I?i?noa?noai ioi?iie caei?ia’y Oe?a?ie Oa?iii?euenueea aea?aeaaia
iaaee/ia aeaaeai?y ?i.?.ss.Ai?aa/aanueeiai

EO*??EA ss?INEAA IEOAEEIAE*

OAeE[616.33-002.44+616.33-005.1+616.342]:616-078

EIIIEAENIA E?EOAAIIss

OAE?EIAAEOA?-I?EI?? CAEAAEIEO E?EAAAEss*EO AE?ACIE OEOIEA ?
AeAAIAAeOessOEIAEI? EEOEE

14.01.03.-o??o?a?y

AAOI?AOA?AO

aeena?oaoe?? ia caeiaoooy iaoeiaiai nooiaiy eaiaeeaeaoa iaaee/ieo iaoe

Oa?iii?eue — 1999

Aeena?oaoe?y ? ?oeiien.

?iaioa aeeiiaia a ?aaii-O?aie?anuee?e aea?aeaai?e iaaee/i?e aeaaeai??
IIC Oe?a?ie.

Iaoeiaee ea??aiee : aeieoi? iaaee/ieo iaoe , i?ioani? Aii/a? Ieoaeei
A?eai?iae/ ,

?aaii-O?aie?anueea aea?aeaaia iaaee/ia aeaaeai?y, caa?aeoaa/ eaoaae?e
o??o?a?? noiiaooaeoeueoaoo c eo?nii o?ieia??.

Io?oe?ei? iiiiaioe : aeieoi? iaaee/ieo iaoe , Ai?iaee ?aaai Iaeneiiae/,
Oa?iii?euenueea aea?aeaaia iaaee/ia aeaaeai?y ?i.?.ss.Ai?aa/aanueeiai,
i?ioani? eaoaae?e iaaeeoeeie iaa?aeeeaaeieo noai?a;

aeieoi? iaaee/ieo iaoe , i?ioani? I?eueeia Ai?en Ieaaiae/, Aoeiaeinueea
aea?aeaaia iaaee/ia

aeaaeai?y , i?ioani? eaoaae?e oaeoeueoaonueei? o??o?a??.

I?ia?aeia onoaiiaa: ?inoeooo ee?i?/ii? ? aenia?eiaioaeueii? o??o?a?? AII
Oe?a?ie , i. Ee?a.

Caoeno aeena?oaoe?? a?aeaoaeaoueny «18»eenoiiaaea 1999 ?ieo i1600aiaeei?
ia

can?aeaii? niaoe?ae?ciaaii? a/aii? ?aaee E.58.601.01. o Oa?iii?euenuee?e
aea?aeaai?e iaaee/i?e aeaaeai?? ?i.?.ss.Ai?aa/aanueeiai (46001
,i.Oa?iii?eue , Iaeaeai Aie?, 1).

C aeena?oaoe??th iiaeia iciaeiieoenue o a?ae?ioaoe? Oa?iii?euenueei?
aea?aeaaii? iaaee/ii? aeaaeai?? ?i.?.ss.Ai?aa/aanueeiai (46001
I.Oa?iii?eue , aoe. ?onueea , 12).

Aaoi?aoa?ao ?ic?neaiee «18»aeiaoiy 1999 ?.

I.I. E?o

A/aiee nae?aoa?

niaoe?ae?ciaaii? a/aii? ?aaee E58.601.01,

eaiaeeaeao iaaee/ieo iaoe , i?ioani?

Caaaeueia oa?aeoa?enoeea ?iaioe

Aeooaeuei?noue oaie. Ae?aceiaith oai?iaith oeoiea ?
aeaaiaaeoeyoeiaei? eeoee no?aaeaea? 5-10% aei?ineiai ianaeaiiy
(?.I.Iaeei, A.?.Iaeei oa ?i., 1996; E.ss.Eiaaeue/oe oa ?i.,1997;
I.Ae.Aaneethe oa ?i., 1998; G.Battaglia et al.,1992). Iacaaaeath/e ia
aaeeea iaaeeei-nioe?aeueia cia/aiiy oe??? iaaeoae, aaaaoi i?eioeeiiaeo
ieoaiue ao?ieia??, iaoiaaiaco, ee?i?ee oa e?eoaaiiy ?? caeeoathoueny
noia?a/eeaeie oa aei e?ioey ia c’yniaaieie (A.I.Iaeauoe oa ?i.,1995;
A.A.Oa?aaa?tho e ae?.,1997, I.A.O?eueoe oa ?i.,1998; M.Z.Panos et
al.,1993). Iaei a?aeii? i?e/eie ? oaeoi?e, ye? coiiaeththoue ?icaeoie ??
oneeaaeiaiue. Na?aae ieo iniiaia i?noea caeia? e?iaioa/a, yea
niinoa??aa?oueny o 13,7% — 42,3% oai?eo (I.ss.A?eai?ueaa e ae?.,1996;
A.A.Oaeeiia,1997; ?.I.Ai?iaee oa ?i.,1997; ?.ss.Aecthaaiianueeee oa ?i.,
1998; ?.A.Turner et al.,1991). Oea niiioea? ia iiooee iiaeo aniaeo?a
ao?iiaoiaaiaco, a?eueo aoaeoeaieo iaoiae?a ?o e?eoaaiiy oa i?io?eaeoeee
ye ae?aceiai? oai?iae a oe?eiio, oae ? ?? aaii?aa?/ieo oneeaaeiaiue.

Iaeiei c iaea?eueo aaaiieo aeinyaiaiue aano?iaioa?ieia?? a inoaii? ?iee
? oa, ui i?e/eiith ae?aceiai? oai?iae oeoiea ? aeaaiaaeoeyoeiaei? eeoee
iiaea aooe i?e?iaiee oaeoi?, oae caaiee Helicobacter pylori /H.pylori/
(A.O.Na?iei e ae?.,1996; I.?.Aieioei oa ?i.,1997; ?.I. Noa?iaeoa e
ae?.,1998; A.O.Aoii, 1993; M.I.G.Fartbing,1998). Aeine?aeaeaiiy aeayeeo
a/aieo (I.A.Aii/a? oa ?i., 1996,1997; ?.I.Eaoa?ei/oe,1996;
A.A.Ia?aaea?ee e ae?.,1997) aeicaieeee aeyaeyoe I. pylori o oai?eo
ae?aceiaith oai?iaith aeaaiaaeoeyoeiaei? eeoee iaeaea o 100% aeiaaee?a,
ui aeaei i?aenoaao na?aae i?e/ei aeieeiaiiy oa ?icaeoeo oeueiai
caoai?thaaiiy oa ie?aieo eiai oneeaaeiaiue, a?aoiaoaaoe ? H.pylori.

Ieoaiiy o??o?a?/ii? oaeoeee oa e?eoaaiiy aano?iaeoiaeaiaeueieo e?iaioa/
ae?aceiaiai aaiaco caeeoa?oueny iaeiei c iaea?eueo aeooaeueieo o
iaa?aeeeaaei?e o??o?a?? i?aai?a /a?aaii? ii?iaeieie. Ca inoaii? ?iee
aeinyaioo? cia/i? oni?oe o e?eoaaii? e?eaaaey/eo ae?acie oeoiea ?
aeaaiaaeoeyoeiaei? eeoee (A.Ae.A?aoonue e ae?., 1991,1997; A.O.Caeoeaa
oa ?i., 1994; A.E.Iai/e/ e ae?., 1997; I.A.Oaa/oe oa ?i., 1998;
I.I.Aaeeaioeeee e ae?., 1999; R.Bumm et al., 1989). Iaeiae ieoaiiy
oaeoeee, iieac?a aei iia?aoeaiiai /e eiina?aaoeaiiai e?eoaaiiy
caeeoathoueny aeeneooaaaeueieie oa aei e?ioey ia ae??oaieie. Ia aeoieo
ie?aieo aaoi??a (A.I.Oioiey e ae?., 1988; A.A.Oa?aaa?tho e ae?., 1994;
I.A.Aii/a? oa ?i., 1998; M.Trybo et al., 1992;! F.Bretagne,1995),
o??o?a?/io oaeoeeo i?e ae?aceiaeo aano?iaeoaaeaeueieo e?iaioa/ao ia
aeioe?eueii aoaeoaaoe ia i?eioeeiao iaaei??iiai caoiieaiiy o??o?a?/iith
aeoeai?noth. Oiio aeooaeueieie caeeoathoueny ieoaiiy eiina?aaoeaii?
oa?ai?? ae?aceiaeo e?iaioa/ (I.ss.Aaaae, A.Ae.Oaaea?iei, 1996) a
aino?iio ia??iae? c ianooiiei ieaiiaei iia?aoeaiei icaei?iaeaiiyi.

A?aoiaoth/e iiyao ua iaeiiai oaeoi?a /I.?o?ia?/, yeee aieeaa? ia
aeieeiaiiy oa ia?aa?a ae?aceiai? oai?iae oeoiea ? aeaaiaaeoeyoeiaei?
eeoee, a?aee?eaathoueny iia? ia?niaeoeai? iai?yiee iiooeo i?e/ei
?icaeoeo ?? aaii?aa?/ieo oneeaaeiaiue. Oea niiioea? aei a?eueo aeeaieiai
aea/aiiy oe??? «a?ei? ieyie» a aano?iaioa?ieia?? c iine?aeoth/ei
ae?iaeaiiyi aaeaeaaoiiai eiiieaeniiai e?eoaaiiy aeacaiiai a??ciiai
oneeaaeiaiiy ae?aceiai? oai?iae, anioe?eiaaii? I?-?ioaeoe??th.

Ca’ycie ?iaioe c iaoeiaeie i?ia?aiaie, ieaiaie, oaiaie. Aeena?oaoe?eia
?iaioa aeeiiaia a ?aieao iaoeiai? oaiaoeee aeaaeai?/ii? a?oie aeaaeai?ea
AII Oe?a?ie ?.I. Iaeea oa ca?aeii c ieaiaie iaoeiai-aeine?aeieoeueeeo
?ia?o ?aaii-O?aie?anueei? aea?aeaaii? iaaee/ii? aeaaeai?? «?ic?iaea
iiaeo iaaee/ieo oaoiieia?e oa noaiaea?o?a yeino? ae?aaiinoeee,
i?io?eaeoeee ? e?eoaaiiy ia?ioaeoe?eieo oa ?ioaeoe?eieo caoai?thaaiue»
(? aea?aeaaii? ?a?no?aoe?? 01.02.032.96n).

Iaoa aeine?aeaeaiiy. Aea/eoe iniaeeaino? ee?i?ei — a?io?i?/ieo oa
ooieoe?iiaeueii — ii?oieia?/ieo ci?i neeciai? iaieiiee oeoiea ?
aeaaiaaeoeyoeiaei? eeoee o aca?iica’yceo c ?io?eoaaiiyi I.?o?ia? oa
iaa?oiooaaoe aea?? iaoiaeo e?eoaaiiy I.?o?ia? -caeaaeieo e?eaaaey/eo
ae?acie oeoiea ? aeaaiaaeoeyoeiaei? eeoee.

Caaaeaiiy aeine?aeaeaiiy:

1. Aecia/eoe iniaeeaino? ?io?eoaaiiy I.?o?ia? neeciai? iaieiiee oeoiea ?
aeaaiaaeoeyoeiaei? eeoee o oai?eo c oeoieiai-eeoeiaeie e?iaioa/aie
ae?aceiaiai aaiaco.

2. Iieacaoe aca?iicaeaaei?noue nooiaith can?thaaiiy I.?o?ia? neeciai?
iaieiiee oeoiea a?ae nooiaith e?iaiao?aoe.

3. C’ynoaaoe noai ie?aieo oaeoi??a cai?oaeueii? nenoaie e?ia?, ??
?aieia?/i? aeanoeaino?, ai?no na/iaeie oa a?eeo e?ia? a caeaaeiino? a?ae
nooiaith e?iaiao?aoe oa iayaiino? I.?olir?.

4. Anoaiiaeoe iniaeeaino? nae?aoi?ii? ooieoe?? oeoiea a caeaaeiino? a?ae
nooiaith e?iaiao?aoe oa nooiaith ian?thaaiiy I.?o?ia? .

5. Aea/eoe oa?aeoa? a?noino?oeoo?e a?iin?eiiai oa iia?aoe?eiiai
iaoa??ae?a no?iee oeoiea o oai?eo c aano?iaeoiaeaiaeueieie e?iaioa/aie
ae?aceiaiai aaiaco, anioe?eiaaieo I.?o?ia? -?ioaeoe??th.

6. ?ic?iaeoe oa iaa?oiooaaoe e?eoaaeueio oaeoeeo e?eaaaey/eo ae?acie
oeoiea ? aeaaiaaeoeyoeiaei? eeoee a caeaaeiino? a?ae nooiaith
e?iaiao?aoe oa nooiaith ian?thaaiiy neeciai? iaieiiee oeoiea I.?olir?
-?ioaeoe??th.

Iaoeiaa iiaecia iaea?aeaieo ?acoeueoao?a.

A ?iaio? aia?oa anoaiiaeaia iayai?noue I.?o?ia? i?e aaii?aa?/ieo
oneeaaeiaiiyo ae?aceiai? oai?iae a caeaaeiino? a?ae eieae?caoe??
ae?aceiaiai i?ioeano ? aaaeeino? e?iaiao?aoe. Aia?oa aea/aii iniaeeaino?
aieeao I.?o?ia? -?ioaeoe?? ia ?aieia?/i? aeanoeaino? e?ia? oa
i?e?ioee?eoeyoi?ia ?onei oeoiea, nae?aoi?io caeaoi?noue eiai caeic oa
ii?oino?oeoo?i? ci?ie neeciai? iaieiiee o oai?eo c ae?aceiaeie
e?iaioa/aie. Iaoeiai iaa?oioiaaii ? aeiaaaeaii aoaeoeai?noue ?
aeioe?euei?noue canoinoaaiiy aioeaaeoa??aeueieo na?aaeiee?a, iai?aaeaieo
ia cieuaiiy I.?o?ia? i?e e?eaaaey/eo ae?aceao oeoiea ?
aeaaiaaeoeyoeiaei? eeoee. Aeiiiaiaii iieace aei eiina?aaoeaiiai oa
iia?aoeaiiai e?eoaaiiy aano?iaeoiaeaiaeueieo e?iaioa/ ae?aceiaiai
aaiaco, a caeaaeiino? a?ae nooiaith e?iaiao?aoe oa nooiaith ian?thaaiiy
neeciai? iaieiiee oeoiea I.?o?ia?.

I?aeoe/ia cia/aiiy iaea?aeaieo ?acoeueoao?a. Aeiaaaeaia
aeioe?euei?noue aecia/aiiy iayaiino? I.?o?ia? ia neecia?e iaieiioe?
aio?aeueiiai a?aeae?eo oeoiea o oai?eo c aaii?aa?/ieie oneeaaeiaiiyie
ae?aceiai? oai?iae. Iiaeeo?eiaaia oa oaeineiiaeaia eeaneo?eaoe?y
nooiaith ian?thaaiiy I.?o?ia? neeciai? iaieiiee oeoiea c i?eaaaeaiiyi
aei 4 nooiai?a e?iaiao?aoe i?e e?eaaaey/eo ae?aceao oeoiea ?
aeaaiaaeoeyoeiaei? eeoee. Anoaiiaeaii i?e/eiiee ca’ycie iayaiino? oa
nooiaith ae?aaeaiino? oae?eiaaeoa??ico aio?aeueiiai a?aeae?eo oeoiea o
?icaeoeo ?aoeeaeea?a aaii?aa?/ieo oneeaaeiaiue ae?aceiai? oai?iae.
C’yniaaia iniaeea?noue oa ae?aaeai?noue ii?ooaiue ?aieia?/ieo
aeanoeainoae e?ia? oa nae?aoi?ii? ooieoe?? oeoiea a caeaaeiino? a?ae
nooiaith e?iaiao?aoe oa iayaiino? I.?o?ia? -?ioaeoe??. ?ic?iaeaii
eiiieaen eiina?aaoeaii? aioeoae?eiaaeoa?ii? oa?ai?? I.?o?ia?
-caeaaeieo aano?iaeoiaeaiaeueieo e?iaioa/ ae?aceiaiai aaiaco a
caeaaeiino? a?ae nooiaith can?iai?iiy I.?o?ia? . Aeiiiaiaii iieace aei
iia?aoeaiiai e?eoaaiiy oai?eo c I.?o?ia? -caeaaeieie e?eaaaey/eie
ae?aceaie oeoiea ? aeaaiaaeoeyoeiaei? eeoee — IV nooi?iue ian?thaaiiy
I.?o?ia? . C o?aooaaiiyi ae?iaeaii? oa canoiniaaii? oaeoeee e?eoaaiiy
oai?eo aeaii? iaoieia??, caaaeueia oa i?neyiia?aoe?eia eaoaeuei?noue
cieaeaia a?aeiia?aeii aei 2,17% oa 6,25%.

Io?eiai? ?acoeueoaoe ai?iaaaeaeai? a oa?aiaaoe/iiio oa o??o?a?/iiio
a?aeae?eaiiyo OeEE I.?aaii-O?aie?anueea, iaeanii? ee?i?/ii? e?ea?i?,
o??o?a?/ieo a?aeae?eaiiyo oeaio?aeueieo ?aeiiieo e?ea?aiue. Aiie
aeei?enoiaothoueny a iaaeaaia?/iiio i?ioean? ia eaoaae?ao
?aaii-O?aie?anueei? iaaee/ii? aeaaeai??.

Iniaenoee aianie caeiaoaa/a. Caeiaoaa/ai cae?eniaii ?ic?iaeo iniiaieo
oai?aoe/ieo oa i?aeoe/ieo iieiaeaiue ?iaioe. Aaoi? iaieiae?a no/anieie
iaoiaeaie aeyaeaiiy I?-?ioaeoe??, aecia/aiiy noaio o?aineai?ey?iiai
iai?io, aa?aaaoe?? o?iiaioeeo?a, nae?aoi?ii? ooieoe?? oeoea. Naiino?eii
i?ia?a e?oa?aoo?iee iaeyae c oe??? i?iaeaie. I?ecia/aa e?eoaaiiy,
i?iaiaeea ae?aaiinoe/i? ianoaaeaiiy 163 oaiaoe/iei oa 27 eiio?ieueiei
oai?ei . I?ia?a 17 iia?aoeaieo ao?o/aiue, a yeino? ia?oiai anenoaioa-12.
Aeaioiaeaiiy oa ?ioa?i?aoaoe?th ?acoeueoao?a a?noieia?/iiai oa
aeaeo?iiii-i?e?ineii?/iiai aeine?aeaeaiiy iaoa??aeo i?iaiaeea ia
eaoaae?? a?noieia?? oa aia??ieia?? (caa.eaoaae?e — ae.i.i.,
i?io.Ae?eueoeiaa 0.1.) oa ia eaoaae?? iaoieia?/ii? aiaoii??
(caa.eaoaae?e -ae.i.i.,i?io. Ieoaeethe 1.0.), a oaeiae noi?nii c
aeioeaioii eaoaae?e iaoieia?/ii? aiaoii?? e.i.i. N.A. Aa?auaiei
?aaii-O?aie?anueei? aea?aeaaii? iaaee/ii? aeaaeai??.

Aaoi? naiino?eii i?ia?a nenoaiaoecaoe?th oa aiae?c io?eiaieo
?acoeueoao?a, ii??aiya ?o c aeaieie a?o/eciyieo oa ca?oa?aeieo
aeine?aeiee?a, noi?ioethaaa aeniiaee oa i?aeoe/i? ?aeiiaiaeaoe??.
Ai?iaaaeea ?ic?iaeai? iaoiaeeee a i?aeoeeo.

Ai?iaaoe?y ?acoeueoao?a aeena?oaoe??. Aeena?oaoe?y i?ieoea ai?iaaoe?th
ia ni?eueiiio can?aeaii? iaoeiai? eii?n?? oa o??o?a?/ieo eaoaae?
iaaee/ii? aeaaeai?? (?aaii-O?aie?anuee, 1998). Iniiai? oai?aoe/i? oa
i?aeoe/i? iieiaeaiiy aeena?oaoe?? aeiiia?aeaeeny ia I?aeia?iaeiiio
eiia?an? iieiaeeo a/aieo-oe?a?ioe?a (?aaii-O?aie?anuee, 1995),
can?aeaiiyo iaeaniiai iaoeiaiai oiaa?enoaa o 1995, 1996, 1997, 1998
?ieao, a iaoa??aeao iaoeiai-i?aeoe/ii? eiioa?aioe?? aiaeineii?no?a
Oe?a?ie «Aeooaeuei? i?iaeaie ae?aaiinoe/ii? oa e?eoaaeueii?
aiaeineii??»» ( Ee?a, 1996 ), iaoa??aeao 1-i? oa 2-i? tha?eaeii?
iaa/aeueii-iaoiaee/ii? oa iaoeiai? eiioa?aioe?e caa?aeoaa/?a eaoaae?
o??o?a?/ieo oai?ia noiiaooaeoeueoao?a iaaee/ieo aoc?a Oe?a?ie (Iieoaaa,
1997, 1998), ca??ieeo iaoeiaeo i?aoeue, i?enay/aiiai 75-??//th eaoaae?e
o??o?a?? EIA i?neyaeeieiiii? ina?oe IIC Oe?a?ie (Ee?a 1997), iaoa??aeao
oe?a?inueei? iaoeiai? eiioa?aioe?? c i?aeia?iaeiith o/anoth
«I?e?ioee?eoeyoe?y oa ?? a?eia? ci?ie» (Ee?a, 19-21 o?aaiy 1999 ?ieo),
iaoa??aeao Anaoe?a?inueei? iaoeiai? eiioa?aioe?? o??o?a?a «I?iaeaie
?ioiieia?? a o??o?a??» (?aaii-O?aie?anuee 22-24 aa?aniy 1999 ?ieo).

Ioae?eaoe??. Ca iaoa??aeaie aeena?oaoe?? iioae?eiaaii 12 iaoeiaeo
i?aoeue: 5 iaoeiaeo, noaooae o oaoiaeo iaoeiaeo aeaeaiiyo (1 – a
?iicaiiiio (?in?y)); 2 — o ca??ieeao iaoeiaeo i?aoeue; 4 — o iaoa??aeao
? 1 — o oacao iaoeiaeo eiioa?aioe?e, eiia?an?a. Iiaeaii cayaeo ia
aeiao?ae. Io?eiaii iina?ae/aiiy ia 1 ?aoe?iiae?caoi?nueeo i?iiiceoe?th.

Ianya ? no?oeoo?a aeena?oaoe??. Iaoa??aee aeena?oaoe?? aeeeaaeai? ia 175
noi??ieao iaoeiiieniiai oaenoo. Aeena?oaoe?y neeaaea?oueny c anooio,
iaeyaeo e?oa?aoo?e, iaoa??ae?a oa iaoiae?a aeine?aeaeaiiy, ?acoeueoao?a
aeanieo aeine?aeaeaiue, aiae?co oa ocaaaeueiaiiy ?acoeueoao?a
aeine?aeaeaiiy, aeniiae?a, i?aeoe/ieo ?aeiiaiaeaoe?e. ?iaioa
?ethno?iaaia 26 oaaeeoeyie ? 28 ?enoieaie. O nieneo e?oa?aoo?e 345
aeaea?ae, c yeeo 190 ?iicaiieo.

Ci?no ?iaioe.

Iaoa??ae oa iaoiaee aeine?aeaeaiue. A iniiao
ee?i?ei-eaai?aoi?ii-?ino?oiaioaeueiiai aeine?aeaeaiiy iieeaaeaii aiae?c
?acoeueoao?a ianoaaeaiiy 189 oai?eo ia ae?aceiao oai?iao, oneeaaeiaio
e?iaioa/ath c ??ciei nooiaiai e?iaiao?aoe oa 39 iaoe??io?a c ae?aceiaith
oai?iaith aac oneeaaeiaiue (eiio?ieue). Aeey aeai?o aaeaeaaoii?
e?eoaaeueii? oaeoeee oa aeinoia??iino? ?acoeueoao?a aeine?aeaeaiiy
ei?enooaaeeny 4 nooiaiaaith nenoaiith aaaeeino? e?iaiao?aoe oa
iiaeeo?eiaaiith iaie (?aoe?iiae?caoi?nueea i?iiiceoe?y ?20 (2390 a?ae
21.04.1996 p.) 4-nooiaiaaith nenoaiith ioe?iee ian?thaaiiy neeciai?
iaieiiee oeoiea oae?iaaeoa??yie.

On? oai?? aoee iiae?eai? ia ee?i?/i? a?oie : ?- c e?iaiao?aoith ?
nooiaith; 2- II nooiaith; C- III nooiaith; 4-IV nooiaith; 5-oai?? c
??ciei nooiaiai e?iaiao?aoe, yeei i?iaiaeeeiny iia?aoeaia ao?o/aiiy.
Na?aae ianoaaeoaaieo iaoe??io?a aoee : c ae?aceith oeoiea — 54 /ie., c
ae?aceith aeaaiaaeoeyoeiaei? eeoee — 135 /ie. A?e iaoe??io?a eieeaaany
a?ae 17 aei 84 ?ie?a. C ieo : ae?iie — 68, /ieia?e?a — 160.

Iaoa??aeii aeine?aeaeaiiy neoaeeee a?iioaoe neeciai? iaieiiee oeoiea ?
aeaaiaaeoeyoeiaei? eeoee, ia?eoa??eia e?ia, oeoieiaiee n?e oa
iia?aoe?eiee iaoa??ae ianoaaeoaaieo i?aai?a. Aiae?c iniiaieo ee?i?/ieo
iieaciee?a i?iaiaeeany i?e iinooieaii?, a i?ioean? e?eoaaiiy ( 4-5 aeiaa
) oa a e?ioe? eo?no eiina?aaoeaiiai /e iia?aoeaiiai e?eoaaiiy (12-15
aeiaa). ?iaioa i?iaiaeeeanue ia aac? o??o?a?/iiai oa oa?aiaaoe/iiai
a?aeae?eaiue OeIEE i. ?aaii-O?aie?anueea.

A ?iaio? aoa canoiniaaiee eiiieaeniee i?aeo?ae c a?eueo aeaoaeueiei
aeine?aeaeaiiyi i?e?iaiiai oaeoi?o (I.?o?ia?). I?e oeueiio
aeei?enoiaoaaeeny no/ani? iaoiaee ? iaoiaeeee aeine?aeaeaiiy oai?eo c
aeaiith iaoieia??th:

1) ee?i?/i? niinoa?aaeaiiy oa aeine?aeaeaiiy e?ia? i?iaiaeeeenue ca
caaaeueiii?eeiyoeie iaoiaeeeaie;

2) aecia/aiiy a?io?ce/ieo aeanoeainoae e?ia?: o?aineai?ey?iee iai?i
aea/aee ca iaoiaeii A.I. Eacia/a?aa oa A.A. Aec?c?inueeiai (1975);

aa?aaaoe?th o?iiaioeeo?a aecia/aee ia OAE-56 ca iaoiaeii A.?. Ai?ia a
iiaeeo?eaoe?? A.A. Caoa??y oa I.A.E?iao (1986);

3) nae?aoi?io ooieoe?th oeoiea aeine?aeaeoaaee iaoiaeii o?aeoe?eiiai
ciiaeoaaiiy c ianooiiei oeo?oaaiiyi oeoieiaiai nieo;

4) acioaaiaano?iaeoiaeaiineii?th aeeiioaaee i?e iinooieaii? oai?eo oa a
??ci? oa?i?ie e?eoaaiiy o noaoe?iia?? (eiio?ieuei? aeine?aeaeaiiy). I?e
oeueiio i?iaiaeeee caa?? a?iin?eiiai iaoa??aeo neeciai? iaieiiee c
iaoith aeyaeaiiy I.?o?ia? iaoiaeii iinoaiiaee a?io?i?/ii? ?aaeoe?? ia
o?aaco ca aeiiiiiaith noaiaea?oieo CLO-oano?a oa i?e?ineii?? iace?a aeey
aecia/aiiy iayaiino? oa nooiaith ian?thaaiiy I.?o?ia?;

5) ii?oieia?/ia aeine?aeaeaiiy a?iin?eiiai oa iia?aoe?eiiai iaoa??ae?a
i?iaiaeeee i?ney caaa?aeaiiy aaiaoienee?i — oa aco?- aiceiii oa
aeaeo?iiii-i?e?ineii?/iiai aeine?aeaeaiiy, i?ney caio?aiiy oiaoi/ea
oeaieie (1o1 ii) o 2 % ?ic/ei /ioe?ueioieeno ini?th ? caeeth/aiiy a
noi?o aiiio c a?aeae?oii i?e ca?eueoaii? o 8-17 oeny/ ?ac;

6) noaoenoe/io ia?iaeo iaea?aeaieo aeaieo i?iaiaeeee caaaeueiii?eeiyoeie

iaoiaeaie, ioe?ithth/e a??ia?aei?noue ia ??ai? cia/eiino? ia iaioa 95 %

(?<0,05) ca e?eoa???i Nouethaeaioa. ?acoeueoaoe aeine?aeaeaiue oa ?o iaaiai?aiiy. I?e aiae?c? caoai?thaaiino? e?eaaaey/eie ae?aceaie oeoiea ? aeaaiaaeoeyoeiaei? eeoee eiinoaioiaaii aeii?ioaaiiy iaoieia?/iiai i?ioeano o aeaaiaaeoeyoeiae?e eeooe? - o 2,6 ?ace /ano?oa , i?ae o oeoieo, oa o /ieia?e?a - o 2,4 ?ace /ano?oa, i?ae o ae?iie. Iniiai? nea?ae oai?? i?aae'yaeyee ia iayai?noue "iaeaie" (97,76%), caaaeueiiai iacaeoaeaiiy (73,24%), i?enooio iaii/? c aieiaie?oae?iiyi (47,87%). O 20,47% iaoe??io?a 3-4 ee?i?/ieo a?oi aeacai? iciaee noi?iaiaeaeoaaeenue iioueia?aiiyi na?aeiiino? oa iai?eoiii?noth. Aethaioi? iane eieuei?o "eaaiai? aou?" aeyaeaii o eiaeiiai i'yoiai c ae?aceith oeoiea oa o eiaeiiai aeanyoiai c ae?aceith aeaaiaaeoeyoeiaei? eeoee. A?io?i?/ieie aeine?aeaeaiiyie aeyaeaii, ui e?euee?noue na/iaeie ne?iaaoee e?ia? o oai?eo ? ee?i?/ii? a?oie ia 19,72% a?eueoa i?e ae?acoe? aeaaiaaeoeyoeiaei? eeoee ? ia 20,45% a?eueoa o oai?eo c I.?o?ia?. C ia?inoaiiyi e?iaiao?aoe ca?eueoo?oueny e?euee?noue na/iaeie ?c cia/iith ia?aaaaith o oai?eo c oae?eiaaeoa??icii. Iniaeeai oea i?iyaey?oueny o iaoe??io?a 4-5 ee?i?/ieo a?oi, aea I.?o?ia? aeyaeaii o 100% aeiaaee?a c III-IV nooiaiyie ian?thaaiiy. I?e aea/aii? ii?ooaiue i?e?ioee?eoeyoe?? aeiaaaeaii, ui o oai?eo 1 ee?i?/ii? a?oie aaeaeaaoia ?aaeoe?y eiiiainaoi?ii-i?enoinoaaeueieo iaoai?ci?a i?eaaea aei iiieaeaiiy aaiaoie?eoo a?oa??aeueii? oa aaiicii? e?ia? c ia?aaaaith a a?oa??aeuei?e eaioe? aaii?onea i?e iayaiino? I.?o?ia? -?ioaeoe?? ia 9-10% i?e ae?aceao oeoiea ? ia 15-18% i?e ae?aceao aeaaiaaeoeyoeiaei? eeoee. O oai?eo 2 ee?i?/ii? a?oie ia?aaaaea? "aaioey?iee" oei i?iieeiino? oa a'yceino? e?ia?. O?eaath/a e?iaioa/a aeeeeea? ii?ooaiiy a a?oa??aeuei?e eaioe? aaii?onea, iniaeeai o oai?eo c ae?aceith aeaaiaaeoeyoeiaei? eeoee i?e iayaiino? I.?o?ia? . Ia oea aeacothoue io?eiai? iaie aeai? o iaoe??io?a c III nooiaiai e?iaiao?aoe i?e ae?aceao oeoiea, aea i?iieei?noue aaiieai?ey??a c I.?o?ia? ia 90% a?eueoa, i?ae aac I.?o?ia? . O oai?eo 4-5 ee?i?/ieo a?oi i?iieei?noue eai?ey??a iaaiaee, ia?aaaaea? i?e ae?aceao aeaaiaaeoeyoeiaei? eeoee, aea noaeeiia ?onei ao?a/a? ??aeeio oa a?eie ia 50-70% a?eueoa, i?ae o oai?eo aac e?iaioa/?. Ae?aaeai? ci?ie anoaiiaeaii ? i?e aeine?aeaeaii? aa?aaaoe?? o?iiaioeeo?a, ye? oa?aeoa?ecoaaeeny aeeaoeie ci?iaie i?e aano?aeueieo ae?aceao o oai?eo c H.pylori . Aeyaeaia iaie ??cieoey ii?ooaiue i?iieeiino? eai?ey??a c ia?aaaaeaiiyi o oai?eo c oae?eiaaeoa??icii, iaaiaeeoue ia aeoieo i?i iaaiee aieea H.pylori -?ioaeoe?? ia ?aieia?/i? aeanoeaino? e?ia?. Aeine?aeaeaiiy nae?aoi?ii? ooieoe?? oeoiea iieacaee, ui aaea i?e e?iaiao?ao? 1 nooiaiy ia'?i oeoieiaiai nieo a on?o ii?oe?yo ia 6-10% iaioee, i?ae o oai?eo eiio?ieueii? a?oie. O iaoe??io?a ?ioeo ee?i?/ieo a?oi i?iaeiaaeo?oueny aeinoia??ia ciaioaiiy ia'?io nae?aoo caeic oeoiea i?eaeecii ia 20-30%. Aiaeia?/ia ea?oeia niinoa??aa?oueny i?e aeine?aeaeaii? oeo?aoe?eii? eeneioiino?, yea a on?o ii?oe?yo aeinoia??ii ieae/a o oaiaoe/ieo oai?eo. ??cieoey aeacaieo iieaciee?a eieeaa?oueny a iaaeao 40,72% - 48,73% c ia?aaaaith o oai?eo c aeoiaeaiaeueieie ae?aceaie i?e iayaiino? H.pylori . Oea i?aeoaa?aeaeo?oueny ? aeaieie A.N.??iieiaa oa ?i.(1998). I?e aiaeineii?/iiio iaeyae? ii?iaeieie oeoiea aeyaey?oueny ?yae niaoeeo?/ieo iciae oae?eiaaeoa??ico: a on?o iaoe??io?a anoaiiaeaiee H.pylori -anioe?eiaaiee aano?eo; o 95% oai?eo aeyaeaia iayai?noue iooiiai neeco; o 87,45% in?a iayai? iioiauai? neeaaeee oeoiea, iaa?ye oa a?ia?ai?y neeciai? iaieiiee; o 37,29% iaoe??io?a eiinoaoiaaii ii?aeiaiiy ae?aceiaiai i?ioeano c a?iceaiei. Io?eiai? ?acoeueoaoe aeyaeaiiy H.pylori ca aeiiiiiaith o?aaciiai oanoo oa oeeoieia?/iiai aeine?aeaeaiiy iacea-iao?e/ee a?iioao?a neeciai? iaieiiee oeoiea iieacaee aenieee a?aenioie ?o ia?nenoaioe??, iniaeeai i?e aeoiaeaiaeuei?e eieae?caoe?? ae?acee (oaae.1). Oaaeeoey 1. ?acoeueoaoe aeyaeaiiy Helicobacter pylory Ee?i?/i? a?oieIiceoeaiee o?aaciee oanoOeeoieia?/ia aeine?aeaeaiiy AO oeoieaAOAeIEAO oeoieaAOAeIE16(10)37(41)7(10)38(41)28(12)30(35)9(12)32(35)38(11)24(27)7( 11)25(27)46(6)10(10)6(6)10(10)57(7)13(13)7(7)13(13)Na?aaei?35(46)114(126 )36(46)118(126) (76,08%)(90,48%)(78,26%)(93,65%)Eiio?ieue6(11)20(27)7(11)22(27) (54,55%)(74,07%)(63,64%)(81,48%) I?ei?oea: a aeoaeeao - aaniethoia e?euee?noue oai?eo. Oaeei /eiii, anoaiiaeaii i?yio caeaaei?noue nooiaith ian?thaaiiy I.?o?ia? a?ae nooiaith e?iaiao?aoe. I?e ii?oieia?/iiio aeine?aeaeaii? iaoa??aeo oai?eo c oae?eiaaeoa??icii a on?o aeiaaeeao ae?aaiinoiaaii iiaa?oiaaee aio?aeueiee aano?eo oa aeoiaeai?o ??ciiai nooiaith ae?aaeaiino?. O iaoe??io?a c ?-?? nooiaiyie ian?thaaiiy I.?o?ia? niinoa??aaeeny iciaee o?ii?/iiai caiaeaiiy neeciai? iaieiiee oeoiea ? aeaaiaaeoeyoeiaei? eeoee c ia?aaaaith a?ia?ieanoe/ieo i?ioean?a, iniaeeai o in?a iioeeiai a?eo. Ae?aaeai?noue caiaeueieo ci?i ei?aethaaea c? nooiaiai ian?thaaiiy I.?o?ia? . Aeeaeia no?oeoo?ieo ii?ooaiue caeaaeaea a?ae nooiaith e?iaiao?aoe oa ?ioaineaiino? ?iaac?? oae?eiaaeoa??e. Oae, yeui o oai?eo 1 oa 2 ee?i?/ieo a?oi niinoa??aaeeny ci?ie, eieae?ciaai? o?eueee o iiaa?oiaaeo oa?ao ai?oae?th ?c ceaaea ae?aaeaiith iaeo?io?eueiith ?io?eueo?aoe??th, oi o oai?eo 3 oa 4 ee?i?/ieo a?oi ianooiaea ae?aaeaia aeano?oeoe?y neeciai? iaieiiee ? ?? aeanii? ieanoeiee, ui iioe?thaaeany iica aacaeueio iaia?aio ?c cia/iith ?io?eueo?aoe??th iaeo?io?eaie, e?ioioeeoaie, ieaciaoe/ieie ee?oeiaie c ooai?aiiyi ie?aieo aiaieu oeeo ee?oei. Anoaiiaeaii oaeiae, ui i?e ?-?? nooiaiyo e?iaiao?aoe oa ian?thaaiiy I? ia?aaaaeathoue a?ia?ieanoe/i? i?ioeane, a i?e III-IV nooiaiyo - ao?io?/i? ci?ie, ye? iioe?ththoueny ? ia aeeao? oa?e no?iee oeoiea. Oeueo?ano?oeoo?i? ci?ie oa?aeoa?ecoaaeeny ??ciei nooiaiai aeano?oeoe??, aae aei iiaiiai cieuaiiy i?e?iai?neiie ai?eaeueii? /anoeie ai?oae?ioeeo?a, yea iaea i?yio caeaaei?noue a?ae nooiaith e?iaiao?aoe oa nooiaith ian?thaaiiy I.?o?ia? . Iniaeea?noth oeeo ci?i aoei ? oa, ui c ia?inoaiiyi ?iaac?? I.?o?ia? i?ia?anoaaee no?oeoo?i? ii?ooaiiy i?aaiae ee?oei, cie?aia aia?aaoe/iiai ?yaeo. E??i oiai, anoaiiaeai? ae?aaeai? ci?ie i?e?ioee?eoeyoi?iiai ?onea, ye? i?iyaeyeenue iaa?yeii oeeoiieacie aiaeioae?ioeeo?a, ??ciiai ?iaeo aeieiaiiyi inoaiiuei? o i?ina?o eai?ey?a, aeeno?io??th ee?oeiieo i?aaiae. Aeeaeia oeeo ii?ooaiue oaeiae caeaaeaea a?ae nooiaith e?iaiao?aoe oa nooiaith ian?thaaiiy I.?o?ia? . ?ACOEUeOAOE E?EOAAIIss. ?acoeueoaoe e?eoaaiiy oai?eo ? ee?i?/ii? a?oie, yeei canoiniaoaaee iiaea?eio (aiieneoeee?i + iao?ii?aeacie aai eea??o?ii?oeei+iao?ii?aeacie) aioeoae?eiaaeoa?io oa?ai?th iieacaee, ui i?ney iaeiiai oaeiai eo?no (7-10 ae?a) e?eoaaiiy aano?aeueieo e?iaioa/ o 20% iaoe??io?a caa??aathoueny I.?o?ia? . Oaea ae oa?ai?y a ii?aeiaii? c aioenae?aoi?ieie na?aaeieeaie (aiieneoeee?i + iao?ii?aeacie + ?ai?o?ae?i) aai (eea??o?ii?oeei+iao?ii?aeacie+eaaiaoae) o oai?eo aeoiaeaiaeueieie e?iaioa/aie i?eaaea aei cieuaiiy I.?o?ia? o 100% in?a. I?e e?eoaaii? oai?eo 2 ee?i?/ii? a?oie, ine?eueee o ieo anoaiiaeai? on? 4 nooiai? ian?thaaiiy H/pilori, ia’?i oa?ai?? aecia/aa nooi?iue ?iaac?? H.pylori. Eiio?ieueia aiaeineii?/ia aeine?aeaeaiiy aeaei iiaeeea?noue o 4 oai?eo i?ney iaeiiai eo?no i?ioeae?aceiai? oa?ai?? aeyaeoe H.pylori I-II nooiai? ian?thaaiiy. O ca'yceo c oeei, ?i i?ecia/aii iiaoi?iee eo?n aioeoae?eiaaeoa?ii? oa?ai??, yeee i?ea?a aei iiaiiai cieuaiiy H.pylori a on?o aeiaaeeao. Aaaeea e?iaiao?aoa oa cia/iee nooi?iue ian?thaaiiy H.pylori o oai?eo C ee?i?/ii? a?oie aoee iieacaiyie aei i?ecia/aiiy 3-eiiiiiaioii? aioeoae?eiaaeoa?ii? oa?ai?? (aiieneoeee?i + iao?ii?aeacie + iiai?acie), (aiieneoeee?i + eea??o?ii?oeei + ?ai?o?ae?i), (aiieneoeee?i + eaaiaoae + aea-iie). I?e eiio?ieuei?e acioaaiaano?iaeoiaeaiineii?? H.pylori I-II nooiai?a aeyaeaii o 12,5% iaoe??io?a, ye? i?eeiaee aiieneoeee?i + eaaiaoae+aea-iie. I?e eiina?aaoeaiiio e?eoaaii? oai?eo 4 ee?i?/ii? a?oie canoiniaoaaeany 4 eiiiiiaioia (aiieneoeee?i +eea?eo?ii?oeei + iao?ii?aeacie+iiai?acie aai aiieneoeee?i+eea?eo?ii?oeei+aea-iie+ ?ai?o?ae?i) aioeoae?eiaaeoa?ia oa?ai?y. O 3 c ieo c ae?aceith aeaaiaaeoeyoeiaei? eeoee ianooiea ?aoeeaeea e?iaioa/?, aea i?e aiaeineii?/iiio aeine?aeaeaii? anoaiiaeaii iayai?noue H.pylori I-II nooiai?a ian?thaaiiy. Oeei iaoe??ioai, o ca'yceo c aenieith eeneioi?noth, a eo?n e?eoaaiiy aoee aeeth/ai? aioenae?aoi?i? na?aaeieee. 5 ee?i?/io a?oio neeaee 32 iia?iaai? iaoe??ioe, ui noaiiaeoue 16,93% o??o?a?/ii? aeoeaiino? ? ni?aiaaea? c aeaieie ?ioeo aeine?aeiee?a (I.A.O?eueoe oa ?i.,1998): c ae?aceith oeoiea - 17(26%), c ae?aceith aeaaiaaeoeyoeiaei? eeoee - 15 (9,09%). *anoeia - 7 (21,88%) iaoe??io?a iia?iaaia ia aenio? e?iaioa/?. Iiia?ei aeai? oai?eo: ?-c IV nooiaiai e?iaiao?aoe i?ney ?acaeoe?? oeoiea a i?neyiia?aoe?eiiio ia??iae? ia oii? ?icaeiaiiai AeAC-neiae?iio; 2- c III nooiaiai e?iaiao?aoe i?ney aen?/aiiy ae?acee c naeaeoeaiith i?ieneiaeueiith aaaioii??th oa i?ei?iieanoeeith ia a?oio? i?ioocii? e?iaioa/?. Iaeaea a on?o iia?iaaieo oai?eo aoei ian?thaaiiy H.pylori III-IV nooiai?a. Oae, yeui i?e ? nooiai? ian?thaaiiy iia?iaaii 2 oai?eo, a i?e II- 3, oi oaea i?e III nooiai? - 12 , a i?e IV nooiai? - 15. Na?aae iia?aoeaieo ao?o/aiue a?aeaeaaaee ia?aaaao ?acaeoe?? oeoiea ca A?eue?io-?? a iiaeeo?eaoe?? Aioiaenoa?a-O?inoa?a?a ia aeiaa?e iaoe? c ni?aonoyi ca A?aoiii. Oeei ae??ooaaeeny ianooii? caaaeaiiy: coieiea e?iaioa/?, onoiaiiy i?e/ei aeieeiaiiy ae?aceiai? oai?iae (i?noea iaea?eueoi? eieae?caoe?? oeoieiaeo caeic oa ia?nenoaioe?? H.pylori -?ioaeoe??), caiia?aaiiy ?aoetheno aeoiaeaiaeueiiai ai?noo o oeoiie, ye i?io?eaeoeea ?a?ioaeoe??. Eiio?ieueia acioaaiaano?iaeoiaeaiineii?y, aeeiiaia o iia?iaaieo iaie oai?eo a ?aiiueiio i?neyiia?aoe?eiiio ia??iae?, iieacaea, ui o 17 iaoe??io?a i?ney ?acaeoe?? oeoiea ca A?eue?io-?? H.pylori a?aenooi?. A oie aea /an c 6 iaoe??io?a, yeei i?iaaaeai? i?aaiicaa??aath/? iia?aoe?? oa c 9, yeei c?iaeaii ?acaeoe?th oeoiea ca A?eue?io-?, H.pylori aeyaeaii o 40% aeiaaee?a. On?i ?i i?ecia/aii iiaoi?iee 3-eiiiiiaioiee eo?n aioeoae?eiaaeoa?ii? oa?ai??. Oaeei /eiii, i?e e?eoaaii? 189 oai?eo c e?eaaaey/eie ae?aceaie oeoiea ? aeaaiaaeoeyoeiaei? eeoee eiina?aaoeaia e?eoaaiiy canoiniaoaaeinue o 157 (83,07%). Iia?aoeaia ao?o/aiiy aeeiiaii 32 (16,93%) iaoe??ioai c ??ciei nooiaiai e?iaiao?aoe oa III-IV nooiaiyie ian?thaaiiy neeciai? iaieiiee oeoiea H.pylori . Eaoaeuei?noue i?e eiina?aaoeaiiio e?eoaaii? neeaea 1,27 %, i?ney iia?aoeaiiai ao?o/aiiy - 6,25 %. Caaaeueia nia?oi?noue noaiiaeea 2,17 %. I?eaaaeai? aeai? o??o?a?/ii? oaeoeee i?e I.?o?ia?-caeaaeieo e?eaaaey/eo ae?aceao oeoiea ? aeaaiaaeoeyoeiaei? eeoee ?c canoinoaaiiyi eiiieanii? aioeoae?eiaaeoa?ii? oa?ai?? na?ae/aoue i?i aenieo aoaeoeai?noue oa ia?aaaae cai?iiiiiaaiiai iaoiaeo e?eoaaiiy. AENIIAEE 1. Oae?eiaaeoa??? aeyaeythoueny o ia?aaaaeii? a?eueoino? oai?eo ae?aceiaith oai?iaith, oneeaaeiaiith e?iaioa/ath, iae/ano?oa i?e eieae?caoe?? iaoieia?/iiai i?ioeano o aeaaiaaeoeyoeiae?e eeooe? ? aeaui ??aeoa - o oeoieo. Oae, aecia/aiiy iayaiino? H.pylori ca aeiiiiiaith o?aaciiai oanoo iieacaei iiceoeai? ?acoeueoaoe i?e oeoieiaeo ae?aceao o 76,08% aeiaaee?a, i?e aeoiaeaiaeueieo - o 90,48% oai?eo; oeeoieia?/iei iaoiaeii H.pylori aeyaeaii a?aeiia?aeii o 78,26% oa 93,65% oai?eo. 2. Nooi?iue ?io?eoaaiiy neeciai? iaieiiee oeoiea aaeoa??yie H.pylori i?e iaio oi?iao ae?aceiai? oai?iae ciaoiaeeoueny a i?yi?e caeaaeiino? a?ae ?ioaineaiino? oa aaaeeino? e?iaiao?aoe. I?e ? nooiaith e?iaiao?aoe niinoa??aa?oueny ?-?? nooi?iue ian?thaaiiy H.pylori; i?e II nooiai? - ??-??? nooi?iue ; i?e III - IV nooiaiyo e?iaiao?aoe - a?aeiia?aeii III — IV nooiai? ian?thaaiiy H.pylori . 3. O oai?eo ae?aceiaith oai?iaith oeoiea ? aeaaiaaeoeyoeiaei? eeoee, oneeaaeiaieo e?iaioa/ath, ii?ooaiiy ?aieia?/ieo aeanoeainoae e?ia? caeaaeaoue ia o?eueee a?ae nooiaiy e?iaiao?aoe, aea e a?ae iayaiino? H.pylori -?ioaeoe?? oa nooiaiy ?? ian?thaaiiy. I?e oeueiio niinoa??aa?oueny ca?eueoaiiy i?iieeiino? i?e?inoaeei, cieaeaiiy iieacieea aaiaoie?eoo oa e?eueeino? a?eea ne?iaaoee e?ia?. Eiaaoeyoe?eia caeaoi?noue e?ia? i?aeaeuo?oueny o iaoe??io?a c ?-??? nooiaiyie e?iaiao?aoe c caa?icith ?icaeoeo AeAC-neiae?iio, oiae? ye i?e IV nooiai? ia?aaaaea? i?ioecai?oaeueia nenoaia e?ia? oa ?? o?a?eiie?oe/ia aeoeai?noue c ia?aoiaeii o ie?aieo iaoe??io?a AeAC-neiae?iio o eiaaoeiiao?th niiaeeaaiiy. 4. I?e aano?iaeoiaeaiaeueieo e?iaioa/ao ae?aceiaiai aaiaco ciaioo?oueny ia’?i oeoieiaiai nieo oa i?iaeoeoe?y nieyii? eeneioe o oai?eo c iayaiith H.pylori - ?ioaeoe??th. Oea iniaeeai i?iyaey?oueny a noeioeueiaaieo ii?oe?yo oeoieiai? nae?aoe?? i?e eieae?caoe?? iaoieia?/iiai i?ioeano a oeoieo. 5. A?noino?oeoo?i? ci?ie neeciai? iaieiiee oeoiea ? aeaaiaaeoeyoeiaei? eeoee caeaaeaoue a?ae nooiaith e?iaiao?aoe oa nooiaith ian?thaaiiy H.pylori . I?e ?-?? nooiaiyo e?iaiao?aoe ? ?-?? nooiaiyo ian?thaaiiy H.pylori -?ioaeoe??th iaoieia?/i? ci?ie eieae?cothoueny o iiaa?oiaaeo oa?ao neeciai? iaieiiee (aiaieuaaee ?iciaae i?e?iai?neiie ai?oae?ioeeo?a, iie?ii?oiiee?oeiia ?io?eueo?aoe?y aeanii? ieanoeiee). O iaoe??io?a c III-IV nooiaiyie e?iaiao?aoe oa III-IV nooiaiyie ian?thaaiiy H.pylori i?e?ino?oeoo?e! ci?ie i?iyaeythoueny a aeeaieeo oa?ao no?iee oeoiea, i?e?iai?neiee c?oeiiaai?, a ai?oae?ioeeoao - ??ci? noaae?? aeano?oeoe?? i?oioiiae??e oa ia?aaaaeii aaeoieueia o?ainoi?iaoe?y ?ioeo iaia?aiieo i?aaiae. Aecia/a?oueny i?ia?anoaaiiy ae?aceiaiai i?ioeano c i?iyaaie cia/ii? aeaeiiiainaoe?? eieaeueii? aaiiaeeiai?ee. 6. E?eoaaeueia oaeoeea i?e e?eaaaey/eo ae?aceao oeoiea ? aeaaiaaeoeyoeiaei? eeoee iio?aao? ?iaeea?aeoaeueiiai i?aeoiaeo c o?aooaaiiyi nooiaith e?iaiao?aoe oa nooiaith ian?thaaiiy neeciai? iaieiiee oeoiea H.pylori . E?eoaaiiy iiaeiii aooe eiiieaenia c iaia'yceiaei aeeth/aiiyi aioeoae?eiaaeoa?ii? oa?ai?? a caeaaeiino? a?ae nooiaith ian?thaaiiy H.pylori. I?e ?-?? nooiaiyo - eiina?aaoeaia oa?ai?y; i?e III nooiai? - eiina?aaoeaia, a i?e o?eaath/?e e?iaioa/? - iia?aoeaia ao?o/aiiy; i?e IV nooiai? -iia?aoeaia e?eoaaiiy, c iaia'yceiaei i?ecia/aiiyi o?ueioeiiiiiaioii? aioeoae?eiaaeoa?ii? oa?ai?? a i?neyiia?aoe?eiiio ia??iae?. 7. Cai?iiiiiaaiee iaoiae e?eoaaiiy aano?iaeoiaeaiaeueieo e?iaioa/ ae?aceiaiai aaiaco aeicaieea cieceoe e?euee?noue iia?aoeaieo ao?o/aiue aei 16,93%, caiia?aoe aeieeiaiith ?aii?o ?aoeeaeea?a e?iaioa/? aei 6,63%, cieceoe eaoaeuei?noue i?e eiina?aaoeaiiio e?eoaaii? aei 1,27%, a i?e iia?aoeaiiio - aei 6,25%. I?AEOE*I? ?AEIIAIAeAOe?? 1. O oai?eo c aano?iaeoiaeaiaeueieie e?iaioa/aie ae?aceiaiai aaiaco i?ae /an i?iaaaeaiiy aiaeineii?/iiai aeine?aeaeaiiy oeoiea ? aeaaiaaeoeyoeiaei? eeoee iaiao?aeii i?iaiaeeoe ae?aaiinoeeo H.pylori -?ioaeoe?? c aeei?enoaiiyi aeaio iaoiae?a : a?io?i?/ii? ?aaeoe?? ia o?aaco ca aeiiiiiaith noaiaea?oieo CLO-oano?a oa oeeoieia?/ia aeine?aeaeaiiy a?iioaoo neeciai? iaieiiee oeoiea i?ney caaa?aeaiiy iacea-iao?e/ee ca A?aiii aai ca ?iiaiianueeei-A?ica. 2. E?eoaaiiy e?eaaaey/eo ae?acie oeoiea ? aeaaiaaeoeyoeiaei? eeoee, anioe?eiaaieo c H.pylori -?ioaeoe??th, aeioe?eueii ii/eiaoe c i?ecia/aiiy eiina?aaoeaieo caoiae?a (i?noeaaee ? caaaeueiee aaiinoac, ei?aeoe?y a?iiaieai?/ieo ii?ooaiue, iai?aaeaieo ia iiiiaiaiiy ia'?io oee?eoethth/i? ieacie, aeoiaey/e c iayaiiai nooiaiy e?iaiao?aoe -a?aeiiaeaiiy aeiaoey?iiai ia'?io). Oaeo oa?ai?th ne?ae ii?aeioaaoe c aioeoae?eiaaeoa?iei e?eoaaiiyi. Aeica ? eiia?iaoe?y i?aia?ao?a iiaeiia a?aeiia?aeaoe nooiaith ian?thaaiiy neeciai? iaieiiee oeoiea I.?o?ia? ? aeeth/aoe ia iaioa aeaio aioeoae?eiaaeoa?ieo na?aaeiee?a. 3. Iaeiei c iniiaieo e?eoa???a oaeoeee e?eoaaiiy ae?aceiaeo aano?iaeoiaeaiaeueieo e?iaioa/ ? a?aooaaiiy nooiaith ian?thaaiiy I.?o?ia? . Oae, i?e ?-?? nooiaiyo iieacaii eiina?aaoeaia e?eoaaiiy , i?e III nooiai? -eiina?aaoeaia, a o oai?eo c o?eaath/ith e?iaioa/ath - iia?aoeaia, i?e IV nooiai? - iia?aoeaia e?eoaaiiy. I?e e?eaaaey/eo ae?aceao oeoiea ? aeaaiaaeoeyoeiaei? eeoee, anioe?eiaaieo c I.?o?ia? -?ioaeoe??th, ?aeiiaiaeiaaiith iia?aoe??th ? ?acaeoe?y oeoiea. A?aoiaoth/e oeyoe iioe?aiiy I.?o?ia? -?ioaeoe??, ne?ae a?aeaeaaaoe ia?aaaao ?acaeoe?? oeoiea ca A?eue?io-?? a iiaeeo?eaoe?? Aioiaenoa?a-O?inoa?a?a ia aeiaa?e iaoe? c ni?ao noyi ca A?aoiii. A i?neyiia?aoe?eiiio ia??iae? iaiao?aeii i?iaeiaaeoaaoe o?ueioeiiiiiaioio aioeoae?eiaaeoa?io oa?ai?th i?ioyaii 7-TH ae?a. Nienie ?ia?o, iioae?eiaaieo ii oai? aeena?oaoe?? 1. Aeaye? aniaeoe iaoiaaiaco ae?aceiai? oai?iae oeoiea ? aeaaiaaeoeyoeiaei? eeoee, oneeaaeiaii? e?iaioa/ath //Aeooaeuei? ieoaiiy iaaeeoeeie. Oace aeiiia?aeae I?aeia?iaeiiai eiia?ano Iieiaeeo A/aieo Oe?a?ioe?a, I.?aaii-O?aie?anuee, 25-28 aeiaoiy 1995 ?ieo.-?aaii- O?aie?anuee. - 1995.-N.91 2. Aiaeineii?/ia i?aeoaa?aeaeaiiy ?ioaeoe?eiiai oaeoi?o - ye i?e/eie ae?aceiai? oai?iae oeoiea ? aeaaiaaeoeyoeiaei? eeoee //Iaoa??aee iaoeiai-i?aeoe/ii? eiioa?aioe?? aiaeineii?no?a Oe?a?ie “Aeooaeuei? i?iaeaie ae?aaiinoe/ii? oa e?eoaaeueii? aiaeineii??”.- Ee?a. 23-24 o?aaiy 1996?. - N. 12-13. Ni?aaao.: I.A.Aii/a?, A.I.Oa?aiaoa, ?.?.Oeeiaae?noee, ?.A.Iaeueiee. 3. I?e/eie aeieeiaiiy i?ney?acaeoe?eieo oneeaaeiaiue o oai?eo ae?aceiaith oai?iaith oeoiea ? aeaaiaaeoeyoeiaei? eeoee (iiia?aaei? iia?aeiieaiiy). //Iiaue?a oaoiieiaee a oe?o?aee. Nai?iee iao/iue?o o?oaeia, iinayuaiiue?e 75-eaoeth eaoaae?ue? oe?o?aee Eeaaneie iaaeeoeeineie aeaaeaiee iineaaeeieiiiiai ia?aciaaiey IC Oe?aeiue? /Iiae iauae ?aaeaeoeeae i?io. A.E.Iai/e/a. - Eeaa: A?o A?aoee, 1997. - N. 18-19. Ni?aaao.: I.A.Aii/a?,?.A.Iaeueiee,?.?.Oeeiaae?noee. 4. Ii?oieia?/i? ci?ie neeciai? iaieiiee oeoiea ? aeaaiaaeoeyoeiaei? eeoee i?e oae?eiaaeoa?caeaaeieo e?eaaaey/eo ae?aceao //Iiaue?a oaoiieiaee a oe?o?aee. Nai?iee iao/iue?o o?oaeia, iinayuaiiue?e 75-eaoeth eaoaae?u oe?o?aee Eeaaneie iaaeeoeeineie aeaaeaiee iineaaeeieiiiiai ia?aciaaiey IC Oe?aeiu /Iiae iauae ?aaeaeoeeae i?io. A.E.Iai/e/a. -Eeaa: A?o A?aoee, 1997. - N.27-28. Ni?aaao.: I.A.Aii/a?, I.?.Ae?eueoeiaa, I.I.Cae?ae. 5. O??o?a?/ia oaeoeea i?e oae?eiaaeoa?-caeaaeieo ae?aceao oeoiea ? aeaaiaaeoeyoeiaei? eeoee //Iaoa??aee 1-i? iaa/aeueii-iaoiaee/ii? oa iaoeiai? eiioa?aioe?? caa?aeoaa/?a eaoaae? o??o?a?/ieo oai?ia noiiaoieia?/ieo oaeoeueoao?a iaaee/ieo aoc?a Oe?a?ie . - Iieoaaa, 5-6 /a?aiy 1997?. - N.9-10. Ni?aaao.: I.A.Aii/a?, A.I.Oaaei?/oe, ?.A.Eo?eo. 6. O??o?a?/ia oaeoeea i?e e?eaaaey/eo oae?eiaaeoa?-caeaaeieo ae?aceao oeoiea ? aeaaiaaeoeyoeiaei? eeoee //Aii?inue? eeeie/aneie iaaeeoeeie: Iaoa?eaeue? iao/ii-i?aeoe/aneie eiioa?aioeee oe?o?aia, iinayuaiiie 100-eaoiaio thaeeath i?io. A.E.Caoa?iaa. - Neioa?iiieue. -1997. -N. 53-55. Ni?aaao.: I.A.Aii/a?. 7. Iia? aniaeoe iaoiaaiaoe/ii? oa?ai?? ae?acee //Eieaaa. - 1998. -?19. - N.4. Ni?aaao.: I.A.Aii/a?. 8. Ni?aa?aeiioaiiy nae?aoi?ii? ooieoe?? oeoiea oa ii?oieia?/ieo ci?i neeciai? iaieiiee i?e ae?aceia?e oai?ia?, oneeaaeiai?e e?iaioa/ath //Ee?i. o??o?a?y. - 1998. - ?9-10. - N.28-30. 9. Ii?oieia?/i? ci?ie oeoiea ? aeaaiaaeoeyoeiaei? eeoee i?e ae?aceia?e oai?ia? c oae?eiaaeoa??icii //Ee?i. o??o?a?y. - 1998. - ?12. -N.5-6. Ni?aaao.: I.A.Aii/a?, I.?.Ae?eueoeiaa. 10. ?aieia?/i? aeanoeaino? e?ia? oai?eo noa?oiai a?eo c I?-caeaaeieie e?eaaaey/eie ae?aceaie oeoiea ? aeaaiaaeoeyoeiaei? eeoee // I?e?ioee?eoeyoe?y oa ?? a?eia? ci?ie (Iaoa??aee Oe?a?inueei? iaoeiai? eiioa?aioe?? c i?aeia?iaeiith o/anoth (Ee?a, 19-21 o?aaiy 1999?). - Ee?a. -1999. - N.29. Ni?aaao.: I.A.Aii/a? 11. Ii?oiooieoe?iiaeuei? i?iyae ii?ooaiue ?ioiiiai noaoono i?e I?-caeaaeieo e?eaaaey/eo ae?aceao oeoiea ? aeaaiaaeoeyoeiaei? eeoee //Iaoa??aee Anaoe?a?inueei? eiioa?aioe?? o??o?a?a, I.?aaii-O?aie?anuee, 22-24 aa?aniy 1999 ?ieo. Aaeeoeueeee e?ea?nueeee a?niee.- 1999. - O.6, /enei 3 — C.I 1-13. Ni?aaao.: I.A.Aii/a?, I.?.Ae?eueoeiaa. 12. Iaa?oiooaaiiy o??o?a?/ii? oaeoeee e?eoaaiiy e?eaaaey/eo ae?acie oeoiea ? aeaaiaaeoeyoeiaei? eeoee //Iaoa??aee Anaoe?a?inueei? iaoeiai? eiioa?aioe?? o??o?a?a, I.?aaii-O?aie?anuee, 22-24 aa?aniy 1999 ?ieo. Aaeeoeueeee e?ea?nueeee a?niee. - 1999. - O.6, /enei 3. - N.90. Ni?aaao. :I.A.Aii/a?, E.?. Aeieo??a. Aiioaoe?y Eo/??ea ss.I. Eiiieaenia e?eoaaiiy oae?eiaaeoa?-i?ei?? caeaaeieo e?eaaaey/eo ae?acie oeoiea ? aeaaiaaeoeyoeiaei? eeoee. - ?oeiien. Aeena?oaoe?y ia caeiaoooy iaoeiaiai nooiaiy eaiaeeaeaoa iaaee/ieo iaoe ca niaoe?aeuei?noth 14.01.03. - o??o?a?y. Oa?iii?euenueea aea?aeaaia iaaee/ia aeaaeai?y ?iai? ?.ss. Ai?aa/aanueeiai. Oa?iii?eue, 1999. A aeena?oaoe?? i?iaaaeaii aeine?aeaeaiiy ii aeyaeaiith I. pylori ia neecia?e iaieiioe? oeoiea ? aeaaiaaeoeyoeiaei? eeoee o oai?eo c aaii?aa?/ieie oneeaaeiaiiyie ae?aceiai? oai?iae. ?ic?iaeaii 4-io nooiaiaao eeaneo?eaoe?th ian?thaaiiy I. pylori. Anoaiiaeaii caeaaei?noue nooiaith ian?thaaiiy I.?o?ia? a?ae nooiaiy e?iaiao?aoe. Aeyaeaii, ui aeeaeia ii?ooaiue o?aineai?ey?iiai iai?io caeaaeeoue a?ae nooiaith e?iaiao?aoe oa nooiaith ian?thaaiiy I.?o?ia?. I?e ii?oieia?/iiio aeine?aeaeaii? a?iin?eiiai iaoa??aeo oeoiea oa aeaaiaaeoeyoeiaei? eeoee anoaiiaeaia caeaaei?noue aeeaeie a?noino?oeoo?ieo ii?ooaiue a?ae nooiaith e?iaiao?aoe oa nooiaith ian?thaaiiy I.?o?ia? . ?ic?iaeaii eiiieaenia e?eoaaiiy aano?iaeoiaeaiaeueieo e?iaioa/ ae?aceiaiai aaiaco, anioe?eiaaieo c I.?o?ia? -?ioaeoe??th. Aeiaaaeaia aeioe?euei?noue i?ecia/aiiy aaaaoieiiiiiaioii? aioeoae?eiaaeoa?ii? oa?ai?? aaeaeaaoii nooiaith ian?thaaiiy I.?o?ia? i?e e?eaaaey/eo ae?aceao oeoiea ? aeaaiaaeoeyoeiaei? eeoee. Anoaiiaeaii, ui ?-??? nooiai? e?iaiao?aoe i?e aiaeia?/iiio nooiai? ian?thaaiiy I.?o?ia? iiaeia aoaeoeaii e?eoaaoe eiina?aaoeaieie iaoiaeaie, a IV nooi?iue ian?thaaiiy I.?o?ia? ? iaeiei c e?eoa???a aeey iieac?a aei iia?aoeaiiai e?eoaaiiy. ?aeiiaiaeiaaii i?e aano?iaeoiaeaiaeueieo e?iaioa/ao ae?aceiaiai aaiaco, anioe?eiaaieo c I.?o?ia? -?ioaeoe??th c III-IV nooiaiyo ian?thaaiiy, aeeiioaaoe ?acaeoe?th oeoiea ca A?eue?io II a iiaeeo?eaoe?? Aioiaenoa?a-O?inoa?a?a ia aeiaa?e iaoe? c ni?aonoyi ca A?aoiii. Iniiai? ?acoeueoaoe ?iaioe ciaeoee i?aeoe/ia canoinoaaiiy. Eeth/ia? neiaa: ae?aceiaa oai?iaa oeoiea ? aeaaiaaeoeyoeiaei? eeoee, e?iaioa/a, I.?o?ia?, ae?aaiinoeea, e?eoaaiiy. Abstract Kuchirka I.M. The complex treatment of the chelicobacterpylori dependent bleeding ulcers of the stomack and duodenum. The thesis for master's scientific degree of medicine, speciality 14.01.03 surgery. Ternopil State Medical Academy, n.I.J.Gorbachevsky, Ternopil, 1999. The investigation on revealing I.?o?ia? on the mucous membrane of the stomach and duodenum in the patients with thehaemorrages complications of ulcer disease was help in the thesis. The 4 degrees classification of covering H. pylori was worked out. The direct dependence between the stage of bleeding and the stage of covering of H. pylori was established. Using the morphological investigation of the biopsy of the stomach and the duodenum the main dependence of the depth of the histostructural abnormalities upon the stage of bleeding and the stage of covering H. pylori was established. The complex treatment of the gastroduodenal haemorrhages of the ulcer genesisassociated with the H. pylori-infection was worked out. The reason for prescription of numerous antichelicobacteriosis therapy adequate to the stage of the covering H. pylori by the bleeding ulcers of the stomach and the duodenum was proved. It was established that it is possible to treet effectively using conservative treatment the 1^-3^ stages of bleeding with the same stages of covering H. pylori, but the 4th stage of covering H.pylori - is one of main criterion for the operative treatment. The resection of the stomach is the operation of the choice in the gastroduodenal haemorrhages ulcer genesis, associated with the H. pylori-infection with III-IV stages of covering. The main results of the work have been of practical use. Key words: ulcer disease of the stomach and duodenum, haemorrhages, H. pylori, diagnostic, treatment. Aiiioaoeey Eo/e?ea ss.I. Eiiieaeniia ea/aiea oaeeeiaaeoa?-ieei?e caaeneiuo e?iaioi/aueo yca aeaeoaeea e aeaaiaaeoeaoeia?noiie eeoee. -?oeiienue. Aeenna?oaoeey ia nieneaiea o/aiie noaiaie eaiaeeaeaoa iaaeeoeeineeo iaoe ii niaoeeaeueiinoe 14.01.03. - oe?o?aey. Oa?iiiieueneay ainoaea?noaaiiay iaaeeoeeineay aeaaeaiey eiaie E.ss. Ai?aa/aaneiai. Oa?iiiieue, 1999. A aeenna?oaoeee i?iaaaeaii enneaaeiaaiea ii auyaeaieth H.pylori ia neecenoie iaiei/ea aeaeoaeea e aeaaiaaeoeaoeia?noiie eeoee o aieueiuo n aano?iaeoiaeaiaeueiui e?iaioa/aieai ycaaiiiai aaiaca. ?ac?aaioaia 4-nooiai/aoay eeanneoeeaoeey ianaiaiaiey H.pylori neecenoie iaiei/ee aeaeoaeea. Onoaiiaeaia i?yiay ei??aeyoeeiiiay naycue iaaeaeo noaiaiueth e?iaiiioa?e e noaiaiueth ianaiaiaiey H.pylori. Enneaaeiaaiea ii/aaeiu e?iae iicaieeei onoaiiaeoue iiauoaiea aa eiee/anoaa a caaeneiinoe io noaiaie ianaiaiaiey H. pylori. I?e enneaaeiaaiee ?aieiae/aneeo naienoa e?iae onoaiiaeaii, /oi iiauoaiea noaiaie ianaiaiaiey H.pylori onoaoaeyaony i?iieoeaaiinoue eaieeey?iie noaiee. Ii?oieiae/aneia enneaaeiaaiea aeiineeiiai e iia?aoeeiiiiai iaoa?eaea aeaeoaeea e aeaaiaaeoeaoeia?noiie eeoee iieacaei caaeneiinoue aeoaeiu aenoino?oeoo?iuo ia?ooaiee neecenoie iaiei/ee aeaeoaeea e aeaaiaaeoeaoeia?noiie eeoee io noaiaie e?iaiiioa?e e noaiaie ianaiaiaiey H.pylori. ?ac?aaioaii eiiieaeniia ea/aiea aano?iaeoiaeaiaeueieo e?iaioa/aiee ycaaiiiai aaiaca, annioeee?iaaiiuo n H.pylori -eioaeoeeae, a caaeneiinoe io eioaineaiinoe e?iaioa/aiey e noaiaie ianaiaiaiey. Aeieacaia oeaeaniia?aciinoue iacia/aiey aioeoaeeeiaaeoa?iie oa?aiee, iauai eioi?ie caaeneo io noaiaie ianaiaiaiey H.pylori, i?e e?iaioi/aueo ycaao aeaeoaeea e aeaaiaaeoeaoeia?noiie eeoee a aei- e iineaiia?aoeeiiiii ia?eiaea n oeaeueth i?ioeeaeoeee ?aoeeaeeaa eae ycaaiiie aieacie, oae e aa aaii??aae/aneeo ineiaeiaiee. Onoaiiaeaii, /oi IV noaiaiue ianaiaiaiey H.pylori yaeyaony iaeiei ec e?eoa?eaa iieacaiee aeey iia?aoeaiiai aiaoaoaeuenoaa, a oaeaea, /oi iaeaieaa iioeiaeueiie iia?aoeeae i?e aano?iaeoiaeaiaeueiuo e?iaioaieyo ycaaiiiai aaiaca n III-IV noaiaiyie ianaiaiaiey H.pylori, yaeyaony ?acaeoeey aeaeoaeea ii Aeeue?io-I a iiaeeoeeaoeee Aioiaenoa?a-Oeinoa?a?a ia aeeeiiie iaoea n iaaeeeoa/iui nionoueai ii A?aoio. Iniiaiua ?acoeueoaou ?aaiou iaoee naia i?aeoe/aneia i?eiaiaiea. Eeth/aaua neiaa: ycaaiiay aieaciue aeaeoaeea e aeaaiaaeoeaoeia?noiie eeoee, e?iaioa/aiea, H.pylori, aeeaaiinoeea, ea/aiea.

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