CAAAEUeIA OA?AEOA?ENOEEA ?IAIOE

Aeooaeuei?noue oaie. Iaoai?/ia aeiaoyieoey — neeaaeia ? iaae??oaia
i?iaeaia no/anii? iaaeeoeeie. ?acoeueoaoe o??o?a?/iiai e?eoaaiiy oai?eo
?c o?eaaeith no?eeith iaoai?/iith aeiaoyieoeath iaao?oi?.
I?neyiia?aoe?eia eaoaeuei?noue i?e oe?e iaoieia?? noaiiaeoue 15-60%
(Eoee/aa I. Ae. e niaao., 1990; Little J. M., 1987).

O?eaaea a?e?a?ia a?ia?oaic?y noi?iaiaeaeo?oueny ii?oieia?/ieie oa
a?noieia?/ieie ci?iaie a ia/?ioe?: aiane?aeie oeneo ia?aiiaiaieo
eai?ey??a aeieea? iae?ic ia/?ieiaeo ee?oei, ii?ooo?oueny
e?iai-e?ioiia?a, i?aeaeuo?oueny ii?oaeueiee oene, aeieeathoue aeaea?aea
aeia/iiai noaco, ooai?ththoueny aeia/i? o?iiae a eai?ey?ao oa
?icaeaathoueny aeeno?io?/i? ci?ie a aaiaoioeeoao (Eo/ei N. E. e niaao.,
1988; Lygidakis N. J. et al., 1987).

Iaoiii?oieia?/i? ci?ie a ia/?ioe? i?ecaiaeyoue aei ooieoe?iiaeueieo
ci?i ? ?icaeoeo ia/?ieiai? iaaeinoaoiino?. Cieaeo?oueny
aaiaoioeaethey?ia oa aeia/inae?aoi?ia ooieoe?? ia/?iee, i?eai?/o?oueny
neioac a?ee?a. Ii?ooothoueny iaoaaie?ci ai?iieeneio, aoaeaaiae?a oa
aee??a, i?ioiaeaeaiiy aeia/ieo eeneio o ia/?ieiai-eeoeiaiio ?one?.
C?inoa? neioac oieanoa?eio ieacie oa eaoeeoeio. Cieaeo?oueny aeoeai?noue
i?oioiiae??aeueieo oeeoio?ii?a, ii?ooo?oueny neioac oaiiae?ieneoieao?a
oa e?oioieao?a (Dawson P. A. et al., 1995; Pellegrini C. A. et al.,
1987). Ciaioo?oueny eiioeaio?aoe?y aioeieneaeaio?a ia oii? i?aeaeuaiiai
??aiy i?iaeoeo?a ia?ieneaeaoe?? e?i?ae?a (Krahenbuhl S. et al., 1995).

Ia iaio oyaee? ci?ie a?aeaoaathoueny a ?ioeo i?aaiao oa nenoaiao. I?e
o??o?a?/iiio e?eoaaii? o 9-18% oai?eo ?c iaoai?/iith aeiaoyieoeath
aeieea? aino?a ie?eiaa iaaeinoaoi?noue, yea, o a?eueoino? aeiaaee?a, ?
aaciina?aaeiueith i?e/eiith nia?o? (Fogarty B. J. et al., 1995; Green J.
et al., 1995). O oai?eo ?c o?eaaeei noacii aeia/? iayaia ?ioiia
iaaeinoaoi?noue (Garg P. K. et al., 1994; Rodolico A. et al., 1994),
/ano?oa niinoa??aathoueny aeiaaeee aaeoa??ia?e?? oa aaeoa?ai??
(Lygidakis N. J. et al., 1987; O’Connor M., 1985). ?icaeaa?oueny
aiaeioienai?y, yea ? iaeiei ?c iiaeeeaeo ao?ieia?/ieo /eiiee?a aenieiai
??aiy i?neyiia?aoe?eieo oneeaaeiaiue oa nia?oiino? (Gouma D. J. et al.,
1986). I?e iaoai?/i?e aeiaoyieoe? ? i?yiee ca’ycie i?ae nenoaiiith
aiaeioienai??th oa aino?ith ie?eiaith iaaeinoaoi?noth (Wilkinson S. P.
et al., 1976). Niinoa??aathoueny ci?ie a nenoai? cn?aeaiiy e?ia?.
Ee?i?/i? iciaee aaiieiaaoeyoe?eieo c?ooaiue aeyaeythoueny o 25,5%
iaoe??io?a ?c iaoo?aoe?eiith aeiaoyieoeath (Costamagna G. et al., 1995;
Ieeeoi?ia A. E. e niaao., 1989).

Aeooaeuei?noue i?iaeaie e?eoaaiiy oai?eo ?c iaoai?/iith aeiaoyieoeath
niiioea? aei iiooe?a iiaeo oa aaeineiiaeaiiy ?nioth/eo iaoiae?a.
Iniiaiei iaoiaeii e?ea?aeaoe?? iai?io?aeiino? iicaia/?ieiaeo aeia/ieo
oeyo?a caeeoa?oueny o??o?a?/iee. O a?eueoino? aeiaaee?a oea oaoi?/ii
neeaaei? iia?aoe??, ye? noi?iaiaeaeothoueny aenieei ??aiai oneeaaeiaiue
oa eaoaeueiino?. Oea a cia/i?e i??? iiynith?oueny iaa?aeiia?aei?noth
i?ae aaaee?noth iia?aoeaiiai ao?o/aiiy ? eiiiainaoi?ieie iiaeeeainoyie
i?aai?cio, a ia?oo /a?ao — ia/?iee. Ia?eic, o??o?a?/ia o?aaia,
i?neyiia?aoe?eia oaeaeea iaaeiciaaia aeaeiii?an?y aeia/ieo oeyo?a cia/ii
iiaeeaeth? aaaee?noue noaio oai?eo, o 20-90% iia?iaaieo i?ecaiaeeoue aei
ia?aoiaeo noaee?i?/ii? ia/?ieiai? iaaeinoaoiino? o ee?i?/ii ae?aaeaio,
yea ? iniiaiith i?e/eiith aenieiai iieacieea i?neyiia?aoe?eieo
oneeaaeiaiue (52-70%) oa eaoaeueiino? (Ieeeoi?ia A. E. e niaao., 1991).

E?eoaaiiy oai?eo ?c o?eaaeei oieanoacii, ni?e/eiaiei iicaia/?ieiaith
iano?oeoe??th aeia/ieo oeyo?a, ? iaaecae/aeii oyaeeei caaaeaiiyi, ui
coiiaeaii iaaeinoaoiuei aea/aieie iaoio?c?ieia?/ieie iaoai?ciaie
caoai?thaaiue aeaii? a?oie, ia/?ieiaith ? ie?eiaith iaaeinoaoi?noth,
nenoaiiei oa?aeoa?ii i?ioeano. Iae/ano?oeie i?e/eiaie aeiaaio?eaaei?
iaoai?/ii? aeiaoyieoe? ? ceiye?ni? iooeeii? o?aaeaiiy
aaiaoiiaie?aaoia?e?a?ii? ciie (Cahill C. J. et al., 1989; Yasuda K. et
al., 1989).

O?aaeeoe?eia e?eoaaiiy, yea ia’?aeio? eiiieaen eiina?aaoeaieo caoiae?a
oa o??o?a?/i? iaoiaee, ua iaaeinoaoiuei aoaeoeaia.

No/aniee i?aeo?ae aei eiiieaeniiai e?eoaaiiy o?eaaei? iaoai?/ii?
aeiaoyieoe? iio?aao? aeei?enoaiiy o ia?aaeiia?aoe?eiiio ia??iae?
aeaeiii?an?? aeia/iiai aea?aaa (Agnello G. et al., 1988). ?c ?icaeoeii
iaei?iaaceaii? o??o?a?? noaei aeinooiiei canoinoaaiiy aiaeineii?/ieo ?
/a?acoe??ieo iaoiaeee aeey ae?aioaaiiy aeia/ieo oeyo?a (Sukigara M. et
al., 1994; Frimberger E. et al., 1989; Blenkharn J. I. et al., 1984).

Iacaaaeath/e ia cia/i? oni?oe canoinoaaiiy oeeo iaoiae?a, aaaaoi
ieoaiue iio?aaothoue iiaeaeueoiai aea/aiiy, a naia: ?ieue ? i?noea
/a?acoe??iiai /a?acia/?ieiaiai a?e?a?iiai ae?aioaaiiy o eiiieaeniiio
e?eoaaii? iaoai?/ii? aeiaoyieoe?, eiai aoaeoeai?noue caeaaeii a?ae
iicieia??, ??aiy a?e??oa?iai?? oa o?eaaeino? caoai?thaaiiy, aieea
/a?acoe??iiai ae?aioaaiiy ia noai ia?ieneaeii? ieneaeaoe?? e?i?ae?a,
iiaeeea? oneeaaeiaiiy iaoiaeo oa oeyoe ?o i?io?eaeoeee.

Ca’ycie ?iaioe c iaoeiaeie i?ia?aiaie, ieaiaie, oaiaie. ?iaioo aeeiiaii
a ?aieao iaoeiai-aeine?aeii? oaie eaoaae?e oaeoeueoaonueei? o??o?a??
Euea?anueeiai aea?aeaaiiai iaaee/iiai oi?aa?neoaoo “Aea/eoe i?e/eie ?
iane?aeee oieanoaco, eiai ii?oi-ooieoe?iiaeuei? oa?aeoa?enoeee c iaoith
aecia/aiiy iioeiaeueieo iaoiae?a ae?aaiinoeee ? e?eoaaiiy” (?
aea?ae?a?no?aoe?? 0197U000743).

Iaoa ? caaea/? aeine?aeaeaiiy. Iaoa ?iaioe — iie?auaiiy ?acoeueoao?a
e?eoaaiiy oai?eo ?c o?eaaeith oyaeeith iaoai?/iith aeiaoyieoeath oeyoii
ia?aaeiia?aoe?eiiai /a?acoe??iiai ae?aioaaiiy a?e?a?ii? nenoaie.

Aeey aeinyaiaiiy oe??? iaoe aoee noi?ioeueiaai? ianooii? iniiai?
caaaeaiiy aeine?aeaeaiiy:

Aea/eoe oa?aeoa?, no?oeoo?o oa i?e/eie i?neyiia?aoe?eieo oneeaaeiaiue o
oai?eo ?c iaoai?/iith aeiaoyieoeath;

Oaeineiiaeeoe ?nioth/? oa ii?aoethaaoe i?ea?iaeuei? iaoiaeeee
/a?acoe??iiai /a?acia/?ieiaiai ae?aioaaiiy a?e?a?ii? nenoaie i?ae
eaia?ineii?/iei oa oeueo?aniiia?ao?/iei eiio?ieai, ai?iaaaeeoe ?o o
ee?i?/io i?aeoeeo;

Aeine?aeeoe aieea ia?aaeiia?aoe?eii? a?e?a?ii? aeaeiii?an?? aeia/ieo
oeyo?a ia ia?aa?a caoai?thaaiiy, noai ia/?ieiai? ? ie?eiai? ooieoe?e,
?aieia?/i? ia?aiao?e e?ia?, iieacieee e?iii?ioa?aeiiai niaeo?o ieacie;

Aea/eoe aieea ia?aaeiia?aoe?eiiai ae?aioaaiiy aeia/iiai aea?aaa ia noai
ia?ieneaeii? ieneaeaoe?? e?i?ae?a;

Aecia/eoe iieacaiiy aei canoinoaaiiy iaoiae?a e iioeiaeuei? oa?i?ie
/a?acoe??ii? aeaeiii?an?? aeia/ieo oeyo?a o ia?aaeiia?aoe?eiiio
ia??iae?;

Aeyaeoe iiaeeea? oneeaaeiaiiy i?ioeaaeo?e oa oeyoe ?o i?io?eaeoeee;

Ii?aoethaaoe ?aeiiaiaeaoe?? aeey ai?iaaaeaeaiiy o ee?i?/io i?aeoeeo
iaoiaeee /a?acoe??iiai /a?acia/?ieiaiai ae?aioaaiiy aeia/ieo oeyo?a ye
ia?oiai aoaio o eiiieaeniiio e?eoaaii? oai?eo ?c iaoai?/iith
aeiaoyieoeath.

Iaoeiaa iiaecia iaea?aeaieo ?acoeueoao?a. ?iaioa i?noeoue ieceo
aeaiaio?a iiaecie, ye? ia ciaeoee a?aeia?aaeaiiy o ioae?eaoe?yo ?c
aeaii? i?iaeaie. Aaeineiiaeaii ?nioth/? e ii?aoeueiaaii i?ea?iaeueio
iaoiaeeeo iaeeaaeaiiy i?e?ioieaoeenoinoiie ca aeiiiiiaith niaoe?aeueii
cai?iiiiiaaiiai eaoaoa?a. Aea/aii ?ieue ? i?noea /a?acoe??iiai
/a?acia/?ieiaiai ae?aioaaiiy a?e?a?ii? nenoaie o eiiieaeniiio e?eoaaii?
iaoai?/ii? aeiaoyieoe?. Ae?iaeaii iieacaiiy aei canoinoaaiiy iaoiaeo a
caeaaeiino? a?ae o?eaaeino? aeiaoyieoe? oa ??aiy a?e??oa?iai??. Aeyaeaii
iniiai? caeiiii??iino? aieeao ia?aaeiia?aoe?eii? aeaeiii?an?? aeia/iiai
aea?aaa ia ooieoe?iiaeueiee noai ia/?iee ? ie?ie, iieacaii ??
aoaeoeai?noue. Cai?iiiiiaaii eiiieaen caoiae?a o oa?ai?? oai?eo ?c
ia?aaeiia?aoe?eiith a?e?a?iith aeaeiii?an??th. Aea/aii iiaeeea?
oneeaaeiaiiy iai?ioeyoe?? oa oeyoe ?o caiia?aaiiy. Aeine?aeaeaii aieea
iaoiaeo ia noai ia?ieneaeii? ieneaeaoe?? e?i?ae?a ? nenoaie
aioeieneaeaioiiai caoenoo.

I?aeoe/ia cia/aiiy iaea?aeaieo ?acoeueoao?a. Ooi/iaii iieacaiiy aei
canoinoaaiiy /a?acoe??iiai /a?acia/?ieiaiai a?e?a?iiai ae?aioaaiiy o
eiiieaeniiio e?eoaaii? iaoai?/ii? aeiaoyieoe?. Cai?iiiiiaaii
iioeiaeueiee ?aaeei oa oa?i?ie /a?acoe??ii? aeaeiii?an?? aeia/iiai
?onea. Iieacaii aoaeoeai?noue oa aeioe?euei?noue aeei?enoaiiy iaoiaeo a
i?aeaioiaoe? oyaeeeo oai?eo aei iia?aoe??. Aea/aii iniiai? oneeaaeiaiiy
oa cai?iiiiiaaii niiniae ?o i?io?eaeoeee.

Iniaenoee aianie caeiaoaa/a. Caeiaoaa/ iniaenoi ai?iaaaeea ? aeeiiaa
on? /a?acoe??i? ae?aioaaiiy aeia/ieo oeyo?a o oai?eo Euea?anueei?
i?nueei? ee?i?/ii? e?ea?i? oaeaeei? iaaee/ii? aeiiiiiae oa o 18 oai?eo
Euea?anueei? iaeanii? ee?i?/ii? e?ea?i?; i?ia?a ianoaaeaiiy iaoe??io?a
ia?aae ae?aioaaiiyi oa i?ney iia?aoe??; iia?oaaa 12 oai?eo.

Ai?iaaoe?y ?acoeueoao?a aeena?oaoe??. Aeiiia?ae? ca iaoa??aeaie
aeena?oaoe?? c?iaeaii ia: 6-iio Eiia?an? Iieuenueei? anioe?aoe??
aano?iaioa?ieia?a (E?ae?a, 1994 ?.); i?aeia?iaeiiio nai?ia?? “Aeooaeuei?
i?iaeaie aano?iaioa?ieia?? oa aiaeineii??” (Euea?a, 1995 ?.); 3-iio
Neiiic?oi? ?a?iiaenueei? anioe?aoe?? iieiaeeo a/aieo-iaaeee?a
(Aaeainuee, 1995 ?.); 4-o?e eiioa?aioe?? o??o?a?a-aaiaoieia?a ?in??
(Ooea, 1996 ?.); can?aeaii? Euea?anueeiai oiaa?enoaa o??o?a?a (Euea?a,
1996 ?.); i?aeia?iaeiiio neiiic?oi? “Iia? oaiaeaioe?? o ae?aaiinoeoe? oa
e?eoaaii? caoai?thaaiue ia/?iee oa oianoi? eeoee” (Euea?a, 1997 ?).

Ioae?eaoe??. Ca iaoa??aeaie aeena?oaoe?? iioae?eiaaii 11 ae?oeiaaieo
?ia?o, na?aae ieo o?e noaoo? a iaoeiaeo aeo?iaeao, /ioe?e — o ca??ieeao
iaoeiaeo i?aoeue, /ioe?e — o ca??ieeao oac iaoeiaeo eiioa?aioe?e.

Ianya ? no?oeoo?a ?iaioe. Aeena?oaoe?eia ?iaioa aeeeaaeaia ia 154
noi??ieao iaoeiiieno. Neeaaea?oueny ?c anooio, 4 ?icae?e?a, aeniiae?a,
nieneo aeei?enoaieo e?oa?aoo?ieo aeaea?ae, yeee aeeth/a? 204 ?iaioe oa
aeiaeaoea. ?iaioo ?ethno?othoue 20 ?enoie?a, 15 a?ao?e?a, ye? caeiathoue
4 noi??iee.

INIIAIEE CI?NO

Iaoa??aee ? iaoiaee

Ee?i?/ia oa?aeoa?enoeea oai?eo. ?iaioa a?oioo?oueny ia ianoaaeaii? 397
oai?eo, ye? ca 10 ?ie?a (1988-1997 ??.) ciaoiaeeeeny ia e?eoaaii? c
i?eaiaeo oyaeei? (a?e??oa?iai?y iiiaae 150 ieI/e) iaoai?/ii? aeiaoyieoe?
o 2-iio o??o?a?/iiio a?aeae?eaii? Euea?anueei? iaeanii? ee?i?/ii?
e?ea?i? (aaca eaoaae?e oaeoeueoaonueei? oa caaaeueii? o??o?a??
Euea?anueeiai aea?aeaaiiai iaaee/iiai oi?aa?neoaoo — EAeIO) oa 1-iio
o??o?a?/iiio a?aeae?eaii? Euea?anueei? i?nueei? ee?i?/ii? e?ea?i?
oaeaeei? iaaee/ii? aeiiiiiae (aaca eaoaae?e o??o?a?? oaeoeueoaoo
i?neyaeeieiiii? ina?oe EAeIO). Ia?aaaaeaee /ieia?ee (64%). Iaoe??ioe
i?aoeacaeaoiiai a?eo neeaee 43,1%.

Na?aaeiy o?eaae?noue aeiaoyieoe? noaiiaeea 26,0(14,01 aeiae. On?
iaoe??ioe i?ieoee iiaiee ?ooeiiee ae?aaiinoe/iee eiiieaen caaaeueieo oa
a?io?i?/ieo aeine?aeaeaiue. Na?aaei?e ??aaiue a?e??oa?io ieacie noaiiaea
273(94,2 ieI/e. E??i eaai?aoi?ieo oa a?io?i?/ieo aeine?aeaeaiue i?e
ianoaaeaii? oai?eo ?c iaoai?/iith aeiaoyieoeath canoiniaoaaeenue
?ino?oiaioaeuei? iaoiaee: oeueo?acaoeiaa aeine?aeaeaiiy, eaia?ineii?y,
eiii’thoa?ia oiii-a?ao?y, ?aioaaiineii?y oeoieiai-eeoeiaiai o?aeoo,
o?a?iaano?iaeoiaeaii-neii?y.

Na?aae ao?ieia?/ieo /eiiee?a iaoai?/ii? aeiaoyieoe? ia?oa i?noea ca
/anoioith caeiaee ceiye?ni? iooeeie iaie?aaoia?e?a?ii? ciie — 77,8%
(?en.1).

?en. 1. Ae?aa?aia ?iciiae?eo iaoe??io?a ca ao?ieia?/ieie /eiieeaie.

E?eoaaiiy on?o iaoe??io?a ?c iaoai?/iith aeiaoyieoeath aoei eiiieaen-iei
? neeaaeaeiny ?c eiina?aaoeaieo oa o??o?a?/ieo iaoiae?a. O??o?a?/ia
e?eoaaiiy aoei iaeii- aai aeaioaoaiiei. Aeaioaoaiiiio e?eoaaiith
i?aeeyaaee iaoe??ioe o noai? na?aaeiuei? aaaeeino? oa oyaeeiio noai? c
aenieei nooiaiai iia?aoe?eiiai ?eceeo. O eiiieaen? ia?aaeiia?aoe?eii?
i?aeaioiaee oai?ei aeeiioaaee /a?acoe??io /a?acia/?ieiao aeaeiii?an?th
a?e?a?ii? nenoaie. O caaaeueiiio aeeiiaii 44 /a?acoe??ieo
/a?acia/?ieiaeo ae?aioaaiiy aeia/ieo oeyo?a, ye ia?oee aoai o??o?a?/iiai
e?eoaaiiy: 26 oieaoeenoinoii?e i?ae eaia?ineii?/iei eiio?ieai, 18
oieaoeenoinoii?e i?ae oeueo?aniiia?ao?/iei eiio?ieai.

On?o iaoe??io?a iia?iaaii. A?aenioie eiaeiiai oeio iia?aoe?e
(?aaeeeaeuei?, iae?aoeai?, neiioiiaoe/i?, aeniei?aoeai?) o oai?eo ?c
iieieia?/iei aaiacii aeiaoyieoe? noaiiaea a?aeiia?aeii 11,6%, 79,0%,
5,2% oa 4,2%.

I?neyiia?aoe?ei? oneeaaeiaiiy eiinoaoiaaii o 34,3% oai?eo.
I?neyiia?aoe?eia eaoaeuei?noue, aei yei? aeeth/ai? an? iieieia?/i?
oai??, ui iiia?ee i?ioyaii iaeiiai i?nyoey i?ney iia?aoe?? (Nazarian,
1993), neeaaea? 20,2% (80 oai?eo).

?ino?oiaioaeuei? iaoiaee. Aeey eiio?ieth /a?acoe??iiai /a?acia/?ieiaiai
ae?aioaaiiy aeia/ieo oeyo?a ie canoiniaoaaee eaia?ineii?th (oaa?aeee
eaia?ineii MLW ae?iaieoeoaa IAe?) oa oeueo?aniiia?ao?th (ae?aaiinoe/i?
aia?aoe LS-5000 o??ie «Picker International” ?c ioieoe?eiei aeao/eeii c
aecia/aiith /anoioith 3,5 MHz oa Sonoline SL 400 o??ie «Siemens»
(I?ia//eia). Ae?aiaaeaie neoaeeee eaoaoa?e iaoiai aaoi?noaa ?c
aioo??oi?i ae?aiao?ii 1,8-2,2 ii iaaii? oaa?aeino?, ye? aeaioiaeai? c
oa?iieaa?eueiiai iaoa??aeo, a oaeiae o?iaea?i? ni??aeaaeaei? (“pigtail”)
eaoaoa?e ae?aiao?ii 7-9 F (2,3-3,0 ii) o??ie «Medi-tech».

Ee?i?/i? oa eaai?aoi?i? iaoiaee. Aeey ioe?iee noaio oai?eo
aeei?enoiaoaaee ?acoeueoaoe caaaeueii-ee?i?/ieo oa eaai?aoi?ieo iaoiae?a
ianoaaeaiiy. I?iaaaeaii ianooii? a?io?i?/i? aeine?aeaeaiiy. ??aaiue
aetheice o e?ia? aecia/aee i?oi-oieo?aeeiiaei iaoiaeii. Ca aeiiiiiaith
a?o?aoiai? ?aaeoe?? aecia/aee caaaeueiee a?eie ne?iaaoee.
Aeine?aeaeoaaee a?e??oa?i o ne?iaaooe? e?ia? ca ae?aci?aaeoe??th a
i?enooiino? aenaea?aoi?a (iaoiae Iendrassik et al., 1937). Ie??i
oeueiai, aecia/aee ia/?ieia? i?iae — oeiieiao oa i?iao Aaeueoiaia.
Aea/aee oa?iaioio aeoeai?noue ne?iaaoee e?ia?: ania?oaoai?iio?ainoa?ace
? aeai?iai?iio?ainoa?ace ca ?aaeoe??th c 2,4-aeei?o?ioai?ea?ae?aceiii
iaoiaeii Reitman oa Frankel (1957), eoaeio oinoaoaco
n-i?o?ioai?eoinoaoiei iaoiaeii ca Bessey oa Lowry (1946). Ai?no
(-e?iii?ioa?ae?a aeine?aeoaaee iaoiaeii aecia/aiiy noia?ii? o?aeoe?? oa
i?i-(-e?iii?ioa?ae?a ca I.I. Aine?anaineei oa A.A. Ooiaiiaei (1982),
iaaoa?eo?eiaaieo aee?ieo eeneio — iaoiaeii Konitzer (1964). Eiiieaen
ie?eiaeo i?ia aeeth/aa aecia/aiiy caeeoeiaiai acioo e?ia? i?ney
i?ia?ae?caoe?? i?yii? ?aaeoe?? c ?aaeoeaii Ianea?a ca
?aiiii?oii-Aeoai?iii, na/iaeie o ne?iaaooe? e?ia? — o?aaciei iaoiaeii ca
Weller (1962) oa eieuei?iaith ?aaeoe??th ?c ae?aoeaoeeiiiieneiii
iaai?aie «Lahema», e?aaoei?io ca ?aaeoe??th ssooa (iaoiae Iieia?a). O
an?o iaoe??io?a ??aaiue aeaeo?ie?o?a ne?iaaoee e?ia? (eae?e, iao??e,
eaeueoe?e) aecia/aany iaoiaeii iieoi’yii? oioiiao???. Aecia/aiiy /ano
cn?aeaiiy e?ia? i?iaiaeeee ca E?-Oaeoii o ianee?eiaaiiio ? nee?eiaaiiio
iinoae? o iiaeeo?eaoe?? A.I. Eaaiiaa (1964). Ioe?ieo ?ioieneeaoe??
i?iaiaeeee ca aeiiiiiaith eaeeioeeoa?iiai ?iaeaeno ?ioieneeaoe?? ?
ae?aoiaoaaee ca?aeii ?c oi?ioeith Eaeueo-Eae?oa. Aeine?aeaeoaaee noai
ia?ieneaeii? ieneaeaoe?? e?i?ae?a e?ia? (IIE): ai?no ae??iiaeo
eii’thaao?a aecia/aee iaoiaeii C. Ieyoea?a (1970) o iiaeeo?eaoe?? A.A.
Aaa?eeiaa oa I.*. I?oei?oaeii? (1983); iaeiiiaiai aeeaeueaeaa?aeo —
iaoiaeii ?. O?i??aoeaoiaa oa N. Naeaciueiaa (1981) c o?iaa?a?oo?iaith
eeneioith; aeoeai?noue noia?ieneaeaeeniooace (NIAe) o e?ia? — iaoiaeii
N. *aaa?oea (*aaa?oe N. e niaao., 1985; Nishimuri N. et al., 1972);
aeoeai?noue ia?ieneaeace — ca I. Iiiiaei oa E. Iaeeianeie (1971);
eaoaeace — i?e?iiaoiaeii A. Aaoa oa N. Coaeiaa o iiaeeo?eaoe?? A.A.
Ia?oeithe (1984); ni?aa?aeiioaiiy ai?noo eaeoaoo ? i??oaaoo — iaoiaeii
Bergmeyer (1965). Iayai?noue ? ae?aaeai?noue o oai?eo ia/?ieiai?
aioeaoaeiiao?? ioe?ithaaee ca aeiiiiiaith niaoe?aeueieo oano?a: oano ia
c’?aeiaiiy oeeo? ? ia i?iaaaeaiiy e?i?? (Conn H.O., 1977; Schomerous H.
et al., 1981), eiiieaeniee aiae?c (Nonn H.O., 1994) e?eoa???a West Haven
(ioe?iea ?icoiiai? ae?yeueiino?, eii?aeeiaoe?y ?oo?a, /anoioa iiyae
aeueoa-oaeeue ia eeaeo?iaioeaoaeia?ai?). AEia/ aeey aaeoa??ieia?/iiai
aeine?aeaeaiiy ? aecia/aiiy /ooeeaino? aei aioea?ioee?a io?eioaaee
oeyoii ioieoe?? aeia/iiai i?oo?a, i?ci?oa – /a?ac ae?aiaaeiee eaoaoa?
/a?ac aeiao, o?e-/ioe?e aeiae, /a?ac oeaeaeaiue oa ia?aae iia?aoe??th.

Io?eiai? ?acoeueoaoe ii?aoeueiaoaaee iaoiaeaie aa??aoe?eii? noaoenoeee
ca aeiiiiiaith e?eoa???a Nouethaeaioa-O?oa?a.

?acoeueoaoe aeine?aeaeaiue

Ie aea/aee ?acoeueoaoe o??o?a?/iiai e?eoaaiiy 397 iaoe??io?a ?c
o?eaaeith aaaeeith iaoai?/iith aeiaoyieoeath ca ia??iae 1988-1997 ??.
Aei oe??? a?oie aa?eoee oai?? c a?ia?a?e??oa?iai??th iiiaae 150 ieI/e, a
oiio a?eueo?noue oai?eo, ye? oieoae?ciaai? o o??o?a?/i? a?aeae?eaiiy c
oieaaeioie?o?acii, o?eaae?noue aeiaoyieoe? o yeeo aoea iacia/iith ?
caaaeueiee noai i?e oieoae?caoe?? yeeo aoa caaeia?eueiee, ia aoee
aeeth/ai? aei iaoiai aeine?aeaeaiiy. Ia?aae iniiaiith iia?aoe??th 44
oai?ei ia?oei aoaiii aoei iaeeaaeaii i?e?ioieaoeenoinoiio
(aeine?aeaeoaaia a?oia A). 353 oai?eo iia?iaaii o?aaeeoe?eii aac
iiia?aaeiuei? a?e?a?ii? aeaeiii?an??. Aiie neeaee iiia?aaeith
eiio?ieueio a?oio oai?eo (a?oia A). ?ic?aooiie i?iaiinoe/ieo
eiao?oe??io?a aeey ie?aieo iciae iieacaa, ui eiia??i?noue oneeaaeiaiiai
ia?aa?ao i?neyiia?aoe?eiiai ia??iaeo ca?eueoo?oueny eeoa i?e ??ai?
caaaeueiiai a?e??oa?io e?ia? iiiaae 250 ieI/e. Aei oe??? iaae? a?e??oa?i
i?aeoe/ii ia aieeaa? ia /anoioo ? oa?aeoa? oneeaaeiaiue, ye? caeaaeaoue
oiae? a?ae ?ioeo /eiiee?a. Oiio ie aeae?eeee aeiaeaoeiao a?oio (185
oai?eo) ?c a?e??oa?iai??th iiiaae 250 ieI/e (a?oia A), yea noaea ae?enii
eiio?ieueiith. Ie ii??aithaaee ia?aa?a caoai?thaaiiy o o?ueio a?oiao
oai?eo ?c o?eaaeith iaoai?/iith aeiaoyieoeath ? aea/aee aoaeoeai?noue
canoinoaaiiy ia?aaeiia?aoe?eii? a?e?a?ii? aeaeiii?an?? oa ?? aieea ia
ianooiia o??o?a?/ia e?eoaaiiy. Ie?aii i?iaiaeeee ii??aiyeueiee aiae?c
noaio ia?ieneaeii? ieneaeaoe?? e?i?ae?a.

Na?aaeiy o?eaae?noue aeiaoyieoe? noaiiaeea 26,0(14,01 aeiae, a o
iaoe??io?a a?oie A aoea a?eueoith (36,0(12,61 aeiae), i?ae o a?oi? A
(21,2(14,1 aeiae) oa o eiio?ieuei?e a?oi? A (30,8(9,32 aeiae).

I/aaeaeii, ui iaoieia?y, yea i?ecaaea aei aaaeei? o?eaaei?
a?ia?a?e??oa?iai??, aaciina?aaeiuei aieeaaea ? ia caaaeueiee ee?i?/iee
noai iaoe??io?a (?en. 2).

?en. 2. Ioe?iea ee?i?/iiai noaio oai?eo (1).

O caaaeuei?e a?oi? caaeia?eueiee noai i?e oieoae?caoe?? niinoa??aaany o
50,3% oai?eo, noai na?aaeiuei? aaaeeino? — o 28,4%, oyaeeee — o 21,3%.
Iaoe??ioe a?oie A iaee ia’?eoeaii aaae/ee caaaeueiee ee?i?/iee noai
(p<0,05), i?ae iaa?oue o eiio?ieuei?e a?oi? A. I?aeoaa?aeaeaiiyi cia/ii aaae/iai noaio iaoe??io?a a?oie A ? ?acoeueoaoe ii??aiyeueiiai aiae?co nooiaiy aioeaoaeiiao?? o oai?eo eiaeii? a?oie: a a?oi? A iaioa oai?eo ?c eaaeith aioeaoaeiiao??th (47,8%) ? a?eueoa c aioeaoaeiiao??th ???-?V nooiai?a (52,2%; p<0,001). On?i iaoe??ioai i?iaaaeaii iiaiee ?ooeiiee ae?aaiinoe/iee eiiieaen eaai?aoi?ieo ianoaaeaiue. Na?aaei?e ??aaiue a?e??oa?io ieacie noaiiaea 273(94,2 ieI/e, aeai?iai?iio?ainoa?ace (AEO) - 1,46(0,86 iI/e, ania?oaoai?iio?ainoa?ace (ANO) - 0,86(0,48 iI/e, caaaeueiiai a?eea - 72,1(7,4 a/e, e?aaoei?io - 0,155(0,095 iI/e, na/iaeie - 8,22(5,4 iI/e. Na?aaei?e ??aaiue a?e??oa?iai?? o oai?eo a?oie A aoa aeinoia??ii aeuee, i?ae o oai?eo a?oie A (371(96,3 ieI/e i?ioe 264(94,8 ieI/e; p<0,05), i?ioa nooo?ai ia a?ae??ciyany a?ae eiio?ieueii? a?oie A (?en. 3). ?en. 3. Ioe?iea ee?i?/iiai noaio oai?eo (2). Iiae?aia oaiaeaioe?y eiinoaoiaaia ? a cia/aiiyo ?ioeo ?ooeiieo a?io?i?/ieo iieaciee?a (oaae. 1). Oaaeeoey 1. Ii??aiyiiy ?acoeueoao?a eaai?aoi?ieo ianoaaeaiue o oai?eo i?e oieoae?caoe??. On? iaoe??ioe A?oia A A?oia A A?oia A Caaaeueiee a?e??oa?i, ieI/e 275(114,9 371(96,3 264(94,8 348(54,2 Iai?yiee a?e??oa?i, ieI/e 69(26,4 94(29,7 61(21,2 87(16,4 Caaaeueiee a?eie, a/e 65,8(4,09 63,8(3,68 67,1(4,04 63,8(3,12 Aeueaoi?i, a/e 46,4(3,56 42,9(3,45 47,2(3,68 43,1(3,05 E?aaoei?i, iI/e 155(95 210(38,2 125(36,5 193(32,2 Na/iaeia, iI/e 8,2(5,40 10,7(3,38 7,8(3,15 9,8(2,83 Oieanoa?ei, iI/e 9,7(2,33 11,5(2,15 10,2(2,27 11,5(2,01 Aaiiaeia?i, a/e 121(12,8 113(12,5 124(12,1 119(10,6 ?iaeaen ?ioieneeaoe?? 1,2(0,44 1,4(0,58 1,1(0,39 1,2(0,32 Ee?i?/i? oa eaai?aoi?i? iciaee ie?eiai? iaaeinoaoiino? noaa?aeaeaii o 26% on?o iaoe??io?a: a?oia A - 53,1%; a?oia A - 21,4%; a?oia A - 36,7%. Aeine?aeaeaiiy noaio IIE aeaei ianooii? ?acoeueoaoe: ie niinoa??aaee aenieee ??aaiue ae??iiaeo eii’thaao?a (5,8(0,4 o.i.; p<0,05) ? iaeiiiaiai aeeaeueaeaa?aeo (173(8iI/e; p<0,05) i?e cieaeai?e aeoeaiino? eaoaeace oa ia?ieneaeace. O an?o oai?eo aoei noaa?aeaeaii iaaeeeoie i?ii?aeieo (ae??iia? eii’thaaoe) oa e?ioeaaeo (iaeiiiaee aeeaeueaeaa?ae) i?iaeoeo?a IIE ia oii? cieaeaii? aeoeaiino? eaoaeace, iaeiie/aiiy iiei/ii? oa i??iaeiia?aaeii? eeneio. ?oei?aia ae?y i?iaeoeo?a IIE ia ee?oeii? oa noaee?oeii? iaia?aie i?aeoaa?aeaeoaaeany i?aeaeuaiiyi aeoeaiino? ianaaeeiaioiaaii? eenei? oinoaoace, eoaeii? oinoaoace, AEO, ANO oa i?aeaeuaiei ai?noii (-e?iii?ioa?ae?a o ne?iaaooe? e?ia?. Eeoa a 17 ?c 129 ianoaaeaieo oai?eo (13,2%) aoee ciaeaeai? iecueea aeoeai?noue eaoaeace (6,0(0,65 iI I2I2(ie/aiae) i?e cieaeaiiio ??ai? iaeiiiaiai aeeaeueaeaa?aeo (55(8,2 ieI(e), a oaeiae cia/i? ci?ie ?ioeo iieaciee?a iai?io aee??a, ui aoei i?iaiinoe/ii iani?eyoeeaith iciaeith. O oai?eo aeine?aeaeoaaii? a?oie A oaeiae aeyaeaii oeiia? aeey iaoai?/ii? aeiaoyieoe? ci?ie iieaciee?a IIE, a oaeiae cia/i? ci?ie ?ioeo iieaciee?a iai?io aee??a. I?e/iio, i?iaiinoe/ii iani?eyoeeaa ciaioaiiy ??aiy iaeiiiaiai aeeaeueaeaa?aeo ciaeaeaii o 13 (29,5%) oai?eo. A?aecia/aeany ea?oeia aia?aaoe/iiai aeao?oeeoo ia oii? iaaei??iiai iaeiie/aiiy iaoaaie?/ieo noano?ao?a. Na?aae ao?ieia?/ieo /eiiee?a iaoai?/ii? aeiaoyieoe? a eiio?ieuei?e a?oi? ia?oa i?noea ca /anoioith caeiaee ceiye?ni? iooeeie aaiaoia?e?a?ii? ciie - 162 (87,6%); o 23 (12,4%) iaoe??io?a aa?eo?eiaaii aeia/iieai'yio oai?iao. A aeine?aeaeoaai?e a?oi? o?eueee a iaeiiai iaoe??ioa (2,3%) aoa oieaaeioie?o?ac, ui iaei cia/aiiy a ieai? i?iaiicoaaiiy ia?aa?ao i?neyiia?aoe?eiiai ia??iaeo . E?eoaaiiy on?o iaoe??io?a ?c iaoai?/iith aeiaoyieoeath aoei eiiieaeniei ? neeaaeaeinue ?c eiina?aaoeaieo oa o??o?a?/ieo iaoiae?a. O iaoe??io?a a?oie A ?c iaoai?/iith aeiaoyieoeath ia a?oio? iooeei aeeiiaii 14 ?aaeeeaeueieo iia?aoe?e: 9 (4,9%) iaie?aaoiaeoiaeaiaeueieo ?acaeoe?e, 1 (0,5%) iaie?aaoaeoii?y, 3 (1,6%) iai?eaeoii??, 1 (0,5%) ?acaeoe?y aaiaoeeioieaaeioa oa ia/?iee; aeeiiaii oaeiae 128 iae?aoeaieo iia?aoe?e: 32 (17,3%) oieaoeenoaeoii?e ?c oieaaeioi- aaiaoeeiaeoiaeaiinoii??th, 5 (2,7%) oieaoeenoaeoii?e ?c oieaaeioi- aaiaoeei?thiinoii??th, 87 (47,0%) oieaoeenoiaano?inoii?e, 4 (2,2%) oieaoeenoi?thiinoii??; o 10 (5,4%) oai?eo aeeiiai? neiioiiaoe/i? ao?o/aiiy - ciai?oi? ae?aioaaiiy aaiaoeeioieaaeioa oa a 9 (4,9%) - aeniei?aoeai? eaia?ioii??. I?e aeia/iieai'yi?e oai?ia? o an?o 23 (12,4%) oai?eo aeeiiaia oieaoeenoaeoii?y ?c ?aa?c??th aeia/ieo oeyo?a: o 11 aiia caaa?oaia oieaaeioiaeoiaeaiinoii??th, o 12 - oieaaeioinoii??th. O a?oi? A aeiaoyieoeth iooeeiii? ao?ieia?? iaee 43 iaoe??ioe: ?ae aieiaee i?aeoeoieiai? caeice - 36, oa?i?iaeueiiai a?aeae?eo caaaeueii? aeia/ii? i?ioiee - 3, aaeeeiai aeoiaeaiaeueiiai nini/ea - 4. O iaeiiai oai?iai i?e/eiith aeiaoyieoe? aoa oieaaeioie?o?ac. Ee?i?/i? iciaee oieaia?oo iaee 18 (40,9%) oai?eo. Ia?oei aoaiii o??o?a?/iiai e?eoaaiiy oeeo iaoe??io?a aoea /a?acoe??ia /a?acia/?ieiaa i?e?ioieaoeenoinoii?y (ION), yeo ie aeeiioaaee i?ae eaia?ineii?/iei aai oeueo?aniiia?ao?/iei eiio?ieai. Ca ia?oo aeiao aeae?eyeiny 390-1380 ie aeia/? (o na?aaeiueiio 940(225 ie). *a?ac 2-3 aei? e?euee?noue aeia/?, ui aeae?eyeany, noaa?e?coaaeanue ia ??ai? 700-800 ie ca aeiao. E?ea?aeaoe?y a?ae’?iiiai oeneo a nenoai? i?eaaea aei oaeaeeiai caieeaiiy neiae?iio, ii?iae?caoe?? noaio oai?iai. Aeaioaoaiiiio e?eoaaiith i?aeeyaaee iaoe??ioe c aenieei nooiaiai iia?aoe?eiiai ?eceeo. O eiiieaen? caoiae?a ia?aaeiia?aoe?eiiai i?eaiooaaiiy oai?ei aeeiioaaee /a?acoe??io /a?acia/?ieiao a?e?a?io aeaeiii?an?th oeyoii ION. O?eaae?noue ooieoe?iioaaiiy ION o oai?eo noaiiaeea 20,9(10,8 aeiae. Ca oeae /an iaoe??ioe io?eioaaee eiiieaenio oa?ai?th, yea aeeth/aea ei?aeoe?th aiaeii-aeaeo?ie?oiiai aaeaino, aeac?ioieneeaoe?ei? caoiaee, aaaaeaiiy a?iioei?eaeo iao??y, na?oeaaeo oa a?oai?iieo i?aia?ao?a, ?iooc?? a?eeiaeo oa ai?iieeneioieo ?ic/ei?a i?e a?iii?ioa?iai?? oa ia?aeeaaiiy e?ia? /e a?eo?iiane i?e aiai??. Ee?i?/ii aaaeeei oai?ei c iciaeaie ia/?ieiai? iaaeinoaoiino? ? aioeaoaeiiao?? ia?aioa?aeueii aaiaeeee noa?i?aei? i?aia?aoe, i?aeueii - eaeooeico, i?iaiaeeee aioa?ini?aoe?th ca aeiiiiiaith aa?ineeo. I?ci?oa oai?? aaeeaaee c ?aeath naith aeanio i?io?eueo?iaaio /e i/euaio ia ni?aaioao aeia/, ui ni?eyei ii?iae?caoe?? i?e?ioei?e eeoie, ciaioaiith ?ioieneeaoe??, aniieooaaiith aee?i?ic/eiieo a?oai?i?a. I?e iayaiino? oieaia?oo oai??, i?ney aecia/aiiy niaeo?o i?e?ioei?e aeia/? oa ?o /ooeeaino? aei aioea?ioee?a, io?eioaaee a?aeiia?aei? aioeaaeoa??aeuei? i?aia?aoe. Aiaeii/an a i?aai?ci? oai?eo a?aeaoaaeeny aaaeeea? iiceoeai? ci?ie. Ciaiooaaany ??aaiue a?e??oa?io a e?ia? (caaaeueiiai aei 91(17,8 ieI/e, i?yiiai - 64(15,3 ieI/e, iai?yiiai - 27(7,8 ieI/e), AEO aei 1,45(0,337 iI/e, ANO - 0,95(0,282 iI/e, eoaeii? oinoaoace - 172(40,0 iae., e?aaoei?io - 133(33,5 iI/e, na/iaeie - 6,4(2,28 iI/e, oieanoa?eio - 9,2(1,76 iI/e, aetheice - 6,3(1,57 iI/e. I?aeaeuoaaany ??aaiue caaaeueiiai a?eea aei 68,2(3,96 a/e, aeueaoi?io - 46,0(4,01 a/e. Eeoa o iaeiiai (2,3%) iaoe??ioa a iiiaio iia?aoe?? oo?eioaaany i?aeaeuaiee ??aaiue e?aaoei?io ? na/iaeie. O iieacieeao eiaaoeyoe?eieo aeanoeainoae e?ia? ca?eueooaaany ??aaiue caaaeueiiai o?a?eiiaaio (2,5±0,63 a/e), i?aeaeuoaaany i?io?iia?iiaee ?iaeaen (71±5,1%). O e?ia? ciaiooaaany ??aaiue i?ii?aeieo oa e?ioeaaeo i?iaeoeo?a IIE (ae??iia? eii’thaaoe ? iaeiiiaee aeeaeueaeaa?ae), i?ioa a?i caa??aaany i?aeaeuaiei ia oii? cieaeaii? aeoeaiino? oa?iaio?a aioeieneaeaioiiai caoenoo ? iaeiie/aiiy iiei/ii? oa i??iaeiia?aaeii? eeneio. Ciaiooaaeany ? ?oei?aia ae?y i?iaeoeo?a IIE ia ee?oeii? oa noaee?oeii? iaia?aie, ui i?aeoaa?aeaeoaaeiny cieaeaiiyi aeoeaiino? ianaaeeiaioiaaii? eenei? oinoaoace, eoaeii? oinoaoace, AEO, ANO oa ai?noo (-e?iii?ioa?ae?a o e?ia?. Ia?aae iia?aoe??th iaeaea a on?o oai?eo aoea ii?iaeueiith e?euee?noue a?eo?ioeeo?a, aaiiaeia?io, eaeeioeeo?a. Eeoa a iaeiiai oai?iai caa??aaany eaeeioeeoic. O 34 (77,3%) iaoe??io?a ?iaeaen ?ioieneeaoe?? Eaeueo-Eae?oa aoa o iaaeao ii?ie, o 10 (22,7%) caeeoaany aeaui i?aeaeuaiei (1,18(0,309). Iia?iaaii an?o iaoe??io?a a?oie A. Aeeiiaii iaeio iaie?aaoaeoii?th, i’youe iaie?aaoiaeoiaeaiaeueieo ?acaeoe?e, aea? iai?eaeoii??, 31 oieaoeenoaeoii?th ?c oieaaeioiaeoiaeaiinoii??th, aea? oieaoeenoaeoii?? c aaiaoeeiaeoiaeaiinoii??th, iaeio oieaoeenoaeoii?th c aaiaoeei?thiinoii??th, iaeio oieaoeenoiaano?inoii?th. Oaaeeoey 2. Iia?aoeaia e?eoaaiiy oai?eo ?c iaoai?/iith aeiaoyieoeath. Iia?aoe?? On? iaoe??ioe (n=397) A?oia A (n=44) A?oia A (n=353) A?oia A (n=185) Neiioiiaoe/i?, n(%) 128 (32,2) 2 (4,5) 126 (35,7) 111 (60,0) Iae?aoeai?, n(%) 234 (58,9) 35 (79,5) 199 (56,4) 60 (32,4) ?aaeeeaeuei?, n(%) 35 (8,8) 7 (15,9) 28 (7,9) 14 (7,6) Aeey ii??aiyiiy oeie iia?aoeaieo ao?o/aiue ca ia’?iii i?aaenoaaeai? a oaaeeoe? 2. A aeine?aeaeoaai?e a?oi? aoei aeeiiaii eeoa aeaa (4,5%) i?i?iaeuei? ca ia’?iii iia?aoeai? ao?o/aiiy (oieaoeenoiaano?inoii?y oa oieaoeenoinoii?y), 35 (79,5%) na?aaei?o (oieaoeenoaeoii?y oa oi?ioaaiiy iao?aeieo i?ioieiai-eeoeiaeo aianoiiic?a) oa n?i (15,9%) ?aaeeeaeueieo ao?o/aiue, ui aeinoia??ii a?ae??ciy? oeth a?oio a?ae ?aooe. Oaaeeoey 3. I?neyiia?aoe?ei? oneeaaeiaiiy ? eaoaeuei?noue oai?eo ?c iaoai?/iith aeiaoyieoeath. On? iaoe??ioe (n=397) A?oia A (n=44) A?oia A (n=353) A?oia A (n=185) Oneeaaeiaiiy, n (%) 136 (34,3) 11 (25,0) 125 (35,4) 97 (52,4) o o./. ia/?ieiaa iaaeinoaoi?noue, n (%) 32 (8,1) 1 (2,3) 31 (8,8) 28 (15,1) ?aeaia?ioii??, n (%) 18 (4,5) 3 (6,8) 15 (4,3) 7 (3,8) Eaoaeuei?noue, n (%) 80 (20,2) 6 (13,6) 74 (21,0) 53 (28,6) I?neyiia?aoe?ei? oneeaaeiaiiy a caaaeuei?e a?oi? noaa?aeaeaii o 136 (34,3%) oai?eo, a a eiio?ieuei?e - o 97 (52,4%) oai?eo, i?e/iio aino?a ia/?ieiai-ie?eiaa iaaeinoaoi?noue aeieeea iaeaea aeeeth/ii a oai?eo a?oie A (oaae. 3). O oe?e aea a?oi? aoea iaeiaioa e?euee?noue ?aeaia?ioii?e: o ca’yceo c aaaee?noth oai?eo iiaoi?i? ao?o/aiiy o ieo /anoi aeeiioaaee oeyoii ?icoe?aiiy eiio?aia?oo? aac ?aeaia?ioii??. Caa?oa? ia naaa oaaao iaioa e?euee?noue oneeaaeiaiue (25,0%) o aeine?aeaeoaai?e a?oi?, iniaeeai ia/?ieiai? iaaeinoaoiino? (2,3%). Aeinoia??ii ciaioeeany ? eaoaeuei?noue - 13,6% - ?acii ?c oai?ei, yeee iiia? aeiia /a?ac i?nyoeue i?ney iia?aoe??. Oaeei /eiii, ii??aiyeueiee aiae?c aeine?aeaeoaaii? ? eiio?ieueii? a?oi ia?aeiieeai cana?ae/ea, ui iaoe??ioe aeine?aeaeoaaii? a?oie caaaeii aoee cia/ii aaae/eie, ?i aeeiiaii a?eueo? ca ia’?iii iia?aoe?? c? cia/ii iaioith e?euee?noth i?neyiia?aoe?eieo oneeaaeiaiue oa eaoaeuei?noth. A E N I I A E E 1. O iaoe??io?a ?c o?eaaeith aaaeeith iaoai?/iith aeiaoyieoeath a eiiieaen? oa?aiaaoe/ieo caoiae?a i?eaiooaaiiy aei iia?aoe?? aeioe?eueii canoiniaoaaoe a?e?a?io aeaeiii?an?th. 2. *a?acoe??ia /a?acia/?ieiaa oieaoeenoinoii?y ? iaoiaeii aeai?o i?e aeaioaoaiiiio o??o?a?/iiio e?eoaaii? oai?eo ?c iaoai?/iith aeiaoyieoeath ceiye?niiai aaiaco. 3. *a?acoe??ia /a?acia/?ieiaa oieaoeenoinoii?y caaacia/o? aaeaeaaoio a?e?a?io aeaeiii?an?th i?e oiia? aeia?i? i?io?aeiino? i?oo?iai? i?ioiee. 4. Ia?aaeiia?aoe?eia aeaeiii?an?y aeia/ieo oeyo?a, ye neeaaeiaa /anoeia eiiieaeniiai ia?aaeiia?aoe?eiiai i?eaiooaaiiy, aea? iiaeeea?noue ca?eueoeoe a?aenioie ?aaeeeaeueieo iia?aoe?e i?e ceiye?nieo o?aaeaiiyo aaiaoiiaie?aaoia?e?a?ii? ciie. 5. Ia?aaeiia?aoe?eio aeaeiii?an?th aeia/ieo oeyo?a, ye neeaaeiao /anoeio eiiieaeniiai ia?aaeiia?aoe?eiiai i?eaiooaaiiy, aeioe?eueii canoiniaoaaoe o iaoe??io?a c aenieei nooiaiai iia?aoe?eiiai ?eceeo, oyaeeith noi?ia?aeiith iaoieia??th, o noa?oiio a?oe?. 6. Canoinoaaiiy ia?aaeiia?aoe?eii? a?e?a?ii? aeaeiii?an?? o o??o?a?/iiio e?eoaaii? oai?eo ?c no?eeith o?eaaeith iaoai?/iith aeiaoyieoeath cieaeo? e?euee?noue i?neyiia?aoe?eieo oneeaaeiaiue oa eaoaeuei?noue. 7. Ia?aaeiia?aoe?eia a?e?a?ia aeaeiii?an?y cieaeo? aeoeai?noue i?ioean?a ia?ieneaeii? ieneaeaoe?? e?i?ae?a ?, iiaeeeai, oeei ni?ey? cieaeaiith i?neyiia?aoe?eii? ii?a?aeiino? oa eaoaeueiino?. NIENIE IOAE?EAOe?E CA OAIITH AeENA?OAOe?? Iioio?nueeee A.A. Ia?aaeiia?aoe?eia /a?acoe??ia /a?acia/?ieiaa oieaoeenoinoii?y o e?eoaaii? oai?eo ?c iaoai?/iith aeiaoyieoeath // Ee?i?/ia o??o?a?y.- 1998.- ? 1.- N. 15-17. Iioio?nueeee A.A. Canoinoaaiiy /a?acoe??ieo aiaeia?e?a?ieo iaoiae?a o o??o?a?/iiio e?eoaaii? oai?eo ?c iaoai?/iith aeiaoyieoeath // Aaeeoeueeee e?ea?nueeee a?niee.- 1998.- O. 5.- ? 2.- N. 114-118. Iaaeianueeee I.I., Eieii?eoeaa A.?., Oaoiaa O.?., Iioio?nueeee A.A. O??o?a?/ia e?eoaaiiy oai?eo ?c iaoo?aoe?eiith aeiaoyieoeath iieieia?/iiai aaiaco // Aaeeoeueeee e?ea?nueeee a?niee.- 1998.- O. 5.- ? 2.- N. 81-82. Iaaeianueeee I.I., Eieii?eoeaa A.?., Oa?eaoeueea I.?., Iaea?aiei O.I., Iioio?nueeee A.A. Noai ia?aeeniiai ieeneaiiy e?i?ae?a (IIE) a e?ia? i?e oieaoeenoinoii?? a oai?eo ia ceiye?nio iaoai?/io aeiaoyieoeth / Aeooaeuei? ieoaiiy i?aeoe/ii? iaaeeoeeie. Aei. 1. Ca??iee iaoeiaeo i?aoeue. - Euea?a: Aneoeai, 1995.- N. 22-23. Oa?eaoeueea I.?., Eieii?eoeaa A.?., Iioio?nueeee A.A., Noaoeeiae/ O.N., I?ae A.E., Iaaeianueeee I.I. I?ioeane e?i?aeii? ia?ieneaeaoe?? o oai?eo c iaoai?/iith aeiaoyieoeath / AI AO Oe?a?ie. Cao?aeia ?aa?iiaeueia a?aeae?eaiiy. Atheaoaiue ? 1. Iaoa??aee can?aeaiue. - 1994. - N. 35-36. Kolomiytsev V., Terletska O., Pochmursky V., Pavlovsky M. Changes of indices of lipid peroxidation after laparoscopic cholecystostomy in patients with malignant obstructive jaundice / Abstracts of 6th Congress of the Polish Association of Gastroenterology and 3rd Conference of the Section for Endoscopic Surgery at the Polish Society of Surgeons ( Krakow, Poland, September 18-21, 1994). - Krakow, 1994. - P. 264. Eieii?eoeaa A.?., Iioio?nueeee A.A., Oaoiaa O.?., Iaaeianueeee I.I. I?i iieace aei eaia?ineii?/ii? i?e?ioieaoeenoinoii?? i?e iaoai?/i?e aeiaoyieoe? / Iaoa??aee i?aeia?iaeiiai nai?ia?o “Aeooaeuei? i?iaeaie aano?iaioa?ieia?? oa aiaeineii??” (8-10 /a?aiy 1995 ?., Euea?a, Oe?a?ia): Ca??iee oac. - Euea?a, 1995.- N. 93-95. Pavlovsky M.P., Kolomiytsev V.I., Pochmursky V.V., Shachova T.I. On indications for laparoscopic mycrocholecystostomy in obstructive jaundice / The 3rd Symposium of Association of European Young Medical Scientists. Minimal Invasive Surgery (14-16 September, 1995, Gdansk, Poland). - Gdansk, 1995.- P. 35. Iaaeianeee I.I., Eieiieeoeaa A.E., Oaoiaa O.E., Iioio?neee A.A. Eaia?ineiie/aneay iee?ioieaoeenoinoiiey i?e iaoaie/aneie aeaeoooa, ineiaeiaiiie ia/aii/iie iaaeinoaoi/iinoueth / Aiiaeu oe?o?ae/aneie aaiaoieiaee: Nia?aiaiiua i?iaeaiu oe?o?ae/aneie aaiaoieiaee. Iaoa?eaeu /aoaa?oie eiioa?aioeee oe?o?aia-aaiaoieiaia (a. Ooea, 3-5 ieoya?y 1996 a.). - Ooea, 1996, O. 1, i?eeiaeaiea.- N. 58-59. Grytsiv M., Didukh P., Gloskovsky A., Shachova T., Kolomiytsev V., Pochmursky V., Hanitkevych Ja., Pavlovsky M. Spectra of absorption and photoluminescence of bile and bile stones in patientes with cholelithiasis / Adstracts of Falk Symposium “New Trends in Diagnosis and Treatment of Liver and Colonic Diseases” (October 25, 1997, Lviv, Ukraine). - Lviv, 1997.- P. 98. Shachova T., Kolomiytsev V., Lukavetsky O., Dovgan Ju., Zshemela V., Dezyk Ja., Pochmursky V., Pavlovsky M. Algorithm of clinic investigation of patients with cholestasis / Adstracts of Falk Symposium “New Trends in Diagnosis and Treatment of Liver and Colonic Diseases” (October 25, 1997, Lviv, Ukraine). - Lviv, 1997.- P. 183. AIIOAOe?ss Iioio?nueeee A.A. Ia?aaeiia?aoe?eia /a?acoe??ia /a?acia/?ieiaa ae?aioaaiiy aeia/ieo oeyo?a i?e iaoai?/i?e aeiaoyieoe?. Aeena?oaoe?y (?oeiien) ia caeiaoooy iaoeiaiai nooiaiy eaiaeeaeaoa iaaee/ieo iaoe ca niaoe?aeuei?noth 14.01.03 - o??o?a?y, Euea?anueeee aea?aeaaiee iaaee/iee oi?aa?neoao ?i. Aeaieea Aaeeoeueeiai. Euea?a, 1998. Iieacaii aeioe?euei?noue canoinoaaiiy a?e?a?ii? aeaeiii?an?? a eiiieaen? oa?aiaaoe/ieo caoiae?a i?eaiooaaiiy aei iia?aoe?? iaoe??io?a ?c o?eaaeith aaaeeith iaoai?/iith aeiaoyieoeath. Anoaiiaeaii, ui /a?acoe??ia /a?acia/?ieiaa oieaoeenoinoii?y caaacia/o? aaeaeaaoio a?e?a?io aeaeiii?an?th ? ? iaoiaeii aeai?o i?e aeaioaoaiiiio o??o?a?/iiio e?eoaaii? oai?eo ?c iaoai?/iith aeiaoyieoeath ceiye?niiai aaiaco. Aeiaaaeaii, ui ia?aaeiia?aoe?eia aeaeiii?an?y aeia/ieo oeyo?a, ye neeaaeiaa /anoeia eiiieaeniiai ia?aaeiia?aoe?eiiai i?eaiooaaiiy, aea? iiaeeea?noue ca?eueoeoe a?aenioie ?aaeeeaeueieo iia?aoe?e i?e ceiye?nieo o?aaeaiiyo aaiaoiiaie?aaoia?e?a?ii? ciie. Canoinoaaiiy ia?aaeiia?aoe?eii? a?e?a?ii? aeaeiii?an?? o o??o?a?/iiio e?eoaaii? oai?eo ?c no?eeith o?eaaeith iaoai?/iith aeiaoyieoeath cieaeo? e?euee?noue i?neyiia?aoe?eieo oneeaaeiaiue oa eaoaeuei?noue. Eeth/ia? neiaa: iaoai?/ia aeiaoyieoey – ia/?ieiaa iaaeinoaoi?noue - ia?aaeiia?aoe?eia a?e?a?ia aeaeiii?an?y – i?neyiia?aoe?ei? oneeaaeiaiiy SUMMARY Pokhmursky V.V. Preoperative percutaneous transhepatic biliary decompression in obstructive jaundice. The dissertation (manuscript) for obtaining the scientific degree of candidate of medical science, speciality 14. 01. 03 - surgery, Lviv State Medical University named after D. Galitsky. Lviv, 1999. The possibility of biliary decompression application in therapeutic pre-operation complex in patients with long-term intensive obstructive jaundice is shown. It was established that percutaneous transhepatic cholecystostomy provides an adequate biliary decompression and is the method of choice using two-step surgical management in patients with malignant obstructive jaundice. It was proved that preoperative bile ducts decompression, as a constituent part of the complex preoperative preparing, gives possibility of radical procedure percentage increasing in the case of malignant injury of the hepatopancreatobiliary zone. The preoperative biliary decompression application in the surgical management in patients with long-term intensive obstructive jaundice decreases an amount of postoperative complications and mortality. Key words: obstructive jaundice – hepatic failure – percutaneous biliary drainage – postoperative complications AIIIOAOeEss Iioio?neee A.A. I?aaeiia?aoeeiiiia /?aneiaeiia /?ania/aii/iia ae?aie?iaaiea aeae/iuo iooae i?e iaoaie/aneie aeaeoooa. Aeenna?oaoeey (?oeiienue) ia nieneaiea o/aiie noaiaie eaiaeeaeaoa iaaeeoeeineeo iaoe ii niaoeeaeueiinoe 14.01.03 - oe?o?aey, Eueaianeee ainoaea?noaaiiue iaaeeoeeineee oieaa?neoao ei. Ae. Aaeeoeeiai. Eueaia, 1999. Eco/aiu oa?aeoa?, no?oeoo?a e i?e/eiu iineaiia?aoeeiiiuo ineiaeiaiee o aieueiuo n iaoaie/aneie aeaeoooie, oniaa?oainoaiaaiu nouanoaothuea e ?ac?aaioaiu i?eaeiaeueiua iaoiaeeee /?aneiaeiiai /?ania/aii/iiai ae?aie?iaaiey aeeea?iie nenoaiu iiae eaia?inei-ie/aneei e oeueo?aniiia?aoe/aneei eiio?ieai, aiaae?aii eo a eeeie/aneoth i?aeoeeo, enneaaeiaaii aeeyiea i?aaeiia?aoeeiiiie aeeea?iie aeaeiii?annee aeae/iuo iooae ia oa/aiea caaieaaaiey, ninoiyiea ia/aii/iie e ii/a/iie ooieoeee, ?aieiae/aneea ia?aiao?u e?iae, iieacaoaee eeiii?ioaeaeiiai niaeo?a ieaciu, ninoiyiea ia?aeeniiai ieeneaiey eeieaeia (IIE) e nenoaiu aioeieneaeaioiie caueou. Ii?aaeaeaiu iieacaiey e i?eiaiaieth iaoiaeia a caaeneiinoe io i?iaeieaeeoaeueiinoe aeaeoooe e o?iaiy aeee?oaeiaiee, a oaeaea i?aaeeiaeaiu iioeiaeueiua n?iee /?aneiaeiie aeaeiii?annee aeae/iuo iooae a i?aaeiia?aoeeiiiii ia?eiaea. Eco/aiu aiciiaeiua ineiaeiaiey iaieioeyoeee e iooe eo i?aaeioa?auaiey. ?aaioa aace?oaony ia eco/aiee ?acoeueoaoia oe?o?ae/aneiai ea/aiey 397 iaoeeaioia n iaoaie/aneie aeaeoooie, nii?iaiaeaeaaiie aeia?aeee?oaeiaieae nauoa 150 ieI/e. O 309 aieueiuo i?e/eiie caaieaaaiey yaeyeenue ceiea/anoaaiiua iiaiia?aciaaiey. Iia?e?iaaii o?aaeeoeeiiii 353 aieueiuo aac i?aaeaa?eoaeueiie aeeea?iie aeaeiii?annee, 44 aieueiui ia?aae iniiaiie iia?aoeeae ia?aui yoaiii auei noi?ie?iaaii /?aneiaeioth /?ania/aii/ioth iee?ioieaoeenoinoiio (a?oiia A). ?an/ao i?iaiinoe/aneeo eiyooeoeeaioia aeey ioaeaeueiuo i?eciaeia iieacae, /oi aa?iyoiinoue ineiaeiaiiiai oa/aiey iineaiia?aoeeiiiiai ia?eiaea oaaee/eaaaony eeoue i?e o?iaia iauaai aeee?oaeia e?iae nauoa 250 ieI/e. Aei yoiai cia/aiey aeee?oaei i?aeoe/anee ia aeeyao ia /anoioo e oa?aeoa? ineiaeiaiee, eioi?ua caaenyo oiaaea io eiuo oaeoi?ia. Aeaooyoaiiiio ea/aieth iiaeaa?aeenue iaoeeaiou n aunieie noaiaiueth iia?aoeeiiiiai ?enea, a ninoiyiee n?aaeiae oyaeanoe e oyaeaeii, n i?eciaeaie ia/aii/iie iaaeinoaoi/iinoe e yioeaoaeiiaoee, o?iaiai aeee?oaeiaiee nauoa 250 ieI/e e i?iaeieaeeoaeueiinoueth aeaeoooe nauoa o?ao iaaeaeue. Ii oaeei aea e?eoa?eyi auea ioia?aia eiio?ieueiay a?oiia (185 aieueiuo) aeey iauaeoeaiie ioeaiee i?aaeeaaaaiiai iaoiaea (a?oiia A). Iu n?aaieaaee oiae caaieaaaiey a yoeo a?oiiao iaoeeaioia e eco/aee yooaeoeaiinoue i?eiaiaiey i?aaeiia?aoeeiiiie aeeea?iie aeaeiii?annee, aa aeeyiea ia iineaaeothuaa oe?o?ae/aneia ea/aiea. O anao iaoeeaioia iiuoiie e eiio?ieueiuo a?oii aeaeoooa auea ceiea/anoaaiiiai aaiaca, a /anoiinoe aneaaenoaea ?aea aieiaee iiaeaeaeoaei/iie aeaeacu - a 56,5% iaaethaeaiee. N?aaeiyy i?iaeieaeeoaeueiinoue aeaeoooe o iaoeeaioia a?oiiu A ninoaaeyea 36,0(± 12,61 nooie, a eiio?ieueiie a?oiia - 30,8(± 9,32 nooie. N?aaeiee o?iaaiue aeee?oaeiaiee aue, niioaaonoaaiii, 371(± 96,3 e 348(± 54,2 ieI/e. Eeeie/aneea e eaai?aoi?iua i?eciaee ii/a/iie iaaeinoaoi/iinoe eiaee ianoi o 53,1% iaoeeaioia a?oiiu A e o 36,7% - a?oiiu A. Ia?aui yoaiii oe?o?ae/aneiai ea/aiey iaoeeaioia a?oiiu A auei iaeiaeaiea /?aneiaeiie /?ania/aii/iie iee?ioieaoeenoinoiiee (ION). I?iaeieaeeoaeueiinoue ooieoeeiie?iaaiey ION ninoaaeyea 20,9(± 10,8 nooie. Ca yoi a?aiy iaoeeaiou iieo/aee iieiioeaiioth iaaeeeaiaioicioth eiiieaenioth oa?aieth. Iicaeiaa aieueiua oiio?aaeyee n ieuae naith nianoaaiioth i?ioeeueo?e?iaaiioth eee i/euaiioth ia ni?aaioao aeae/ue. Ca yoi a?aiy iaaethaeaeenue neaaeothuea iieiaeeoaeueiua eciaiaiey: oiaiueoaeny o?iaaiue aeee?oaeia a e?iae aei 91(± 17,8 ieI/e, e?aaoeieia - aei 133(± 33,5 iI/e, ii/aaeiu - aei 6,4(± 2,28 iI/e; iiauoaeny o?iaaiue iauaai aaeea aei 68,2(± 3,96 a/e, aeueaoieia - aei 46,0(± 4,01 a/e. Oieueei o iaeiiai (2,3%) iaoeeaioa ia iiiaio iia?aoeee oaea?aeeaaeny iiauoaiiue o?iaaiue e?aaoeieia e ii/aaeiu. A iieacaoaeyo eiaaoeyoeeiiiuo naienoa e?iae oaaee/eaaeny o?iaaiue iauaai oea?eiiaaia (2,5±0,63 a/e), iiauoaeny i?io?iiaeiiaee eiaeaen (71±5,1%). A e?iae oiaiueoaeny o?iaaiue i?iiaaeooi/iuo e eiia/iuo i?iaeoeoia IIE (aeeaiiaua eiiuthaaou e iaeiiiaee aeeaeueaeaaeae), oai ia iaiaa, ii oaea?aeeaaeny iiauoaiiui ia oiia nieaeaiiie aeoeaiinoe oa?iaioia aioeieneaeaioiie caueou e iaeiieaiey iiei/iie e ie?iaeiia?aaeiie eeneio, iaaethaeaeinue nieaeaiea aeoeaiinoe ianaaeeiaioe?iaaiiie eeneie oinoaoacu, uaei/iie oinoaoacu, AEO, ANO e niaea?aeaiey (b -eeiii?ioaeaeia. Eco/aiea ?acoeueoaoia oe?o?ae/aneiai ea/aiey iieacaei, /oi aeeea?iay aeaeiii?anney a eiiieaena i?aaeiia?aoeeiiiuo i?eaioiaeaiee aeaao aiciiaeiinoue auiieieoue aieueoaa eiee/anoai ?aaeeeaeueiuo iia?aoeee i?e ceiea/anoaaiiuo iiaiia?aciaaieyo: 15,9% (7 aieueiuo) a a?oiia A i?ioea 7,7% (14 aieueiuo) a a?oiia A (?<0,05). A oi aea a?aiy oiaiueoaaony eiee/anoai iineaiia?aoeeiiiuo ineiaeiaiee (25% e 52,4%; ?<0,05), nieaeaaony o?iaaiue eaoaeueiinoe (13,6% e 28,6%; ?<0,05). Eeth/aaua neiaa: iaoaie/aneay aeaeoooa – ia/aii/iay iaaeinoaoi/iinoue - i?aaeiia?aoeeiiiay aeeea?iay aeaeiii?anney – iineaiia?aoeeiiiua ineiaeiaiey page page 32 ?ae -309(77,8%) 34(8,5%) aeia/ieo i?ioie Oieaia?ie?o?ac – 88 (22,2%) 14(3,5%) aeia/iiai i?oo?a 27(6,8%) iai?ee 11(2.8%) ?io? 226(56,5%) aieiaee i?aeoeoieiai? caeice

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