ia aeaeaey?oueny ei?eiaee oa? y?/ieea, yeee i?noeoue oie?eoee, a ca’yceo c /ei i? a iaeii? oai?i? ia a?aei?/aii iia??oaiiy ooieoe?e y?/iee?a. Iaeiith ?c caaea/ aeaiiai aeine?aeaeaiiy noaei i?iaaaeaiiy aiae?co ii?oieia?/ii? ea?oeie ?acaeoiaaii? oeaieie y?/iee?a. Iana aeaeaeaii? oeaieie y?/iee?a neeaea a na?aaeiueiio 1,26± 0,126a ? a iniiaiiio neeaaeaeany ?c iiceiai? ?a/iaeie. ?acoeueoaoe a?noieia?/iiai aeine?aeaeaiiy ?acaeoiaaieo /anoei o i?iiia?iaaieo oai?eo iieacaee iayai?noue o ia?aaaaei?e a?eueoino? niinoa?aaeaiue iioiauaiiy a?ei/ii? iaieiiee c ae?aaeaieie a i?e yaeuaie neea?ico. E?euee?noue i?eii?ae?aeueieo oie?eoe?a aoea cieaeaia, ?icoaoiaoaaeeny aiie ia?aaaaeii a ciai?oiueiio a?aeae?e? ei?eiaiai oa?o, aea ia?aaaaea? o?a?icia oeaieia. O an?o oai?eo aeyaeeeny e?noicii-ao?aoe/i? oie?eoee ia ??cieo noaae?yo ?icaeoeo. A?aioeueicia iaieiiea oie?eoea a ia?aaaaei?e a?eueoino? i?aia?ao?a ae?aaeaia aeia?a, o 8,3% oai?eo aoea aeeno?io?/ia. Aioo??oiy iaieiiea oie?eoe?a a 85,4% oai?eo aoea a?ia?ieaciaaiith ? a?ia?o?ioiaaiith. No?iia iiceiaiai oa?o y?/iee?a aoea ooai?aia u?eueii ?icoaoiaaieie ee?oeiieie aeaiaioaie. Ia? i?noea ?ic?inoaiiy o?a?icii? niieo/ii? oeaieie. A 64,5% a no?ii? y?/iee?a niinoa??aaeeny ina?aaeee ethoa?i?caoe??. Ci?ie a noaeeiao ae?aaeaeeny o iioiauaii? ? neea?icoaaii? ?o noaeeiii? no?iee. Eaia?ineii?/io ae?aoa?iieiaaoeyoe?th y?/iee?a (3-y a?oia) i?iaiaeeee a?ae 15 aei 20 cii iiiiii?yiei aeaeo?iaeii ia aeeaeio 0,8-1,5 ni. Aeei?enoiaoaaee no?oi neeith aei 0,9 A, /an ae?? a eiaei?e cii? a?ey 10n. Ii??aiyeueiee aiae?c ai?iiiaeueieo oa?aeoa?enoee a caeaaeiino? a?ae niiniao e?eoaaiiy na?ae/eoue i?i a?aenooi?noue nooo?aeo a?aei?iiinoae a o?ueio a?oiao oai?eo (oaae.1). ??aaiue EA aeinoia??ii cieceany a o?ueio a?oiao oai?eo (?<0,001). Ni?aa?aeiioaiiy EA/ONA aeinoia??ii cieaeoaaeiny o an?o a?oiao oai?eo (?<0,01). ??aaiue oanoinoa?iio aeinoia??ii cieceany a ii??aiyii? c ??aiai aei iia?aoe?? (?<0,01). Anoaiiaeaii noaoenoe/ii aeinoia??ia i?aeaeuaiiy ??aiy i?iaanoa?iiio ? cieaeaiiy ai?noo ano?aae?ieo a na?aaeei? ethoa?iiai? oace (?<0,001) a ii??aiyii? c iieacieeaie aei iia?aoeaiiai e?eoaaiiy. ?ioa?i?aoaoe?y aeaieo aoia?ao??, iaea?aeaieo i?ney eaia?ineii?/ii? ae?aoa?iieiaaoeyoe??, aeicaieeea c?iaeoe aeniiaie i?i ciaioaiiy ?ici???a y?/iee?a, cia/ia nei?i/aiiy /enea a?o?acoth/eo oie?eoe?a, aiane?aeie aeo?eaiiy ??aeeie ? niaaeaiiy e?noicieo aeeth/aiue, ca ?aooiie eiaaoeyoe?? oeaieie iiceiaiai oa?o, ui ciaeoei nai? i?aeoaa?aeaeaiiy i?e aenia?eiaio? ia oaa?eiao. Iaeii?aciaa ae?aoa?iieiaaoeyoe?y y?/iee?a niaae noi?iaiaeaeo?oueny ooai?aiiyi a ieo eeeiiaeaeii? ae?eyiee iae?ico c oe?eiith ioi/oth/ith iae?iciith ciiith ia?eoieaeueiiai caiaeaiiy. Eiaaoeyoe?eiee iae?ic c ooai?aiith iaaeiei ciiith ?aaeoeaiiai caiaeaiiy caeia? na?aaeith /anoeio y?/ieea ? ?iciianthaeaeo?oueny a?ae iiaa?oi? iaianaiiy ioieoo?e aei ai??o y?/ieea ia i?ioeeaaei?e noi?ii?. O i?ci? no?iee ia’?i iae?ico ciaioo?oueny, iaaeiei iueiai ooai?th?oueny oe?iea a?oaa o?a?icia eainoea, yea a i?noe? ioieoo?e ooai?th? aoyaiooee ?oaaoeue, a ia i?ioeeaaei?e noi?ii? o?a?icia iiea aeinyaa? ai??o y?/iee?a. Iiceoeaiee aoaeo ae?aoa?iieiaaoeyoe?? i?eaiaeeoue aei ?oeioaaiiy ai?iiiaeueii-aeoeaii? oeaieie y?/ieea oeyoii cai?uaiiy ?? o?a?iciith oeaieiith. Aiae?c aoaeoeaiino? eeeiiaeaeii? ?acaeoe?? y?/iee?a iieacaa, ui iaaeeaey/enue ia a?aeiiaeaiiy ?aaoey?iiai iaino?oaeueiiai oeeeeo o 91,1% ae?iie, iaie?aei?noue i?iaeiaaeoaaeany o 34,2% oai?eo. A?aenooi?noue aaa?oiino? o a?eueoino? ?c ieo i?ney iia?aoe?? ie ca’yco?ii c ?icaeoeii niaeeiaiai i?ioeano a iaeiio oac?. Oe? ?acoeueoaoe i?aeoaa?aeaeothoue aeai? A.A.Aeeaaa ? ni?aaao. (1990) oa ?i. i?i oa, ui ia?aooaa?ii-ia?aiaa??aeuei? niaeee , ye? ?icaeioeeny i?ney eeeiiaeaeii? ?acaeoe?? y?/iee?a, ? iniiaiith i?e/eiith iaoai?/ii? iaie?aeiino? o oai?eo c neiae?iiii NEss. Aeaia iaoiaeeea noai?th? iaaea?aei? oiiae aeey caaithaaiiy y?/iee?a. Oea iaoiiaeaii ii?ooaiiyi o?io?ee oeaiei, aeieeiaiiyi ae?aaeaieo ci?i iaaeiei oa?a ? a i?eeaaeeo aei ieo ia?aio?iaoicii-no?iiaeueieo aeaiaio?a y?/ieea, /anoeiaei caiathaaiiyi ooeoiai y?/ieea a eiiaeiia?ao c ?ioeie i?aaiaie (A.TH. Oa?aeaeaoe,1990). Iayai?noue ia?aooaa?ii-ia?aiaa??aeueieo niaeie c iai?io?aei?noth iaoeiaeo o?oa i?aeoaa?aeaeoaaeiny i?e iao?inaeuei?iaia?ao??, i?ae /an iia?aoe?? ? eaia?ineii??. I?e iiaoi?ieo iia?aoe?yo o 66 (80,4%) ?c 82 oai?eo aeyaeyany niaeeiaee i?ioean ??ciiai nooiaiy ae?aaeaiino? c aoyaiaiiyi y?/ieea, iaoeiaeo o?oa, iaoee, na/iaiai i?oo?a ? naeueieea. O 5 (6,99%) aeiaaeeao oe? i?aaie aoee niayi? c iaoeyie oiieiai ? oianoiai eeoa/ieea. O 4 (4,8%) niinoa?aaeaiiyo niaeeia? eiiaeiia?aoe aoee i?eiayi? aei ia???oaeueii? i/a?aaeie. Niaeee aoee o aeaeyae? u?eueieo o?a?icieo oeaiei, ye? ?icae?eyeeny ?c coneeeyi aino?ei oeyoii. Ieoaiiy ooai?aiiy aioo??oiuei/a?aaieo niaeie oa aoaeoeaiino? e?eoaaiiy a?ae aeei?enoaiiy ??cieo aeae?a o??o?a?/ii? oaoi?ee i?e iia?aoe?yo ia y?/ieeao i?e neiae?ii? NEss a oaia??oi?e /an caeeoathoueny iaioa aea/aieie. Ieoaiiy i?e aea?? iioeiaeueiiai o??o?a?/iiai e?eoaaiiy aei oaia??oiueiai /ano caeeoa?oueny aeeneon?eieie. Aeey ioe?iee noaio /a?aaii? ii?iaeieie i?ney aeaiaaeoeyoe?? y?/iee?a, ieoaiue ?aiiueiai niaeeiooai?aiiy, ia?aa?ao caaithaaiiy y?/ieea a i?neyiia?aoe?eiiio ia??iae?, aeeiioaaeany eaia?ineii?y o 26 (54,16%), o 4 (8,3%) ae?iie noai y?/iee?a aea/aii i?e iiaoi?i?e eaia?ioii?? i?ae /an iia?aoe?? eana?aaa ?icoeio. Ia?oith iia?aoe??th o oeeo ae?iie aoea aeaiaaeoeyoe?y y?/iee?a. Iniiaieie e?eoa??yie, yeeie ie ei?enooaaeeny i?e a?coaeuei?e ioe?ioe? noaio i?aai?a /a?aaii? ii?iaeieie, aoee eie?? i?aai?a, ?o ?ici??e, oi?ie, noai na?iciiai iie?eao, ?aia?aoeaieo i?ioean?a a y?/ieeao, niaeeiaiai i?ioeano a /a?aai?e ii?iaeiei? ? nooi?iue eiai ae?aaeaiino?, iayai?noue ??aeeie a /a?aai?e ii?iaeiei?, ?? oa?aeoa?. O 6 (20%) oai?eo aeyaeai? i?aei?, oiie? ieine? niaeee, ye? c’?aeioaaee y?/ieee ? iaoeia? o?oae, ?ic’?aeiai? iai?ioeyoi?ii. O 3 (10%) oai?eo aoee ieiueii? niaeee c ae?aaeaiith ?i’?eoe??th noaeei, ye? c’?aeioaaee y?/ieee c iaoeiaeie o?oaaie, caaeiueith no?ieith iaoee ? ia???oaeueiith i/a?aaeiith. O oeeo aea oai?eo aeyaeai? ?eoe? niaeee naeueieea c aeiii iaoee ? ia?aaeiueith /a?aaiith no?ieith. O?ia??aeuei? a?aeae?ee o?oa aoee a?eueieie. A ?ioeo ae?iie (80%) niaeeiaiai i?ioeano a /a?aai?e ii?iaeiei? ia aoei. O 3 ae?iie, yeei c iaeiiai aieo aoea i?iaaaeaia eeeiiaeaeia ?acaeoe?y y?/iee?a, iaeyiooe o?ia??aeueiei a?aeae?e ia aaeaeiny ?c-ca ae?aaeaiiai niaeeiaiai i?ioeano, o?ia??aeueiee a?aeae?e iaoeiai? o?oae aoa caiayiee. Ia a?noa?inaeuei?iaia?aiao iaoeia? o?oae aoee i?io?aei? o 42 (95,4%) oai?eo. Iai?io?aei?noue iaoeiaeo o?oa a aiioey?iiio a?aeae?e? c iaeiiai aieo anoaiiaeaia o 2 oai?eo (4,54%) c aieo y?/ieea, ia yeiio i?iaaaeaia eeeiiaeaeia ?acaeoe?y. Ii??aiyeueiee aiae?c aoaeoeaiino? o?ueio iaoiae?a iia?aoeaiiai ao?o/aiiy (aeaiaaeoeyoe?y y?/iee?a, eeeiiaeaeia ?acaeoe?y y?/iee?a) o oai?eo c neiae?iiii NEss iieacaa, ui o a?eueoino? oai?eo c oeiiaith oi?iith NEss a?aeiiaeany ?eoi iaino?oaeueiiai oeeeeo (95,8%, 91,1%, 90,3%), a?aeiiaeaiiy iaoeyoe?? - 95,8%, 84,4 %, 75%, ianoaiiy aaa?oiino? -77,2%, 65,7%, 71,7%. Iaea?eueo ae?aaeaiee aoaeo o a?aeiioaii? a?aeiiaeaiiy iaino?oaeueii? ooieoe?? niinoa??aaany o oai?eo, o yeeo a ?acoeueoao? a?aen?eaiiy oeaieie ?ici??e y?/iee?a aeiaiaeeee aei ii?ie (aeaiaaeoeyoe?y ? eeeiiaeaeia ?acaeoe?y y?/iee?a). Aaaeeeaa ia?aaaaa iia?aoe?? aeaiaaeoeyoe?? y?/iee?a caeeth/a?oueny a oiio, ui i?ioean caaithaaiiy i?io?ea? i?e i?i?iaeuei?e ae?aaeaiino? niaeeiaiai i?ioeano, ui cia/ii i?aeaeuo? aaia?aoeaio ooieoe?th ae?iie. I?e aeaiaaeoeyoe?? ia aeaeaey?oueny ei?eiaee oa? y?/ieea, yeee i?noeoue oie?eoee, a ca’yceo c /ei i? a iaeii? oai?i? ia aoei a?aei?/aii iia??oaiiy ooieoe?? y?/iee?a. Iaaaoeaiei iiiaioii eeeiiaeaeii? ?acaeoe?? y?/iee?a eaia?ineii?/iei aeinooiii ? ?ecee oi?ioaaiiy niaeeiaiai i?ioeano a iaeiio oac?, yeee iiaea aooe i?e/eiith iaie?aeiino?- o?oaii-ia?eoiiaaeueiiai aaiaco. Iaeiaio ae?aaeaiee aoaeo a?aeiiaeaiiy iaino?oaeueii? ooieoe?? i?e eaia?ineii?/i?e ae?aoa?iieiaaoeyoe?? iiaeeeai ca’ycaiee c iacia/iith aeeaeiith ?oeioaaiiy oeaieie y?/iee?a. O an?o ae?iie i?ney o??o?a?/iiai ao?o/aiiy a?aeaoaaeany ii?iae?caoe?y ??aiy ai?iii?a - cieaeoaaeany eiioeaio?aoe?y EA, aiae?iaai?a. ??aaiue aene?aoe?? ano?iaai?a ? i?iaanoa?iio iaaoaaa oeeee?/iiai oa?aeoa?o. Aaaeeeaa ia?aaaaa aeaiaaeoeyoe??, eaia?ineii?/ii? ae?aoa?iieiaaoeyoe?? y?/iee?a caeeth/a?oueny a oiio, ui i?ioean caaithaaiiy a iaeano? y?/ieea i?io?ea? i?e i?i?iaeuei?e ae?aaeaiino? niaeeiaiai i?ioeano, ui cia/ii i?aeaeuo? aaia?aoeaio ooieoe?th ae?iie. I?ney eeeiiaeaeii? ?acaeoe?? y?/iee?a /ano?oa ?icaeaa?oueny niaeeiaee i?ioean (80,4%) a iaeiio oac?, ui ? i?e/eiith iaoai?/ii? iaie?aeiino? o oai?eo c neiae?iiii NEss. Ia?aa?a aaa?oiino? i?ney o??o?a?/iiai ao?o/aiiy ia? nai? iniaeeaino?. Iayai?noue aiaeie?eiieo ii?ooaiue ni?ey? aeieeiaiith ??cieo oneeaaeiaiue i?ae /an aaa?oiino? ? iieia?a. Aaa?oi?noue /ano?oa ianoa? a iaaeao ia?oeo aeaio ?ie?a i?ney iia?aoe??. Iniiaieie oneeaaeiaiiyie ia?aa?ao aaa?oiino? ? ?iaeiaiai aeoo o ianoaaeaieo iaie ae?iie aoee aeino?ieiaa ia?a?eaaiiy aaa?oiino? (11%), IIA- aanoic (8,3%), ia?aae/ania aeeeooy iaaeieiieiaeiaeo aiae (28,1%), aiiiae?? ?iaeiai? ae?yeueiino? (15,6%), a?iien?y ieiaea (18,6%). Iaea i?noea aeniea /anoioa iia?aoeaiiai ?ic?iaeaeaiiy (12,5%). I?e/eiaie ?icaeoeo aeacaieo oneeaaeiaiue o ?icaeyiooiai eiioeiaaioo ae?iie ? iae?iaoii?aeuei? oa aiaeie?eii? ii?ooaiiy, ooieoe?iiaeueii-ii?oieia?/i? ci?ie a iaooe? ae?iie, aaa?oi?noue o yeeo ianoaea i?ney iia?aoeaiiai e?eoaaiiy, a?aeiinyoueny aei a?oie aenieiai ?eceeo oneeaaeiaiiai ia?aa?ao aaa?oiino? ? iieia?a. I?e aiae?c? ioe?iie iiaiia?iaeaeaieo ca oeaeith AIAA? aeyaeaii, ui a a?oi? iiaiia?iaeaeaieo a?ae ii?iae?eue c neiae?iiii NEss na?aaeiy ioe?iea ia 1,2± 0,09 aaea ieae/a, i?ae a eiio?ieuei?e a?oi?. ?c caaaeueiiai /enea iiaiia?iaeaeaieo a ano?en?? ia?iaeeeiny 6 (18,7%), ui a 4,6 ?ace /ano?oa (?<0,001),i?ae a eiio?ieuei?e a?oi?. Ano?en?y iiaiia?iaeaeaieo eaaeiai nooiaiy cono??/aeany o 13,1% , na?aaeiueiai nooiaiy aaaeeino? - o 5,55%. ?aii?e ia??iae aaeaioaoe?? o 18,7% iiaiia?iaeaeaieo oa?aeoa?ecoaaany iai?oaith ooieoe?e aaaaoueio nenoai. O na?aaeiueiio aeecaaeaioe?eiee neiae?ii cono??/aany o iiaiia?iaeaeaieo a?ae ii?iae?eue c neiae?iiii NEss a 2,0 ?ace /ano?oa, i?ae o iiaiia?iaeaeaieo eiio?ieueii? a?oie (?<0,001). AENIIAEE 1. No/ani? eei?/i? ? ai?iiiaeuei? iaoiaee ianoaaeaiiy aeicaieythoue ae?aaiinooaaoe oeiiao oi?io neiae?iio neea?ie?noicieo y?/iee?a. I?e oeiia?e oi?i? caoai?thaaiiy niinoa??aa?oueny i?aeaeuaiiy EA, oanoinoa?iio, cieaeaiiy eiioeaio?aoe?? ONA a e?ia?. 2. NNEss oa?aeoa?eco?oueny niaaeeiaith noeeuei?noth a 56,7%. Niinoa??aa?oueny aenieee ?ecee n?iaeiiai ?icaeoeo NNEss. Aeaia caoai?thaaiiy cono??/aeiny o eiaeii? ae?oai? aei/ee, ia?iaeaeaii? a?ae iaoa??, yea no?aaeaeaea NNEss. Ae?a/aoee, ia?iaeaeai? a?ae iaoa??a, eio?? no?aaeaeaee NNEss, iiaeii? ciaoiaeeoeny i?ae aeeniaina?iei iaaeyaeii. 3. Aeaiaaeoeyoe?y y?/iee?a ca aeiiiiiaith o?oa/anoiai iiaea c ianooiiei iaeeaaeaiiyi i?aeiaiei/iiai, caaeeaiiai oaa ? aoaeoeaiei iaoiaeii e?eoaaiiy oai?eo c oeiiaith oi?iith NEss. Iia?aoe?y i?eaiaeeoue aei aeoeaaoe?? aiiaaeio?iiii? ooieoe?? a?iio?co, cieaeaiith aene?aoe?? EA, oanoinoa?iio, ca?eueoaiith ??aiy ONA a e?ia?, a?aeiiaeaiith iaino?oaeueii? ? aaia?aoeaii? ooieoe??. 4. Iaeiei ?c iiceoeaieo iiiaio?a aeaiaaeoeyoe?? ? eaia?ineii?/ii? ae?aoa?iieiaaoeyoe?? y?/iee?a ? iaoia a ii??aiyii? c eeeiiaeaeiith ?acaeoe??th y?/iee?a /anoioa ?icaeoeo i?neyiia?aoe?eieo niaeie. I?ney aeaiaaeoeyoe?? y?/iee?a o 80% ae?iie niaeee a?aenooi?, a oie /an ye i?ney eeeiiaeaeii? ?acaeoe?? - o?eueee o 19,6% oai?eo. 5. Eaia?ineii?/ia ae?aoa?iiaiaaoeyoe?y ? aoaeoeaiei iaoiaeii e?eoaaiiy NNEss. Aoaeoeai?noue oe??? iia?aoe?? iaoiiaeaia ii?iae?caoe??th aiaeie?eiii? ooieoe?? ca ?aooiie aeinoaoiueiai ?oeioaaiiy noanoaioe?? y?/ieea ? cai?uaiiyi ?? o?a?iciith oeaieiith, a oaeiae iecueeith /anoioith aeieeiaiiy niaeeiaiai i?ioeano a iaeiio oac?, nei?i/aiiyi /ano ia?aaoaaiiy oai?eo o noaoe?iia??. 6. Ii??aiyeueiee aiae?c aoaeoeaiino? o??o?a?/ieo iaoiae?a e?eoaaiiy oai?eo c oeiiaith oi?iith NNEss iieacaa a?eueo ni?eyoeea? ?acoeueoaoe a ii??aiyii? c eeeiiaeaeiith ?acaeoe??th y?/iee?a. A?aeiiaeaiiy iaino?oaeueii? ooieoe?? i?ney aeaiaaeoeyoe?? i?ioiaeeoue o 95,8% ae?iie, i?ney eaia?ineii?/ii? ae?aoa?iieiaaoeyoe?? o 90,3%, eeeiiaeaeii? ?acaeoe?? o 77,2%; 71,7%; 65,7% oai?eo. 7. AE?iee, o yeeo aaa?oi?noue ianoaea i?ney iia?aoeaiiai e?eoaaiiy NNEss, a?aeiinyoueny aei a?oie aenieiai ?eceeo oneeaaeiaiiai ia?aa?ao aaa?oiino? ? iieia?a. Iniiaieie oneeaaeiaiiyie ia?aa?ao aaa?oiino? ? iieia?a aoee aeino?ieiaa ia?a?eaaiiy aaa?oiino? (11%), IIA-aanoic- (8,3%), ia?aae/ania aeeeooy iaaeieiieiaeiaeo aiae (28,1%), aiiiae?? ?iaeiai? ae?yeueiino? (15,6%), a?iien?y ieiaea (18,6%), /anoa iia?aoeaia ?ic?iaeaeaiiy (12,5%). 8. ?icaeoie ieiaea ? iiaiia?iaeaeaiiai o ae?iie i?ney iia?aoe?e c i?eaiaeo NNEss ia??aeei noi?iaiaeaeo?oueny ii?ooaiiyie o oaoiieaoeaioa?iiio eiiieaen?. A ano?en?? ae?oe ia?iaeaeothoueny a 4,6 ?ace /ano?oa, i?ae a eiio?ie?. ?aii?e ia??iae aaeaioaoe?? o 18,7% iiaiia?iaeaeaieo oa?aeoa?eco?oueny iai?oaith ooieoe?? aaaaoueio nenoai. Aeecaaeaioe?eiee neiae?ii cono??/a?oueny a 2 ?ace /ano?oa, i?ae o eiio?ie?. O iinoiaoaeueiiio ia??iae? a?aeoeeaiiy a?ae ii?iaeueiiai ?icaeoeo niinoa??aa?oueny o 9,3% ae?oae, oiaoi a 1,3 ?ace /ano?oa, i?ae o eiio?ie?. Nienie ?ia?o, iioae?eiaaieo ca oaiith aeena?oaoe?? 1. Aaeeae Eaiaeue Aaae Yeue Naeai Aoea. N?aaieoaeueiay ioeaiea oe?o?ae/aneeo iaoiaeia ea/aiey neiae?iia neea?ieenoiciuo ye/ieeia// I?iaeaiu, aeinoeaeaiey e ia?niaeoeau ?acaeoey iaaeeei-aeieiae/aneeo iaoe e i?aeoe/aneiai cae?aaiio?aiaiey: O?. EIE. - Neioa?iiieue, 1998.- O. 134, *.1. - N. 39-43. 2. Oeiioaaaa I. A., Iaioaie?ia TH. E., Caoioae N. E., Aaeeae Eaiaeue Aaae Yeue Naeyi Aoea., Oaoueaanueyi A. A. Yoeieiae/aneea oaeoi?u e oeaiiinoue ?acee/iuo neiioiiia aeeaaiinoeee aiaiaoi/iie aa?aiaiiinoe // I?iaeaiu, aeinoeaeaiey e ia?niaeoeau ?acaeoey iaaeeei-aeieiae/aneeo iaoe e i?aeoe/aneiai cae?aaiio?aiaiey: O?. EIE. - Neioa?iiieue, 1998.- O. 134, *.2. - N. 242-246. 3. Aaeeae Eaiaeue Aaae Yeue Naeai Aoea. Aeeiaieea ii?oieiae/aneeo eciaiaiee a ye/ieeao niaae iinea aeeaoa?iieiioioo?u // I?iaeaiu, aeinoeaeaiey e ia?niaeoeau ?acaeoey iaaeeei-aeieiae/aneeo iaoe e i?aeoe/aneiai cae?aaiio?aiaiey: O?. EIE. - Neioa?iiieue, 1998.- O. 134, *.2. - N.. 4. Aaeeae Eaiaeue Aaae Yeue Naeai Aoea, Aaiaaeiae/aneia eco/aiea naiaeiie i?aae?aniieiaeaiiinoe e caaieaaaieth neiae?iia neea?ieenoiciuo ye/ieeia //A?niee i?iaeai a?ieia?? ? iaaeeoeeie.- 1999.-?5.- N. 3-6. 5. Aaeeae Eaiaeue Aaae Yeue Naeai Aoea. Nia?aiaiiua aniaeou yoeiiaoiaaiaca, aeeaaiinoeee e ea/aiey neiae?iia neea?ieenoiciuo ye/ieeia // A?niee i?iaeai a?ieia?? ? iaaeeoeeie.-1999.-?8.-N.4-9. 6. ?aoeeiiaeecaoi?neia i?aaeeiaeaiea ? 2276 io 04.02.99a. Aaeeae Eaiaeue Aaae Yeue Naeai Oe?o?ae/aneay ei??aeoeey ye/ieeia o iaoeeaioie n neiae?iiii neea?ieenoiciuo ye/ieeia. 7. ?aoeeiiaeecaoi?neia i?aaeeiaeaiea ? 2278 io 04.02.99a. Aaeeae Eaiaeue Aaae Yeue Naeai Aeeaoa?iieiaaoeyoeey ye/ieeia- aeueoa?iaoeaiue niinia ea/aiey neiae?iia neea?ieenoiciuo ye/ieeia. 8. ?aoeeiiaeecaoi?neia i?aaeeiaeaiea ? 2279 io 04.02.99a. Aaeeae Eaiaeue Aaae Yeue Naeai, Iaioaie?ia TH.E., ?uaaeea A.I., Oeiioaaaa I.A. Niinia i?eiaiaiey aee?eea i?e iia?aoeeyo ia ye/ieeao. 9. ?aoeeiiaeecaoi?neia i?aaeeiaeaiea ? 2277 io 04.02.99a. Aaeeae Eaiaeue Aaae Yeue Naeai, Iaioaie?ia TH.E., ?uaaeea A.I., Oeiioaaaa I.A. Niinia aeeaaiinoeee neiae?iia neea?ieenoiciuo ye/ieeia. AIIOAOe?ss. Aae?ae Eaiaeue Aaae Aeue Naeai Ao?a. Ii??aiyeueia ioe?iea o??o?a?/ieo iaoiae?a e?eoaaiiy neiae?iio neea?ie?noicieo y?/iee?a.- ?oeiien. Aeena?oaoe?y ia caeiaoooy iaoeiaiai nooiaiy eaiaeeaeaoa iaaee/ieo iaoe ca niaoe?aeuei?noth 14. 01. 01- aeooa?noai ? a?iaeieia?y- E?einueeee aea?aeaaiee iaaee/iee oi?aa?neoao ?i. N. ?. Aai?a??anueeiai IIC Oe?a?ie, i.N?ioa?iiieue, 1999. ?iaioa i?enay/aia iiooeo ? aaeineiiaeaiith oaoi?ee iia?aoe?e i?e neiae?ii? NEss. A iniiao aeine?aeaeaiiy aoee iieeaaeai? aeine?aeaeaiiy 325 oai?eo c neiae?iiii NEss, yeei aoei i?iaaaeaii o??o?a?/ia e?eoaaiiy. Ii??aiyeueiee aiae?c o??o?a?/ieo iaoiae?a e?eoaaiiy oai?eo c oeiiaith oi?iith NNEss iieacaa a?eueo ni?eyoeea? ?acoeueoaoe i?e canoinoaaii? aeaiaaeoeyoe?? ? ae?aoa?iieiaaoeyoe?? y?/iee?a a ii??aiyii? c eeeiiaeaeiith ?acaeoe??th. A?aeiiaeaiiy iaino?oaeueii? ooieoe?? i?ney aeaiaaeoeyoe?? a?aeaoaa?oueny o 35,3% ae?iie; i?ney eaia?ineii?/ii? ae?aoa?iieiaaoeyoe?? -90,3%; i?ney eeeiiaeaeii? ?acaeoe?? - 31,1%; a?aeiiaeaiiy iaoeyoe?? a?aeiia?aeii- 95,8%, 75%, 84,4%; a?aeiiaeaiiy aaia?aoeaii? ooieoe??- 77,2%, 71,7%, 65,7%. Eeth/ia? neiaa: neea?ie?noic, y?/iee, e?eoaaiiy, aeaiaaeoeyoe?y, eaia?ineii?y, ae?aoa?iieiaaoeyoe?y. Aiiioaoeey Aaeeae Eaiaeue Aaae Yeue Naeai Aoea.N?aaieoaeueiay ioeaiea oe?o?ae/aneeo iaoiaeia ea/aiey neiae?iia neea?ieenoiciuo ye/ieeia. - ?oeiienue. Aeenna?oaoeey ia nieneaiea o/aiie noaiaie eaiaeeaeaoa iaaeeoeeineeo iaoe ii niaoeeaeueiinoe 14.01.01. - aeooa?noaa e aeiaeieiaey. E?uineee Ainoaea?noaaiiue oieaa?neoao ei. N.E. Aai?aeaaneiai, IC Oe?aeiu, a.Neioa?iiieue, 1999. ?aaioa iinayuaia iieneo e oniaa?oainoaiaaieth oaoieee iia?aoeee i?e NNEss. A iniiao iaoeo enneaaeiaaiee auee iieiaeaiu iaaethaeaiey ca 395 aieueiuie n NNEss, iiaeaa?aioouo oe?o?ae/aneiio ea/aieth. N?aaieoaeueiue aiaeec yooaeoeaiinoe oe?o?ae/aneeo iaoiaeia ea/aiey aieueiuo n oeie/iie oi?iie NNEss iieacae aieaa aeaaii?eyoiua ?acoeueoaou aeaiaaeoeeyoeee e eaia?ineiie/aneie yeaeo?ieiaaoeyoeee ye/ieeia ii n?aaiaieth n eeeiiaeaeiie ?acaeoeeae ye/ieeia. Ainnoaiiaeaiea iaino?oaeueiie ooieoeee iinea aeaiaaeoeeyoeee i?ienoiaeeo o 95,8% aeaiuei, iinea eaia?ineiie/aneie aeeaoa?iieiaaoeyoeee o 90,3%, eeeiiaeaeiie ?acaeoeee - o 91,1%. Ainnoaiiaeaiea aaia?aoeaiie ooieoeee niioaaonoaaiii o 77,2%; 71,7%; 65,7% aieueiuo. Eeth/aaua neiaa: neiae?ii neea?ieenoiciuo ye/ieeia, oe?o?ae/aneia ea/aiea, aeaiaaeoeeyoeey, eaia?ineiiey, aeeaoa?iieiaaoeyoeey. ANNOTATION Walid Kamal Abd El Salam Atia. Comparative study of surgical methods used in the treatment of sclerocystic ovarian syndrome.- Manuscript. Thesis presentation for Candidate of Medical sciences (phD) degree in Obstetrics and Gynecology (14.01.01) at the Crimean State Medical University named after S.I.Georgievsky, Ukraine, Simferopol, 1999. Importance of the topic: The choice of optimal surgical treatment for sclerocystic ovarian syndrome, prophylaxis of peritoneal forms of infertility after operation on the ovaries; the search and perfection of operation technics are still important issues for discussion. Aims of the research: To devise the most optimal pathogenetically based method of surgical treatment to effectively improve restoration of generative function; to work out prophylactic measures against peritoneal forms of infertility in women with sclerocystic ovarian syndrome. Scheme of investigation . 1. Study and determine the clinical features and hormonal profile of patients with typical form of sclerocystic ovarian syndrome. 2. Study the clinico-genicological aspect of regarding familial predisposition to sclerocystic syndrome. 3. Study the morphological feartures of sample ovarian tissues. 4. Make comparative analysis of the frequency of adhesions and tubo-peritoneal infertility after laparatomic and laparoscopic surgery in patients with sclerocystic ovarian syndrome. 5. Define the frequncy and features of development of interabdominal adhesions around the uterine appendages in women who have undergone demedulation of the ovaries in the early post-operative period. 6. Compare the remote results of demedulation and diathermocoagulation of ovaries by their effect in restoring the menstrual and generative functions. 7. To make echographic study of the ovaries and study of tubal potency by hysterosalphingography befor and after the different surgical methods of treatment in patients with sclerocystic ovarian syndrome. 8. Determine the effects of demedulation and diathermocoagulation on excretion of gonadotropic hormones, oestrogenes, androgenes, progesterone. 9. Study the morphological features of the changes in the ovaries in experimental conditions with the use of diathermopuncture. 10. To work out and substantiate practical recommendations to the application of the results in managment of patients with sclerocystic ovarian syndrome. Matereals and methods of investigation. Our work is based on observation carried out on 395 patients who had undergone surgical treatment. The patients were devided into 3 groups. The first group included 48 patients, who had undergone demedulation of the ovaries with the help of tubular knife with subsequent subcapsular stitching and submerging of sutures. The second group consisted of 295 women after bilateral clinoid resection of the ovaries. The third group comprised 52 women who had undergone laparoscopic diathermocoagulation of the ovaries. The frequency and percentage of patients who continued to suffer infertility due to post-operative adhesions was established. To establish the diagnosis different methods of investigation were used: clinico-geneologic, X-ray, ultrasonography, hormonal assay (determination of 17 CS, LT, FSH, T4, T3 Prolactin, E2), organ function tests (progesterone-test, dexthamethazone-test, test with clomiphene), histology of swabs of the mucosa of uterus and ovarian and ovarian tissues. Results of the investigation . On analysing the data, according to the methods used (demedulation of the ovaries; clinoid resection, laparoscopic diathermocoagulation) it was found that demedulation of the ovaries with tubular knife and subsequent subcapsular stitching and submerging of sutures is the most effective surgical treatment in patients with typical form of sclerocystic ovarian syndrome. The operation leads to the activation of gonadotropic function of hypophysis, decreased excretion of LT, testosterone, increased serum FSH level, restoration of menstrual and generative functions. One of the advantages of demedulation over clinoid resection is its low rate of developing post-operative adhesions. After demedulation of the ovaries 80% of the women had no history of adhesions, while after clinoid resection only 19,6% of the patients had no adhesions. Laparoscopic diathermocoagulation is also an effective method in maneging patients with sclerocystic ovarian syndrome. The effectiveness of this operation is due to its normolization of endocrine function through the destruction of ovarian substance and enhancing the growth of fibrose tissue in its place. There is also low rate of development of adhesions in the lower pelvis, decreased patient’s stay in clinic. Comparative analysis of the surgical methods of treatment in patients with typical form of sclerocystic ovarian syndrome has shown the advantages of demedulation and diathermocoagulation over clinoid resection of the ovaries. Restoration of menstrual function after demdedulation occurred in 95,8% of the patients; after laparoscopic diathermocoagulation 90,3%; after clinoid resection - 91,1%. Restoration of generative function occurred in 77,2%; 71,2%; 65,7% correspondingly. Key words: sclerocystic ovarian syndrome, surgical treatment, demedulation, laparoscopy, diathermocoagulation.

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