IIIINOA?NOAI IOI?IIE CAeI?IA’ss OE?A?IE

EE?ANUeEA IAAeE*IA AEAAeAIIss IINEssAeEIEIIII? INAIOE

?i. I.E. Ooieea

AEOEAE Aieiaeeie? A?eoi?iae/

OAeE 616.381-002.1

II??AIssEUeIA IOe?IEA NIINIA?A ?ACAEOe?? IA*?IEE

14.01.03 — oi?o?aiy

Aaoi?aoa?ao aeena?oaoe??

ia caeiaoooy iaoeiaiai nooiaiy

eaiaeeaeaoa iaaee/ieo iaoe

EE?A — 1998

Aeena?oaoei?th ? ?oeiien.

?iaioa aeeiiaia a Iinoeoooi eeiii/ii? oa aenia?eiaioaeueii? oi?o?ai? AII
Oe?a?ie (i. Ee?a)

Iaoeiaee ea??aiee: aeieoi? iaaee/ieo iaoe

Eaeeoa Ieeiea sseiae/

caaiaeoaa/ aiaeaeieo ii?oaeueii? aiia?oaici? oa

oi?o?ai? ia/iiee Iinoeoooo eeiii/ii? oa

aenia?eiaioaeueii? oi?o?ai? AII Oe?a?ie

Ioioeieii iiiiaioe aeieoi? iaaee/ieo iaoe

Eeoaeiaiei Ieaenaiae? Ieaenaiae?iae/

i?ia?aeiee iaoeiaee ni?a?ia?oiee

a?aeae?eo ia?aaeiooeeiieo caoai?thaaiue

?inoeoooo iieieia?? oa ?aae?ieia?? IIC Oe?a?ie

aeieoi? iaaee/ieo iaoe, i?ioani?

Caoa?ao Ieoaeei Iao?iae/

ia/aeueiee iaaee/iiai oi?aae?iiy

neoaeae aaciaee Oe?a?ie

I?iaiaeia onoaiiaa Euea?anueeee iaaee/iee oi?aa?neoao IIC Oe?a?ie,

eaoaae?a caaaeueii? oa oaeoeueoaonueei? o??o?a??.

Caoeno aiaeaoaeaoueny “ 30 “ a?oaeiy 1998 ?. i 14 aiaeeii ia caniaeaiii
niaoeiaeiciaaii? a/aii? ?aaee Ae 26.613.02 i?e Ee?anueeie iaaee/iie
aeaaeaii? iineyaeeieiiii? inaioe IIC Oe?a?ie (254112, i. Ee?a, aoe.
Aei?iaiaeeoeueea, 9).

C aeena?oaoei?th iiaeia iciaeiieoeny o aiaeiioaoei Ee?anueei? iaaee/ii?
aeaaeaii? iineyaeeieiiii? inaioe ?i. I.E. Ooi?ea (254112, i. Ee?a, aoe.
Aei?iaiaeeoeueea, 9).

Aaoi?aoa?ao ?icineaiee “ 18 “ eenoiiaaea 1998 ?.

A/aiee nae?aoa?

niaoeiaeiciaaii? a/aii? ?aaee

eaiaeeaeao iaaee/ieo iaoe, aeioeaio AAICAessE I.I.

CAAAEUeIA OA?AEOA?ENOEEA ?IAIOE

Aeooaeuei?noue oaie. Iianthaeia c?inoaiiy caoai?thaaiiy ia/?iee a
inoaii? aeanyoe??//y i?ecaaei aei oiai, ui ieoiia aaaa ?aeo ia/?iee
na?aae ?ioeo iooeei, aeinyaea 10—11%, i?e oeueiio cieceany na?aaei?e a?e
oai?eo, yeee noaiiaeoue 40—45 ?ie?a (A.A. Oaeeiia e niaao, 1993; P.
McMaster et al., 1992). Aei nueiaiaei? iniiaiei iaoiaeii e?eoaaiiy ?aeo
ia/?iee caeeoa?oueny o??o?a?/iee, ine?eueee ?io? niiniae e?eoaaiiy
(aeeiaie?caoe?y, ?aa?iiaeueia o?i?ioa?ai?y, oioiaeeiai?/ia oa?ai?y,
a?oa??aeueia ?oai?y, e??iaeeno?oeoe?y) eeoa ei?ioei/anii iieaaoothoue
noai iaoe??io?a, aea ia ni?eythoue i?iaeiaaeaiith ?oiueiai aeeooy (K.
Yamakado et al., 1994). sse ?aaeeeaeuei?e iia?aoe?? iaea?eueoa ia?aaaaa
iaaea?oueny aiaoii?/i?e ?acaeoe?? (M. Makuuchi et. al., 1998).
Eaoaeuei?noue i?ney aeeiiaiiy ?aaeeeaeueieo iia?aoe?e neeaaea? 10—15% ca
ia?aeiii? iooeeie ? 20—25% i?e iaoanoaoe/iiio a?aaeaii? i?aaia, a ??ci?
oneeaaeiaiiy niinoa??aathoueny o 40—60% oai?eo (M. Shimada et al., 1994;
M. Suenaga et al., 1992). Iae/ano?oa iacaaeia?euei? ?acoeueoaoe
o??o?a?/iiai e?eoaaiiy niinoa??aathoueny o iaoe??io?a c iaoai?/iith
aeiaoyieoeath aiane?aeie oeaio?aeueii? eieae?caoe?? iooeeie ia/?iee,
?acaeoaaaeuei?noue i?e oeueiio ia ia?aaeuo? 10%. O a?eueoino? aeiaaee?a
iaoe??ioe ?c oaeei oneeaaeiaiiyi aaaaeathoueny iaiia?aaaeueieie ?
i?aeaeathoueny i?i?iaeueiiio iae?aoeaiiio ao?o/aiith. I?eioeei
aeio?eiaiiy ?aaeeeaeueiino? ao?o/aiiy aeiaaa? aeaeaeaiiy 40—60% ia’?io
ia?aio?ie ia/?iee, ui iaaaoeaii a?aeaeaa?oueny ia iane?aeeao e?eoaaiiy.
I?neyiia?aoe?eia eaoaeuei?noue i?ae /an ni?ia aeeiiaiiy ?aaeeeaeueiiai
ao?o/aiiy aeinyaa? 50—80% (H. Bismuth et al., 1994; R. Richlmayr et al.,
1995).

Eeth/iaeie iiiaioaie anyei? ?acaeoe?? ia/?iee ? aaeaeaaoi?noue ??
ia’?io, aea?? iaoiaeo, niiniao ?icn?/aiiy ia?aio?ie ? noa?aii?noue
aaiinoaco. A?ae i?aaeeueiino? aeeiiaiiy ? iaia’yceiaino? caa?aaeaiiy
oeeo iiiaio?a caeaaeeoue /anoioa e oa?aeoa? oneeaaeiaiue, a oaeiae
eaoaeuei?noue (T.E. Starzl et al., 1996). Iniiaiith i?e/eiith ?icaeoeo
i?neyiia?aoe?eieo oneeaaeiaiue ? iae?ic eoeueo? ia/?iee, yeee coiiaeth?
aeieeiaiiy aioo??/a?aaieo e?iaioa/, ia?eoii?oo, aeia/ieo ii?eoeue oa
aanoean?a (A.A. Oaeeiia e niaao., 1997).

I?aaeiaoii aea/aiiy ii nueiaiaei?oi?e aeaiue caeeoathoueny oaeoi?e
?eceeo aeeiiaiiy ?acaeoe?? ia/?iee (D. Mariette et al., 1997; S.
Miyagawa et al., 1995). Oea ieoaiiy iniaeeai aeooaeueia ca oiia
canoinoaaiiy iiaeo niinia?a ?icoeio ia?aio?ie e ii?aoethaaiiy
??caeiaaii? iiaa?oi? ia/?iee: oeueo?acaoeiaiai ani??aoi?a, a?aiiiaiai
ieaciaiiai neaeueiaey, eaca?iiai aeenaeoi?a, i?e?ioaeeueiaiai
eiaaoeyoi?a, aa?icieueieo iie?ia?ieo eiiiiceoe?e.

I?ioa aeiaeai ?c iienaieo iaoiae?a, ye? canoiniaothoueny naiino?eii, ia
aea? aaaeaieo ?acoeueoao?a ciaioaiiy oneeaaeiaiue oa cieaeaiiy
eaoaeueiino?, eio?a aeinyaa? 15—20% (A.A. Oaeeiia e niaao., 1994; C.
Huguet et al., 1992). Iacaaaeath/e ia i?ia?an, aeinyaiooee o
o??o?a?/iiio e?eoaaii? eieaeueii? iaoieia?? ia/?iee, iie?auaiiy oaoi?ee
?acaeoe?? ia an?o aoaiao aeeiiaiiy iia?aoe?? caeeoa?oueny iaei??th ?c
aeooaeueieo i?iaeai. *eneaii? oaoi?/i? aniaeoe ?acaeoe?? ia/?iee, na?aae
yeeo iaoiae aeeiiaiiy ?acaeoe??, niiniae ?icoeiaiiy ia?aio?ie oa
aaiinoaco aei oaia??oiueiai /ano aea/ai? iaaeinoaoiuei, a ieoaiiy
o??o?a?/ii? oaeoeee i?e iaoai?/ii? aeiaoyieoe? iathoue iieai?/iee
oa?aeoa? (H. Bismuth, 1994).

Ca’ycie i?aoe? ?c iaoeiaeie i?ia?aiaie, ieaiaie, oaiaie. Aeena?oaoe?eia
i?aoey ? o?aaiaioii aaeocaai? iaoeiai? i?ia?aie ?inoeoooo ee?i?/ii? oa
aenia?eiaioaeueii? o??o?a?? AII Oe?a?ie ii caieaiiaai?e oai?
«?io?ai?aaii? oa aeno?aei?ii?aeuei? ?acaeoe?? ia/?iee» (? 0194U007346
aea?ae?a?no?aoe??), aeeiiaii? o 1996—1998 ??.

Iaoa ? caaea/? aeine?aeaeaiiy. Iaoa oe??? i?aoe? — iie?auaiiy
?acoeueoao?a ?acaeoe?e ia/?iee i?e eieaeuei?e iaoieia?? ??ciiai
iioiaeaeaiiy. Aeey aeinyaiaiiy aeacaii? iaoe iaie aoee iinoaaeai? oae?
caaea/?:

A?aei?aoethaaoe a aenia?eiaio? oa oi?iaaaeeoe a ee?i?/io i?aeoeeo
oaoi?eo ?acaeoe?? ia/?iee ?c canoinoaaiiyi oeueo?acaoeiaiai ani??aoi?a.

Aea/eoe ii?oieia?th ?aia?aoeaieo i?ioean?a ia/?iee i?ney aeeiiaiiy
??cieo aeae?a ?acaeoe??.

Aeaoe eiiieaenio ioe?ieo ooieoe?iiaeueiiai ?aca?ao ia/?iee i?ney
aeeiiaiiy ??cieo aeae?a ?acaeoe??.

C?iaeoe ii??aiyeueio ioe?ieo ?acoeueoao?a o?aaeeoe?eieo ?
iaeio?aaiaoe/ieo ?acaeoe?e ia/?iee.

?ic?iaeoe ?aoe?iiaeueiee i?aeo?ae aei aeeiiaiiy ?acaeoe?? ia/?iee c
aeei?enoaiiyi i?eioeei?a iaeio?aaiiaaiino?.

Iaoiiaeoe iiaeeea?noue aeeiiaiiy ?aaeeeaeueieo ?acaeoe?e ia/?iee c
aeei?enoaiiyi i?eioeei?a iaeio?aaiiaaiino? i?e iaoai?/i?e aeiaoyieoe?
iooeeiiiai iioiaeaeaiiy.

Iaoeiaa iiaecia iaea?aeaieo ?acoeueoao?a. O oe?e ?iaio? aeeiiaiee
ii??aiyeueiee aiae?c ?acoeueoao?a o?aaeeoe?eiiai ? iaeio?aaiaoe/iiai
i?aeoiae?a aei aeeiiaiiy ?acaeoe?? ia/?iee. I?iaaaeaia ?aeaioeo?eaoe?y
aei- ? ?io?aiia?aoe?eieo oaeoi??a ?eceeo iani?eyoeeaiai ?acoeueoaoo
?acaeoe?? ia/?iee, aei yeeo iaeaaeaoue ii/aoeiaee ??aaiue ne?iaaoeiaiai
aeueaoi?io, caaaeueiiai a?e??oa?io, aeoeaiino? o?ainaieiac oa ia’?i
e?iaiao?aoe. Aeiaaaeaia a?aenooi?noue ei?aeyoe?? i?ae ii/aoeiaei noaiii
ooieoe?iiaeueiiai ?aca?ao ia/?iee oa ia’?iii ia?aaeaa/oaaii? ?acaeoe??
i?e aeei?enoaii? iaeio?aaiaoe/ieo niinia?a. ?ic?iaeaiee iaeio?aaiaoe/iee
eiia?iiaaiee iaoiae ?acaeoe?? ia/?iee, yeee caeeth/a?oueny a
canoinoaaii? oeueo?acaoeiaiai aeenaeoi?a aeey ?icoeiaiiy ia?aio?ie ?
?icoieoniaaiiai eaca?iiai i?iiaiy aeey inoaoi/iiai aaiinoaco. A
aenia?eiaio? aea/aia aeeiai?ea ?aia?aoeaieo i?ioean?a i?ae /an aeeiiaiiy
?acaeoe?e ia/?iee ??cieie niiniaaie. ?ic?iaeaiee iiaee niin?a oi?ioaaiiy
a?e?iaeeaanoeaiiai aianoiiica i?ae /an aeeiiaiiy ?acaeoe?? ia/?iee o
oai?eo c iaoai?/iith aeiaoyieoeath (Iaoaio Oe?a?ie 10489 A). Ia iniia?
iaea?aeaieo aeaieo ?ic?iaeaia ?aoe?iiaeueia o??o?a?/ia oaeoeea i?ae /an
e?eoaaiiy eieaeueii? iaoieia?? ia/?iee.

I?aeoe/ia cia/aiiy iaea?aeaieo ?acoeueoao?a. Cai?iiiiiaaiee o i?aoe?
eiiieaeniee iaeio?aaiaoe/iee i?aeo?ae aei aeeiiaiiy ?acaeoe?? aeicaieea
cia/ii iie?aueoe ?acoeueoaoe o??o?a?/iiai e?eoaaiiy eieaeueii? iaoieia??
ia/?iee. A eiai iniiaio iieeaaeaii: i?iaaaeaiiy noa?aiii? oii?/ii?
ae?aaiinoeee iaoieia?/iiai aiaieua, ioe?iea ooieoe?iiaeueiiai ?aca?ao
ia/?iee, eiia?iiaaia canoinoaaiiy no/anieo niinia?a ?icoeiaiiy ia?aio?ie
ia/?iee e inoaoi/iiai aaiinoaco. ?io?aiia?aoe?eia oeueo?acaoeiaa
aeine?aeaeaiiy aeicaiey? ia eeoa eieae?coaaoe iooeeio, aea e aecia/eoe
?? oiiia?aoi-aiaoii?/i? aca?iinoinoiee ?c noaeeiii-nae?aoi?ieie
no?oeoo?aie, ye? aieeaathoue ia aea?? iaoiaeo ? ianyao o??o?a?/iiai
e?eoaaiiy. ?ic?iaeaiee ? ai?iaaaeaeaiee o i?aeoeeo eiia?iiaaiee iaoiae
?acaeoe?? ia/?iee ?c canoinoaaiiyi oeueo?acaoeiaiai ani??aoi?a ?
?icoieoniaaiiai eaca?iiai i?iiaiy. ?ic?iaeaiee iiaee niin?a oi?ioaaiiy
a?e?iaeeaanoeaiiai aianoiiica i?ae /an aeeiiaiiy ?acaeoe?? ia/?iee o
oai?eo c iooeeiaie ia/?iee, oneeaaeiaieie iaoai?/iith aeiaoyieoeath.

?acoeueoaoe i?aoe? ai?iaaaeaeai? a i?aeoeeo e?eoaaeueieo caeeaae?a
Oe?a?ie oeyoii i?iaaaeaiiy ae?cieo nai?ia??a ? eiioa?aioe?e oa
iciaeiieaiiy c ieie i?aeoe/ieo e?ea??a o??o?a?a ia eo?nao ?ioi?iaoe?? ?
noaaeoaaiiy i?e ?inoeooo? ee?i?/ii? e aenia?eiaioaeueii? o??o?a?? AII
Oe?a?ie.

Iniaenoee aianie aeena?oaioa. Aaoi?o iaeaaeeoue iinoaiiaea iaoe oa
??oaiiy caaea/ aeena?oaoe?eii? i?aoe?, aea/aiiy ee?i?/iiai iaoa??aeo ii
?ic?iaeai?e i?ia?ai?. O i?ioean? aeeiiaiiy ?iaioe aaoi? i?iaiae?coaaa
no/anio iaoeiai-iaoiaee/io e?oa?aoo?o ii oai? aeine?aeaeaiiy. Eiieo?naio
a?aa aaciina?aaeith o/anoue a on?o iia?aoe?yo ? naiino?eii i?iiia?oaaa
38 oai?eo c eieaeueiith iaoieia??th ia/?iee. Aaoi? a?aa o/anoue o
?ic?iaoe? iioeiaeueii? e?eoaaeueii-ae?aaiinoe/ii? oaeoeee oa ia?aa??oe?
?? ee?i?/ii? aoaeoeaiino?. Aaoi?ii cai?iiiiiaaiee iaeio?aaiaoe/iee
eiia?iiaaiee iaoiae ?acaeoe?? ia/?iee, ?ic?iaeaiee iiaee niin?a
oi?ioaaiiy a?e?iaeeaaoeaiiai aianoiiica i?ae /an aeeiiaiiy ?acaeoe??
ia/?iee o oai?eo c iaoai?/iith aeiaoyieoeath. Aeena?oaio aea/ea
iniaeeaino? i?io?eaiiy i?neyiia?aoe?eiiai ia??iaeo ? ?ic?iaea niiniae
i?io?eaeoeee oneeaaeiaiue. Aaoi? iniaenoi aeeiiaa noaoenoe/iee aiae?c ?
ocaaaeueiaiiy iaea?aeaieo ?acoeueoao?a ?c aeei?enoaiiyi eiii’thoa?ieo
i?ia?ai.

Ai?iaaoe?y ?acoeueoao?a aeena?oaoe??. Iniiai? iieiaeaiiy aeena?oaoe??
aeeeaaeai? ia ?O C’?cae? o??o?a?a A?ei?on? ( A?oaanuee, 1995), IIE
«O??o?a?/ia e?eoaaiiy ii?oaeueii? a?ia?oaic?? caoai?thaaiue ? o?aai
ia/?iee» (Oa?e?a, 1986), ?? I?aeia?iaei?e eiioa?aioe??
o??o?a?a-aaiaoieia?a (E??ia, 1994), IIE «Iiaa a ae?aaiinoeoe?
caoai?thaaiue i?aai?a o?aaeaiiy» (Oa?e?a, 1994), ? (XVII) c’?cae?
o??o?a?a Oe?a?ie (Euea?a, 1994), IIE «Aeooaeuei? ieoaiiy iaa?aeeeaaeii?
o??o?a?? (Ee?a, 1995), ??? I?aeia?iaei?e eiioa?aioe??
o??o?a?a-aaiaoieia?a (Naieo-Iaoa?ao?a, 1995), ieaioi? Iaoe?iiaeueiiai
oiaa?enoaa o??o?a?a Oe?a?ie (Iaeana, 1996), IIE «I?iaeaie ee?i?/ii?
o??o?a??» (Ee?a, 1997), IIE, i?enay/ai? 25-??//th ?inoeoooo ee?i?/ii?
o??o?a?? (Oa?e?n?, 1997), ?a?iiaenueeiio eiia?an? I?aeia?iaeii?
anioe?aoe?? aaiaoi-iaie?aaoi-a?e?a?ii? o??o?a?? (Aaiao?a, 1997), IIE
«Aeooaeuei? i?iaeaie aaiaoi-iaie?aaoi-a?e?a?ii? o??o?a??» (Ee?a, 1998).

Ioae?eaoe??. Ii oai? aeena?oaoe?? iioae?eiaaii 13 ae?oeiaaieo i?aoeue,
cie?aia, 6 noaoae a aeo?iaeao ? iaoeiaeo ca??ieeao, ?c ieo 1 naiino?eia,
6 oacen?a o ca??ieeao eiia?an?a, iaea?aeaii iaoaio Oe?a?ie ia aeiao?ae.

No?oeoo?a aeena?oaoe??. Aeena?oaoe?y neeaaea?oueny ?c anooio, iaeyaeo
e?oa?aoo?e, iieno iaoa??ae?a oa iaoiae?a aeine?aeaeaiue, aeaio ?icae?e?a
aeanieo aeine?aeaeaiue, aiae?co oa ocaaaeueiaiiy iaea?aeaieo
?acoeueoao?a, aeniiae?a, i?aeoe/ieo ?aeiiaiaeaoe?e, nieneo aeei?enoaii?
e?oa?aoo?e. Aeena?oaoe?eia ?iaioa aeeeaaeaia ia 160 noi??ieao
iaoeiiieno, i?i?ethno?iaaia oaaeeoeyie, a?ao?eaie oa noaiaie ao?o/aiue.
Nienie aeei?enoaii? e?oa?aoo?e i?noeoue 336 aeaea?ae.

Iniiaiee ci?no ?IAIOE

Iaoa??aee ? iaoiaee aeine?aeaeaiue

O ?iaio? iiaeaii aiae?c ?acoeueoao?a ianoaaeaiiy oa o??o?a?/iiai
e?eoaaiiy 107 oai?eo ?c eieaeueiith iaoieia??th ia/?iee ??ciiai
iioiaeaeaiiy, iia?iaaieo a ?inoeooo? ee?i?/ii? ? aenia?eiaioaeueii?
o??o?a?? AII Oe?a?ie ca ia??iae 1986—1996 ??. Aeine?aeio a?oio neeaee 72
(67,3%) ae?iie ? 35 (32,7%) /ieia?e?a o a?oe? a?ae 17 aei 70 ?ie?a.
?iciiae?e oai?eo ca a?eii, noaooth ? oa?aeoa?ii iaoieia?? iiaeaii a
oaae.1.

Eiioeiaaio in?a i?aoeacaeaoiiai a?eo neeaa 80% oai?eo. Ceiye?nia oi?ia
eieaeueii? iaoieia?? ia/?iee (ia?aeiiee ? iaoanoe/iee ?ae, ?ae aeia/iiai
i?oo?a) aoea ae?aaiinoiaaia o 30% iaoe??io?a, o ?aooe 77 (72%) oai?eo
aeyaeaii aeia?iye?ni? caoai?thaaiiy (aaiaia?iia, aaeaiiia, ao?iieieic,
iie?e?noic, e?iiiaoic, iane?aeee o?aaie ia/?iee). Ee?i?/iee ae?aaiic aoa
aa?eo?eiaaiee aeaieie a?noieia?/iiai aeine?aeaeaiiy a on?o aeiaaeeao.

Aieaaee neiae?ii a?aecia/aii o 24 (80%) oai?eo ?c ceiye?niith oi?iith
eieaeueii? iaoieia?? oa o 35 (45%) — ?c aeia?iye?niith iaoieia??th.
Cieaeaiiy iane o?ea niinoa??aaeinue o 27 (90%) in?a ?c ceiye?niith
iaoieia??th e iineei no?eeee oa?aeoa?. O iaoe??io?a ?c aeia?iye?niith
iaoieia??th ciaioaiiy iane o?ea aeyaeaii eeoa o 38 (50%) aeiaaeeao.

Aeeniaioe/iee neiae?ii, ?c ioaeioith, aethaaiiyi, iaoai?eciii, iiiinii,
caii?ii, niinoa??aaany ?c iaeiaeiaith /anoioith (27%) i?e iaio oeiao
iaoieia??. Iayai?noue iaoai?/ii? aeiaoyieoe? a?aei?/aii o 8 (27%) in?a
?c eieaeueiith iaoieia??th ia/?iee ceiye?niiai iioiaeaeaiiy, ? eeoa o 2
(2,6%) iaoe??io?a — c aeia?iye?nieie caoai?thaaiiyie.

Aaiaoiiaaae?y eiinoaoiaaia o 16 (53%) oai?eo ?c ceiye?niei oeiii
iaoieia?? ? o 25 (32%) — c aeia?iye?niei. Ii?ooaiiy noeoiii?
?ioaa?aoeaii? ooieoe?? ia/?iee oa noaio aaiaoioeeo?a ca aeaieie
a?io?i?/ieo iieaciee?a niinoa??aaeinue o 8 (27%) oai?eo ?c ceiye?niith
oa o 20 (26%) — c aeia?iye?niith iaoieia??th.

On? iaoe??ioe, ye? iinooieee aei ee?i?ee, i?aeaeai? o??o?a?/iiio
e?eoaaiith o ieaiiaiio ii?yaeeo i?ney iiia?aaeiueiai ianoaaeaiiy ?
ia?aaeiia?aoe?eii? i?aeaioiaee. On? oai?? aoee iia?iaai? aia?oa, ie??i
aeaio, ye? ?ai?oa iia?oaaeenue c i?eaiaeo o?aaie ia/?iee a ?ioeo
e?eoaaeueieo onoaiiaao. Iieacieeaie aei aeeiiaiiy ?acaeoe?? ia/?iee
neoaeeee: ia?aeiiee ?ae — 18 (16,8%), ?ae aeia/iiai i?oo?a — 8 (7,5%),
iaoanoe/iee ?ae — 4 (3,7%), aaiaia?iia — 37 (34,6%), ao?iieieic — 21
(19,6%), nie?oa?i? e?noe — 10 (9,4%), aaeaiiia — 4 (3,7%), e?iiiaoic — 2
(1,8%), o?aaia 2 (1,8%), iie?en?oic — 1 (0,9%).

Aeey ioe?iee eaoaai??e ooeioe?iiaeueiiai ?aca?ao ia/?iee aeei?enoiaoaaee
e?eoa??? ca oeaeith Stone, ye? iiaeai? o oaae. 2.

Oaaeeoey 2

Eaoaai??? ooieoe?iiaeueiiai ?aca?ao ia/?iee ca Stone

E?eoa??? Oei A Oei B Oei C

Iaiaaeaiiy ooieoe?? ia/?iee

A?e??oa?i (ieiieue/e)

Aeueaoi?i (a/e)

Anoe?o

Aioeaoaeiiao?y

Noai oa?/oaaiiy

Iia?aoe?eia eaoaeuei?noue i?i?iaeueia

< 35,0 > 35,0

a?aenooi?e

a?aenooiy

+++

< 1% na?aaei? 35,0—50,0 30,0—35,0 o?aiceoi?iee noaee?i?/ia (+) ( 10% oyaeea > 50,0

< 30,0 ?acenoaioiee ee?i?/ia – – – > 50%

C iaoith iiia?aaeiueiai aecia/aiiy iiaeeeaiai ianyao o??o?a?/iiai
ao?o/aiiy aeei?enoiaoaaee o?e a?oie ?eceeo ca Stone: oei A
(ooieoe?iiaeueiee ?aca?a ia/?iee caaeia?eueiee, ?aaaia?aoe?y ii?iaeueia,
iiaeeeaa ?acaeoe?y aei 85% ia?aio?ie); oei B (ooieoe?iiaeueiee ?aca?a
ia/?iee iiieaeaiee, ?aaaia?aoe?y iaiaaeaia, iiaeeeaa ?acaeoe?y aei 20%
ia?aio?ie); oei N (ooieoe?iiaeueiee ?aca?a ia/?iee iacia/iee,
?aaaia?aoe?y a?aenooiy, ?acaeoe?y iaiiaeeeaa).

Ie??i caaaeueiii?eeiyoeo aeine?aeaeaiue aeey ae?aaiinoeee eieaeueii?
iaoieia?? ia/?iee, ?? ao?ieia?? oa aaaeaiiai ia’?io ?acaeoe?? aoee
aeei?enoai? oa ?ino?oiaioaeuei? iaoiaee: oeueo?acaoeiaa aeine?aeaeaiiy
i?aai?a /a?aaii? ii?iaeieie (107), aeeiai?/ia noeeioea?ao?y ia/?iee
(28), eiii’thoa?ia oiiia?ao?y (48), aia?ia?ao?y, ui aeeth/a?
oeae?aeiiacaioa?eeia?ao?th ? ieaeith eaaaa?ao?th (18), ?io?aiia?aoe?eia
oeueo?aniiia?ao?y (36).

Aeey ioe?iee eaoaai??? ooieoe?iiaeueiiai ?aca?ao, ca?aeii c e?eoa??yie
Stone, aecia/aee oae? a?io?i?/i? iieacieee ne?iaaoee e?ia? (o aeoaeeao
iaaaaeai? ii?iaeuei? cia/aiiy), caaaeueiee a?e??oa?i (aei 20,5
ieiieue/e), ui oa?aeoa?eco? aene?aoi?io ooieoe?th ia/?iee, aeueaoi?i
(35,0—55,0 a/e) oa i?io?iia?iiaee ?iaeaen (90—100%), ui oa?aeoa?ecothoue
neioaoe/io ooieoe?th. I?i noai aaiaoioeeo?a noaeeee ca iieacieeaie
aeoeaiino? ne?iaaoeiaeo o?ainai?iac aeai?iai?iio?ainoa?ace (AEAO) (aei
0,68 ieiieue/a-e) oa ania?oai?iio?anoa?ace (ANAO) (aei 0,45
ieiieue/a-e). I?ae?aooiie ee?oei ia?eoa?e/ii? e?ia? oa a?io?i?/i?
aeine?aeaeaiiy aeeiioaaee ia?aeaeueii aei iia?aoe??, /a?ac 3—7—14 ae?a
i?ney iia?aoe?? oa o a?aeaeaeaiee ia??iae.

?acaeoe?? ia/?iee ?c aeei?enoaiiyi o?aaeeoe?eieo niinia?a ?icae?eaiiy
ia?aio?ie (aeea?oieeac?y, i?ioeaaiiy aia?aoaie OEE) ? inoaoi/iiai
aaiinoaco (?o/iee aaiinoaoe/iee oia) aoee aeeiiai? o 53 (49,5%) oai?eo.

?acaeoe?? ?c aeei?enoaiiyi iaeio?aaiaoe/ieo niinia?a ?icae?eaiiy
ia?aio?ie e inoaoi/iiai aaiinoaco c?iaeai? o 54 (50,5%) iaoe??io?a. O
oe?e a?oi? aeey ?icoeiaiiy ia?aio?ie ia/?iee canoiniaoaaee
oeueo?acaoeiaee ani??aoi? Aloka-SUS 201 D (ssiii?y), yeee ooieoe?iio? a
o?eeiioo?iiio ?aaeei? (???eaaoe?y, a?a?aoe?y ? ani??aoe?y), a oaeiae
ia?iaeyee ??ci? ia?aiao?e ?aaeei?a caeaaeii a?ae iaoiaeo oa ieaiiaaiiai
ia’?io ?acaeoe??. Eaca?io onoaiiaeo «?iiaoea-2» (N?N?) ia aac?
aoaea?iaeo oa aae?e-iaiiiaiai eaca?a, aeei?enoiaoaaee aeey ?icoeiaiiy
ia/?iee oeyoii aeia?oaaiiy ia?aio?ie a ?aaeei? ??caiiy c aeiiiiiaith
niaoe?aeueieo caaeei?a ? eiaaoeyoe?? ?acaeoe?eii? iiaa?oi?
?icoieoniaaiei i?iiaiai c iaoith cae?eniaiiy aaiinoaco.

Aeey aeinyaiaiiy inoaoi/iiai aaiinoaco i?iaiaeeee aenoooaaiiy e
eiaaoeyoe?th ?acaeoe?eii? iiaa?oi? no?oiaiai iia?o?y i?e oaiia?aoo??
200—500(N ca aeiiiiiaith iiaaiieiaaoeyoi?a «Leister» (Aano??y).

Iniaeeaino? ii?oieia?/ii? ?aaeoe?? ia?aio?ie i?e aeei?enoaii?
oeueo?acaoeiaiai ani??aoi?a Aloka-SUS 201 D oa o?aaeeoe?eii? iaoiaeeee
?acaeoe?? ia/?iee ?c canoinoaaiiyi aia?aoo, ui i?ioeaa?, aoee aea/ai? a
na??? ?c 20 aenia?eiaio?a ia a?eeo iaoetheao.

Noaoenoe/io ia?iaeo iaea?aeaieo ?acoeueoao?a ii O?oa?-Nouethaeaioo oa
I??niio i?iaiaeeee ?c aeei?enoaiiyi noaiaea?oieo eiii’thoa?ieo i?ia?ai.
?acoeueoaoe aaaaeaee aeinoia??ieie ca ??aiai cia/ouino? ? < 0,05. Iniiai? ?acoeueoaoe aeine?aeaeaiue Ii?aoethaaiiy oaoi?ee ?acaeoe?? ia/?iee ?c canoinoaaiiyi oeueo?acaoeiaiai ani??aoi?a cae?enithaaee a aenia?eiaio? ia 10 iaoetheao (iniiaia a?oia). ?icoeiaiiy ia?aio?ie aeeiioaaee ii e?i?? ?acaeoe?? c i?i?iaeueiith o?aaiaoecaoe??th oeaieie ia/?iee, caaacia/oth/e i?e oeueiio aaeaeaaoio ?aeaioeo?eaoe?th aioo??oiueiia/?ieiaeo noaeeiii-nae?aoi?ieo no?oeoo?. ?acaeoe?y ia/?iee ca o?aaeeoe?eiith iaoiaeeeith c aeei?enoaiiyi aia?aoo, ui i?ioeaa?, i?iaaaeaia oaeiae o 10 iaoethe?a (eiio?ieueia a?oia). Aea/aiiy ii?oieia?? ?aia?aoeaieo i?ioean?a ia/?iee i?iaiaeeee oeyoii aeine?aeaeaiiy aenia?eiaioaeueiiai iaoa??aeo — ?ioaeoieo ae?eyiie ia?aio?ie acaeiaae e?i?? ?acaeoe?? ia a?aeaeae? 1,5 ni a?ae i?noey iioeiaeaeaiiy. Noai oeaieie ia/?iee ioe?ithaaee ia 7 ? 14-oo aeiao i?ney iia?aoe??. ?acoeueoaoe aenia?eiaioaeueieo aeine?aeaeaiue iiaeai? o oaaeeoe? 3. Aiae?c ii?oieia?/ieo ci?i a eiio?ieuei?e a?oi? iieacaa, ui no?oeoo?a ia/?ieiaeo /anoi/ie ? aaeie o oe?eiio aoea cia/ii ii?ooaia. A?eueoa /anoeia noaeei ia/?iee aoea ?icoe?aia ? ?oi? i?ina?oe caiiaiai? a?eo?ioeeoaie. O aaaaoueio aeiaaeeao a?aei?/aia ?io?eueo?aoe?y ia?aio?ie oa ii?oaeueieo o?aeo?a. Ee?oeia? aeaiaioe ?io?eueo?aoo ?icoaooaaeenue eieaeueii ? aeeoocii. O i?noe? ?acaeoe?? aecia/eeenue iaoe?i? eiaaoeyoe?ei? iae?ice, a?aeie?aieai? a?ae caa?aaeaii? ia?aio?ie aocueeith iieineith o?a?icii? oeaieie. Ii ia?eoa??? iae?ioeciaaieo ae?eyiie a?aecia/aii iineeaiiy ee?oeiii? ?io?eueo?aoe??. Iienai? ci?ie noi?iaiaeaeoaaeenue iioe?aiith noaeeiiith ?aaeoe??th o aeaeyae? ?ic?inoaiue a?aioeyoe?eii? oeaieie ? ooai?aiue aia?iiaoicieo no?oeoo?. A iniiai?e a?oi? oaeiae niinoa??aaeenue no?oeoo?i? ci?ie a ia?aio?i? ia/?iee. Aeyaeai? ae?eyiee ii?ooaiiy aaeeiai? aoaeiae, oi/ o oe?eiio iaethiie oeaieie i?aaia aoa caa?aaeaiee. Niinoa??aaeenue ae??aiiaiaieuaa? iae?ice, ie?ai? e?iaiaeeeae, ia aoei ae?eyiie ai?eiiai ?icieaaeaiiy oeaieie. A?aecia/aia iii??ia /e iacia/ia ?io?eueo?aoe?y ie?aieo ii?oaeueieo o?aeo?a. Ciia ?acaeoe?? aoea iiai?noth i/euaia a?ae iae?ioe/ieo ian ? iie?eoa o?a?icieie a?aioeyoe?yie. Aeeno?io?/i? ci?ie aaiaoioeeo?a ae?aaeai? neaai, niinoa??aaeenue ae?eyiee ia?aio?ie, a?aecia/ai? /?oeeie iaaeaie aaiaoioeeo?a ? aacio?e??th oeeoiieacie. Ia 14-oo aeiao aoee aeyaeai? iciaee ?aaaia?aoe??, aaiaoioeeoe ?c e?oiieie yae?aie, /anoi cono??/aeenue aeaoyaea?i? ee?oeie. I?iaaaeaia aenia?eiaioaeueia aeine?aeaeaiiy iieacaei, ui i?e aeei?enoaii? oeueo?acaoeiaiai ani??aoi?a aeey ?icoeiaiiy oeaieie ia/?iee ia’?i aeyaeaieo iioeiaeaeaiue ia?aio?ie aoa o 6 ?ac?a iaioei, i?ae i?e aeei?enoaii? noaiaea?oii? iaoiaeeee. Ia 14-oo aeiao i?ney ?acaeoe?? a?aei?/aii oi?ioaaiiy oiieiai o?a?iciiai ?oaoey. ?noioieo aeeno?io?/ieo ci?i o ia?aio?i? ? c aieo noaeei ia noinoa??aaee. Ii??aiyeueiee aiae?c o?aaeeoe?eieo oa iaeio?aaiaoe/ieo iaoiae?a ?acaeoe?e ia/?iee aoei i?iaaaeaii o 107 oai?eo, yeei o 41 (38,3%) aeiaaeeo aoei aeeiiaii aaeee? ?acaeoe?? (( 4 naaiaioe) ? o 56 (52,3%) aeiaaeeao iae? (< 4 naaiaio?a). A ie?aio a?oio aoee aeae?eai? ?acaeoe?? ia/?iee i?e iaoai?/i?e aeiaoyieoe? iooeeiiiai iioiaeaeaiiy o 10 (9,4%) iaoe??io?a (oaae. 4). O a?eueoino? aeiaaee?a iieacaiiyi aei aeeiiaiiy aaeeeeo ?acaeoe?e neoaeeee ia?aeiiee ?ae ia/?iee ? eaaa?iicia aaiaia?iia. Ia’?i ?acaeoe?? aecia/aany oa?aeoa?ii ? eieae?caoe??th iaoieia?/iiai i?ioeano. Aaeeeo aai?aaiaoaeoii?th aeeiioaaee i?e oe?ieiio i?ioean? ?c iioe?aiiyi ia iaeaea? /anoee ia/?iee. Aaeeeeo ?acaeoe?e aoei i?iaaaeaii 41, cie?aia c a?aooaaiiyi i?eioeei?a iaeio?aaiaoe/iino? — 14, ca o?aaeeoe?eiith iaoiaeeeith — 27. Ia’?i ?acaeoe?e o ii??aithaaieo a?oiao aoa ?aeaioe/iei. Oaaeeoey 4 ?iciiae?e oai?eo ca iaoieia??th oa oa?aeoa?ii ao?o/aiiy Caoai?thaaiiy ?IAA ?EAA IAA EAA ANA NNA NA A? Onueiai Ia?aeiiee ?ae Aaiaia?iia Aaeaiiia Ao?iieieic Nie?oa?ia e?noa Iie?e?noic O?aaia ia/?iee E?iiiaoic Iaoanoaoe/. ?ae ?ae aeia/. i?oo?a 2 2 — 2 — — — — — — 1 1 — — — — — — — — 5 3 — — 3 — — — 2 — 3 12 1 2 1 — 2 — — — 3 10 — 8 3 — — 2 1 — — 1 1 3 — — — — — — 2 3 1 14 2 — — — 1 2 2 5 1 2 1 1 — — — 2 18 37 4 21 10 1 2 2 4 8 Onueiai 6 2 13 21 29 5 15 16 107 I?ei?oea: ?IAA — ?icoe?aia i?aainoi?iiiy aai?aaiaoaeoii?y; ?EAA — ?icoe?aia e?ainoi?iiiy aai?aaiaoaeoii?y; IAA — i?aainoi?iiiy aai?aaiaoaeoii?y; EAA — e?ainoi?iiiy aai?aaiaoaeoii?y; ANA — a?naaiaioaeoii?y; NNA — noanaaiaioaeoii?y; NA — naaiaioaeoii?y; A? — aoeiiaa ?acaeoe?y. Aiae?c ?acoeueoao?a o??o?a?/iiai e?eoaaiiy aeyaea, ui i?e aeei?enoaii? o?aaeeoe?eiiai i?aeoiaeo aei aeeiiaiiy ?acaeoe?? ia/?iee /anoioa ?icaeoeo ?io?a- oa i?neyiia?aoe?eieo oneeaaeiaiue — 14 (51,9%), cia/ii aeua, i?ae i?e iaeio?aaiaoe/iiio i?aeoiae? — 5 (35,7%), ? ?oi?e niaeo? cia/ii oe?oee. No?oeoo?a oneeaaeiaiue i?ae /an aeeiiaiiy aaeeeeo ?acaeoe?e ia/?iee o?aaeeoe?eieie iaoiaeaie aeeth/aea: ?io?aiia?aoe?ei? — o?aaia aaeeeeo noaeei 5 (18,5%), ia?ao?iaoicia e?iaioa/a 11 (40,7%), o?aaia aeia/ieo i?ioie 2 (7,4%), o?aaia ?icoaoiaaieo iiaeeco i?aai?a 2 (7,4%), i?neyiia?aoe?ei? — e?iaioa/a ?c eoeueo? ia/?iee 2 (7,4%), ia/?ieiaa iaaeinoaoi?noue 2 (7,4%), aenoaeaoeaiee ieaa??o 2 (7,4%). No?oeoo?a oneeaaeiaiue i?e aeeiiaii? aaeeeeo ?acaeoe?e ia/?iee ?c aeei?enoaiiyi iaeio?aaiaoe/ieo iaoiae?a aeeth/aea: ?io?aiia?aoe?ei? — ia?aio?iaoicia e?iaioa/a 3 (21,4%), i?neyiia?aoe?ei? — ia/?ieiaa iaaeinoaoi?noue — 1 (7,1%), aenoaeaoeaiee ieaa??o 1 (7,1%). I?e iaeio?aaiaoe/iiio i?aeoiae? ia aoei a?aei?/aii o?aai aaeeeeo noaeei, aeia/ieo i?ioie ? ?icoaoiaaieo iiaeeco i?aai?a, o i?neyiia?aoe?eiiio ia??iae? ia niinoa??aaeinue aeia/ieo ii?eoeue ? aioo??oiuei/a?aaieo e?iaioa/ ?c eoeueo? ia/?iee. I?e/eiith oeueiai ? a?eueo iaae?eiee aaiinoac ? a?aenooi?noue oe?ieeo ae?eyiie iae?ico ia?aio?ie. On? aeua caaaeai? oaeoi?e a?aeia?aceeenue ia eaoaeueiino?, yei? i?e iaeio?aaiaoe/iiio i?aeoiae? ia aoei, a i?e o?aaeeoe?eiiio niinoa??aaeanue a 11,1% aeiaaee?a (3 oai?eo). Iaie i?iaaaeaii ioe?iaiiy noaio ooieoe?iiaeueiiai ?aca?ao ia/?iee ii Stone o a?oiao, ye? ii??aithaaeenue. A iniiaiiio oea aoee oai?? eaoaai??? A — 34 (83%). Inoaii? oai?? a?aeianai? aei eaoaai??? B — 6 (14,6%), N — 1 (2,4%). Oea aiai?eoue i?i oa, ui iaa?oue i?e iecueeiio ooieoe?iiaeueiiio ?aca?a? ia/?iee cieaeaiiy o?aaiaoecaoe?? ia?aio?ie i?ae /an iia?aoe?? aea? iiceoeai? ?acoeueoaoe ? aeicaiey? oai?iio ia?aianoe oaea neeaaeia ao?o/aiiy, yeei ? aaeeea ?acaeoe?y ia/?iee. O i?neyiia?aoe?eiee ia??iae iaie ioe?ithaaeenue ?aaaia?aoi?i? i?ioeane o ia/?ioe? oeyoii aeine?aeaeaiiy neioaoe/ii?, aene?aoi?ii? ooieoe?e ? noai aaiaoioeeo?a. Ioe?iea aene?aoi?ii? ooieoe?? ia/?iee i?iaiaeeeanue oeyoii aeine?aeaeaiiy aeeiai?ee caaaeueiiai a?e??oa?io, ca?eueoaiiy ai?noo yeiai ia 7-io aeiao i?ney iia?aoe?? a iaio a?oiao aeaco? ia iia??oaiiy ooieoe??. I?e aeei?enoaii? o?aaeeoe?eieo iaoiae?a aeeiiaiiy ?acaeoe?? ii?iae?caoe?y ??aiy caaaeueiiai a?e??oa?io ianoaea eeoa o a?aeaeaeaiiio ia??iae?, oiae? ye i?e iaeio?aaiaoe/iiio i?aeoiae? i?eiaa i?aeaeuaiiy ??aiy a?e??oa?io aoei iaioa ae?aaeaia, a ii?iaeuei? iieacieee a?aei?/aeenue oaea ia 14-oo aeiao. Oea na?ae/eoue i?i iaioo o?aaiaoecaoe?th ia?aio?ie ia/?iee ? oaeaeeo ?? ?aaaia?aoe?th o ?aiiueiio i?neyiia?aoe?eiiio ia??iae?. Aiae?c aeeiai?ee iieaciee?a neioaoe/ii? ooieoe?? ia/?iee ? noaio aaiaoioeeo?a aeyaea iiae?aio oaiaeaioe?th ooieoe?iiaeueiiai iia??oaiiy ia 7-io aeiao i?ney iia?aoe?? ?c ianooiiith ii?iae?caoe??th o a?aeaeaeaiiio ia??iae?, i?e/iio i?e iaeio?aaiaoe/iiio i?aeoiae? ii?iae?caoe?y ianooiaea ia 14—21 aeiao, oiaoi cia/ii ?ai?oa, i?ae i?e o?aaeeoe?eiiio i?aeoiae?. Aeeiai?ea iieaciee?a ooieoe?iiaeueiiai noaio ia/?iee aecia/aea i?io?eaiiy i?neyiia?aoe?eiiai ia??iaeo, oiio iaoe??ioe i?ney iaeio?aaiaoe/ieo ?acaeoe?e ciaoiaeeeenue o ee?i?oe? a na?aaeiueiio ia 5 ae?a iaioa. 0,32) ieiieue/a-e a?aeiia?aeii (P< 0,05). 994,7) ie. (P< 0,05). Oaeei /eiii i?aeaeuaiiy e?ioeaaiai ??aiy ai?noo a ne?iaaooe? e?ia? caaaeueiiai a?e??oa?io ? i?aeaeuaiiy aeoeaiino? ne?iaaoeiaeo o?ainai?iac, ye? ? ia?ea?aie aeoeaiino? oeeoie?oe/iiai i?ioeano, na?ae/eoue i?i ca?eueoaiiy ?eceeo ?icaeoeo ia/?ieiai-ie?eiai? iaaeinoaoiino? a iaeaeeae/iio i?neyiia?aoe?eiiio ia??iae? i?ney aeeiiaiiy ?icoe?aii? ?acaeoe?? ia/?iee. Ia’?i ?io?aiia?aoe?eii? e?iaiao?aoe ? aeinoia??iei oaeoi?ii ?eceeo aeeiiaiiy ?icoe?aieo ?acaeoe?e ia/?iee. 90,6)ie., ui a 3 ?ace iaioa a?aeiia?aeiiai iieacieea a a?oi? o?aaeeoe?eieo iaoiae?a. Oea aeicaieeei i?aeaeueoe ?acaeoaaaeuei?noue eieaeueii? iaoieia?? ia/?iee ?c a?aooaaiiyi ia’?io iaoieia??, eieae?caoe?? ? oa?aeoa?o ooieoe?iiaeueiiai ?aca?ao ia/?iee, oiaoi aeiaaeee, eio?? ?ai?oa aaaaeaeenue ia?acaeoaaaeueieie, oni?oii iia?oaaeenue iaie i?e aeio?eiaii? aeuacaaaeaiiai i?aeoiaeo. 22,0) oa. Aaeee? ?acaeoe?? ca o?aaeeoe?eiei iaoiaeii aeeiioaaeenue o na?aaeiueiio ia 30 oaeeei aeiaoa ca ?aooiie i?iaeai, iia’ycaieo c ?io?aiia?aoe?eiith e?iaioa/ath ? iaiao?aei?noth ieeueiiai eiio?ieth aaiinoaco. Iniiaieie iieacaiiyie aei aeeiiaiiy iaeeo ?acaeoe?e o iaoiio aeine?aeaeaii? aoee aeia?iye?ni? caoai?thaaiiy — aaiaia?iie ia/?iee oa ao?iieieic, naaiaioaeoii?? oaeiae aeeiioaaee i?e ceiye?ni?e iooeei? aeia/iiai i?oo?a. Oa?aeoa? iaoieia?? ? eieae?caoe?y i?ioeano aecia/aee ianya iia?aoeaiiai ao?o/aiiy. *ano?oa ca ana oea aoee a?naaiaioaeoii?? /e naaiaioaeoii??. A oeiiao ?acaeoe?th aeeiioaaee i?ae /an eieae?caoe?? i?ioeano iica iaaeaie naaiaioa. Iaeeo ?acaeoe?e ia/?iee aoei c?iaeaii 56, o oiio /ene? c o?aooaaiiyi i?eioeei?a iaeio?aaiaoe/iino? — 35, ca o?aaeeoe?eiith iaoiaeeeith — 21. Noai ooieoe?iiaeueiiai ?aca?ao ia/?iee ioe?iaii ca Stone a iaio a?oiao. A iniiaiiio oea aoee oai?? eaoaai??? A, o a?oi? c o?aaeeoe?eiei i?aeoiaeii — 20 (95%), c iaeio?aaiaoe/iei — 27 (77%). Aiae?c ?acoeueoao?a o??o?a?/iiai ao?o/aiiy oai?eo, yeei aoee c?iaeai? iae? ?acaeoe?? ia/?iee, iieacaa, ui e?euee?noue ?io?aiia?aoe?eieo oneeaaeiaiue o a?oi? c o?aaeeoe?eiei i?aeoiaeii — 11 (52,4%) cia/ii ia?aa?eueooaaea a?aeiia?aeiee iieaciee o a?oi? iaeio?aaiaoe/ieo ?acaeoe?e — 4 (11,4%). Iieacieee e?eueeino? ? /anoioe i?neyiia?aoe?eieo oneeaaeiaiue o a?oiao neeaee a?aeiia?aeii 10 (47,6%) ? 8 (22,9%). I?e iaeio?aaiaoe/iiio i?aeoiae? ia a?aei?/aii o?aai aeia/ieo i?ioie?a ? eeoa a iaeiiai oai?iai aoei iioeiaeaeaiiy e?oiii? noaeeie. Eaoaeuei?noue i?e iaeio?aaiaoe/ieo iaeeo ?acaeoe?yo ia/?iee oaeiae aoea a?aenooiy, a a a?oi? ?c o?aaeeoe?eiei i?aeoiaeii neeaea 4,8% (1 iaoe??io). Ine?eueee a a?oi? iaeio?aaiaoe/ieo ?acaeoe?e aoei a?eueoa iaoe??io?a eaoaai??? B —8 (23%), iiaeia c?iaeoe aeniiaie, ui iaeio?aaiaoe/iee i?aeo?ae aeicaiey? iia?oaaoe iaoe??io?a c iaii/aoeo a??oei ooieoe?iiaeueiei noaiii ? iaea?aeoaaoe e?au? ?acoeueoaoe. Ia’?i ?io?aiia?aoe?eii? e?iaiao?aoe ? iniiaiei oaeoi?ii, yeee aecia/a? /anoioo oneeaaeiaiue ? eaoaeuei?noue, i?e aeeiiaii? iaeeo ?acaeoe?e ia/?iee. I?e iaeeo ?acaeoe?yo, c?iaeaieo ?c aeio?eiaiiyi i?eioeei?a iaeio?aaiaoe/iino?, onoaiiaeaii ae?enia cieaeaiiy ia’?io ?io?aiia?aoe?eii? e?iaiao?aoe o 2 ?ace, ui aeicaieeei aeeiiaoe ?aaeeeaeuei? ?acaeoe?? i?e aaaeeeo eieae?caoe?yo iooeei (iiaeeco e?oiieo noaeei, o ae?eyioe? ?, VII, VIII naaiaio?a oa o ai?ioao) ? iecueeiio ooieoe?iiaeueiiio ?aca?a?, oiaoi o aeiaaeeao, ye? aaaaeaeenue ia?acaeoaaaeueieie. O?eaae?noue iia?aoe?? i?e iaeio?aaiaoe/ieo ?acaeoe?yo ia a?ae??ciyeanue a?ae o?aaeeoe?eieo. ?aaaia?aoi?i? i?ioeane ia/?iee o i?neyiia?aoe?eiee ia??iae ioe?ithaaeenue oeyoii aeine?aeaeaiiy nae?aoi?ii? neioaoe/ii? ooieoe?? ? noaio aaiaoioeeo?a ia 7, 14-oo aeiao ? o a?aeaeaeaiiio ia??iae?. Aiae?c aeeiai?ee aeine?aeaeoaaieo iieaciee?a aeyaea oaiaeaioe?th ooieoe?iiaeueiiai iia??oaiiy ia 7-io aeiao i?ney iia?aoe?? c iiaeaeueoith ii?iae?caoe??th o a?aeaeaeaiiio ia??iae?. I?e iaeio?aaiaoe/iiio i?aeoiae? ci?ie iieaciee?a ooieoe?iiaeueiiai ?aca?ao ia/?iee aoee iaioa ae?aaeai?, a ?o ii?iae?caoe?y ianoaaaea oaeaeoa, ui aeicaieeei ciaioeoe o?eaae?noue ia?aaoaaiiy o ee?i?oe? a na?aaeiueiio ia 5 ae?a. Iaea?eueo /anoei oeiii eieaeueii? iaoieia?? ia/?iee, ui i?eaiaeeoue aei ?icaeoeo iaoai?/ii? aeiaoyieoe?, ? ia?aeiiee ?ae c eieae?caoe??th a iaeano? ai??o i?aaia ( 8 iaoe??io?a). Ca aeaieie ioe?iee noaio ooieoe?iiaeueiiai ?aca?ao ia/?iee, an? oai?? aoee a?aeianai? aei a?oie N, a o??o?a?/i? ao?o/aiiy aoee i?iaaaeai? ca aeeoo?aeie iieacieeaie. I?e o?aaeeoe?eiiio i?aeoiae? aei aeeiiaiiy ?acaeoe?e ia/?iee o 5 iaoe??io?a aoea a?aei?/aia aaeeea e?euee?noue oyaeeeo ?io?a- oa i?neyiia?aoe?eieo oneeaaeiaiue, ui i?ecaaei a 4 (8%) aei eaoaeueiiai e?ioey. Iaie aoa ?ic?iaeaiee niin?a oi?ioaaiiy a?e?iaeeaanoeaiiai aianoiiica i?ae /an aeeiiaiiy ?acaeoe?? ia/?iee c aeei?enoaiiyi oeueo?acaoeiaiai aia?aoo, yeee iieyaa? a oi?ioaaii? i?o? a ia?aio?i? i?aaio a iaeano? ?icaeeee aeia/ieo i?ioie?a ia aeeaeio ? ia i?ioyc? aei a?coae?caoe?? iao?aaeaii? ae?eyiee i?ioie?a ?c ianooiiei iaeeaaeaiiyi aaiaoioieaia?i?thiiaianoiiica (iaoaio Oe?a?ie 10489 A). O 5 oai?eo iia?iaaieo ca?aeii c ?ic?iaeaiei iaie niiniaii eaoaeueieo aeiaaee?a ia aoei. I?e oeueiio ia’?i ?acaeoe?? ? ii/aoeiaee noai iaoe??io?a a iaio a?oiao aoee ?aeaioe/ieie. Oea aeicaiey? c?iaeoe aeniiaie, ui aeeiiaiiy ?aaeeeaeueieo iia?aoe?e i?e iaoai?/i?e aeiaoyieoe? iaoiiaeai?e iooeeiith ai??o ia/?iee, iiaeeeaa ? ia’?i ?acaeoe?? iiaea aooe ??ciei. Iaeiae aeio?eiaiiy an?o i?eioeei?a iaeio?aaiaoe/iino? ? i?e oeueiio iaia’yceiaei. Caaaeueia ioe?iea ?acoeueoao?a ?acaeoe?? ia/?iee, aeeiiaieo o 107 oai?eo i?eaaaeaia a oaaeeoe? 5. Oaeei /eiii, aiae?c iaeaeeae/eo ? a?aeaeaeaieo ?acoeueoao?a ?acaeoe?e ia/?iee o oai?eo c eieaeueiith iaoieia??th ??ciiai aaiaco iieacaa, ui /anoioa ? oa?aeoa? oneeaaeiaiue i?ney aeeiiaiiy ?acaeoe?e, a oaeiae iane?aeie iia?aoe?? caeaaeeoue a?ae aeai?o iaoiaeo, niiniao ?icoeiaiiy ia?aio?ie, iaae?eiino? aaiinoaco ? a?aeiia?aeiino? ianyao ao?o/aiiy, noaio ooieoe?iiaeueiiai ?aca?ao i?aaia. Aeio?eiaiiy i?eioeei?a iaeio?aaiaoe/iino? aeicaiey? a?aeaeueoe ?acaeoaaaeuei?noue eieaeueii? iaoieia??, ciaioeoe e?euee?noue ?io?a- ? i?n?eyiia?aoe?eieo oneeaaeiaiue ? caanoe aei ioey iieacieo eaoaeueiino?, ui ni?ey? nei?i/aiith no?ie?a aini?oae?caoe?? a na?aaeiueiio ia 5 ae?a. Aeio?eiaiiy aeuacaaaeaieo i?eioeei?a aeicaiey? aacia/ii i?iaiaeeoe ?aaeeeaeuei? ?acaeoe?? o iaoe??io?a c iaoai?/iith aeiaoyieoeath, iaoiiaeaiith iooeeiith ai??o ia/?iee. AENIIAEE Iniiaiith i?e/eiith iacaaeia?eueieo ?acoeueoao?a aeeiiaiiy ?acaeoe?e ia/?iee c aeei?enoaiiyi o?aaeeoe?eieo niinia?a ? iaaei?aaaeaia o?aaiaoecaoe?y ia?aio?ie i?aaia, ui i?ecaiaeeoue aei ?icaeoeo iaea?eueo iaaacia/ieo oneeaaeiaiue ?aiiueiai i?neyiia?aoe?eiiai ia??iaeo — aioo??oiuei/a?aaii? e?iaioa/? ? aaiaoa?a??. Ii?oieia?/i? ci?ie ?acaeoe?eiiai e?ath ia/?iee i?e aeeiiaii? ?acaeoe?e c aeei?enoaiiyi oeueo?acaoeiaiai ani??aoi?a a 6 ?ac?a iaioa ae?aaeai?, i?ae i?e aeei?enoaii? o?aaeeoe?eieo niinia?a ?icoeiaiiy ia?aio?ie ? ia?iaee eoeueo? i?aaio. I?neyiia?aoe?ei? ci?ie ooieoe?iiaeueiiai noaio ia/?iee i?e aeeiiaii? iaeio?aaiaoe/ieo ?acaeoe?e ae?aaeai? iaioa i?ae i?e aeei?enoaii? o?aaeeoe?eieo niinia?a, a ii?iae?caoe?y a?io?i?/ieo iieaciee?a ianoa? oaea a iaeaeeae/iio i?neyiia?aoe?eiiio ia??iae?. Iaeio?aaiaoe/iee i?aeo?ae i?e aeeiiaii? ?acaeoe?e ia/?iee ? iaea?eueo ?aoe?iiaeueiei ? aeeth/a? a naaa oii?/io ae?aaiinoeeo, aeei?enoaiiy no/anieo niinia?a ?icoeiaiiy ia?aio?ie ? aaiinoaco. Oeueo?acaoeiaa ani??aoe?y ? ia?iaea ?acaeoe?eiiai e?ath ia/?iee ?icoieoniaaiei i?iiaiai eaca?a caaacia/eee cieaeaiiy ia’?io ?io?aiia?aoe?eii? e?iaiao?aoe a 2—3 ?ace ? i?aeaeuaiiy ?acaeoaaaeueiino?. Aeio?eiaiiy i?eioeei?a iaeio?aaiaoe/iino? i?e aeeiiaii? ?acaeoe?e ia/?iee aeicaiey? i?iaiaeeoe ?aaeeeaeuei? iia?aoe?? o iaoe??io?a c iaoai?/iith aeiaoooith, iaoiiaeaiith eieae?caoe??th iaoieia?/iiai i?ioeano a iaeano? ai??o i?aaia. Ai?iaaaeaeaiiy ?ic?iaeaiiai i?aeoiaeo aei aeeiiaiiy ?acaeoe?e ia/?iee ni?eyei cieaeaiith /anoioe i?neyiia?aoe?eieo oneeaaeiaiue c 51,9% aei 35,7% ? iieacieea eaoaeueiino? aei ioey, a oaeiae nei?i/aiiy no?ie?a aini?oae?caoe?? iaoe??io?a o na?aaeiueiio ia 5 ae?a. NIENIE IOAE?EAOe?E CA OAIITH AeENA?OAOe?? 1.Oaeeiia A.A., Oaeeiia N.A., Eaeeoa I.ss., Eioaiei I.A., AEoeae A.A. Auai? ?aoeeiiaeueiiai niiniaa oe?o?ae/aneiai aiaoaoaeuenoaa i?e i/aaiauo ii?aaeaieyo ia/aie //Ee?i. o??o?a?y.- 1993.- ? 5.- N. 3-8. 2.Eeaoeoe TH.C., AEoeae A.A. Aoeie/iay ?acaeoeey ia/aie n i?eiaiaieai oeueo?acaoeiaiai anie?aoi?a //Ee?i. o??o?a?y.- 1994.- ? 9.- N. 68-69. 3.Aeiioeiaa E.N., AEoeae A.A. I?aeiouanoaa eniieueciaaiey oeueo?acaoeiaiai anie?aoi?a Aloka-201 D i?e ?acaeoeee ia/aie //Ee?i. o??o?a?y.-1996.- ?9.- N.22-24. 4.AEoeae A.A. ?acaeoeee ia/aie //AEo?i.i?aeoe/aneiai a?a/a.-1997.- ?3.- N. 11-13. 5.Oaeeiia A.A., Eaeeoa I.ss., AEoeae A.A. Eeeie/aneee iiuo ?acaeoeee ia/aie //I?iaeaie eeiii/iii oi?o?ai?.- E.., 1997.- N. 113-119. 6.Oaeeiia A.A., AEoeae A.A. ?acaeoeey ia/aie //Aeooaeuei? i?iaeaie iaie?aaoiaaiaoia?e?a?ii? oa noaeeiii? o??o?a??.- E.: Ee?i. o??o?a?y.- 1998.- N.14-18. 7.Iaoaio 10489 A Oe?a?ia, IEA 5 A61A17/00. Niinia ea/aiey no?eeoo? aioo?eia/aii/iuo aeae/iuo i?ioieia /Oaeeiia A.A., Eii/ae A.I., AEoeae A.A. (Oe?a?ia).- ? 95041572; Cayae. 07.04.95; Iioae. 25.12.96, Athe. ? 4.- 2 n. 8.Oaeeiia A.A., Iiaei?yoia N.A., Coaeia A.E., Eiiooaineee ss.I., AEoeae A.A. ?acaeoeey ia/aie n aueeth/aieai ae ec e?iaioiea //Oacenu aeieeaaeia IX nuacaea oe?o?aia Aaei?onnee.- Aeoaane, 1985.- N. 230-231. 9.Iiaei?yoia N.A., Eiiooaineee ss.I., AEoeae A.A. Iieacaiey e ?acaeoeee ia/aie n aueeth/aieai ae ec e?iaioiea //Oe?o?ae/aneia ea/aiea ii?oaeueiie aeia?oaicee, caaieaaaiee e o?aai ia/aie.- Oa?ueeia, 1986.- N. 159-160. 10.Oaeeiia A.A., Eaeeoa I.ss., Ie/eoaeei I.A., Eeaoeoe TH.C., Aoeaiia E.E., AEoeae A.A., Eioaiei I.A. Eeeie/aneee iiuo aiaoiie/aneeo e aoeie/iuo ?acaeoeee ia/aie //I/aaiaua ii?aaeaiey ia/aie e aeethniua iiooiee aeae/iuo i?ioieia.- Ee?ia, 1994.- N. 121-122. 11.Oae?iia N.I., Oae?iia I.I., AEoeae A.A. Aeina?ae 163 ?acaeoe?e ia/?iee i?e aiaieuaaeo o?aaeaiiyo //Oace aeiiia?aeae ? (OVII) c’?caeo o??o?a?a Oe?a?ie.- Euea?a, 1994.- N.145. 12.Oaeeiia A.A., Oaeeiia N.A., Ie/eoaeei I.A., AEoeae A.A. Iiaua oaoiieiaee a ia/aii/iie oe?o?aee //Iiaua oaoiieiaee a oe?o?ae/aneie aaiaoieiaee.- Naieo-Iaoa?ao?a, 1995.- N. 151-153. 13.Shalimov A., Kalita N., Boulanov K., Julay V.Combined technique of liver resection //HPB.- 1997.- Vol. 1 (Suppl. 1).- P. 20. AIIOAOe?ss AEoeae A.A. Ii??aiyeueia ioe?iea niinia?a ?acaeoe?? ia/?iee. - ?oeiien. Aeena?oaoe?y ia caeiaoooy iaoeiaiai nooiaiy eaiaeeaeaoa iaaee/ieo iaoe ca niaoe?aeuei?noth 14.01.03 - o??o?a?y. Ee?anueea iaaee/ia aeaaeai?y i?neyaeeieiiii? ina?oe IIC Oe?a?ie ?i. I.E. Ooieea, Ee?a, 1998. Aeena?oaoe?y i?enay/aia ieoaiiyi o??o?a?/iiai e?eoaaiiy 107 oai?eo c aiaieuaaith iaoieia??th ia/?iee. A aenia?eiaio? aea/aia ii?oieia?y ?aia?aoeaieo i?ioean?a o ia/?ioe? i?ney aeeiiaiiy ?acaeoe??. Aeine?aeaeai? a aeeiai?oe? iieacieee ooieoe?iiaeueiiai ?aca?ao ia/?iee i?ney aeei?enoaiiy ??cieo iaoiae?a ?acaeoe??. A ?acoeueoao? i?iaaaeaiiai aiae?co aena?oeai? a??ia?aei? i?iaiinoe/i? oaeoi?e eaoaeueiiai e?ioey i?ney ?icoe?aieo ?acaeoe?e ia/?iee. Cai?iiiiiaaii iaeio?aaiaoe/iee eiia?iiaaiee niin?a ?acaeoe?? ia/?iee, ni?yiiaaiee ia ciaioaiiy ia’?io ?io?aiia?aoe?eii? e?iaiao?aoe. ?ic?iaeaii iiaee niin?a ?acaeoe?? ia/?iee o oai?eo c iaoai?/iith aeiaoyieoeath iooeeiiiai aaiaco. Ai?iaaaeaeaiiy iaeio?aaiaoe/ieo niinia?a aeeiiaiiy ?acaeoe?? c o?aooaaiiyi aeyaeaieo oaeoi??a ?eceeo aeicaieeei, ii??aiyii c o?aaeeoe?eieie niiniaaie, cia/ii iie?aueoe ?acoeueoaoe o??o?a?/iiai e?eoaaiiy oai?eo c aiaieuaaith iaoieia??th ia/?iee. Eeth/ia? neiaa: ?acaeoe?y ia/?iee, iaeio?aaiaoe/iee niin?a, oaeoi?e ?eceeo, ooieoe?iiaeueiee ?aca?a. AIIIOAOeEss AEoeae A.A. N?aaieoaeueiay ioeaiea niiniaia ?acaeoeee ia/aie. - ?oeiienue. Aeenna?oaoeey ia nieneaiea iao/iie noaiaie eaiaeeaeaoa iaaeeoeeineeo iaoe ii niaoeeaeueiinoe 14.01.03 - oe?o?aey. Eeaaneay iaaeeoeeineay aeaaeaiey iineaaeeieiiiiai ia?aciaaiey IC Oe?aeiu ei. I.E. Ooieea, Eeaa, 1998. Aeenna?oaoeey iinayuaia aii?inai oe?o?ae/aneiai ea/aiey 107 aieueiuo n i/aaiaie iaoieiaeae ia/aie. A yenia?eiaioa eco/aia ii?oieiaey ?aia?aoeaiuo i?ioeannia a ia/aie iinea auiieiaiey ?acaeoeee. Enneaaeiaaiu a aeeiaieea iieacaoaee ooieoeeiiaeueiiai ?aca?aa ia/aie iinea eniieueciaaiey ?acee/iuo iaoiaeia ?acaeoeee. A ?acoeueoaoa i?iaaaeaiiiai aiaeeca auyaeaiu aeinoiaa?iua i?iaiinoe/aneea oaeoi?u eaoaeueiiai enoiaea iinea ?anoe?aiiuo ?acaeoeee ia/aie. I?aaeeiaeai iaeio?aaiaoe/iue eiiaeie?iaaiiue niinia ?acaeoeee ia/aie, iai?aaeaiiue ia oiaiueoaiea iauaia eio?aiia?aoeeiiiie e?iaiiioa?e. ?ac?aaioai iiaue niinia ?acaeoeee ia/aie o aieueiuo n iaoaie/aneie aeaeoooie iiooieaaiai aaiaca. Aiaae?aiea iaeio?aaiaoe/iuo ciiniaia auiieiaiey ?acaeoeee n o/aoii auyaeaiiuo oaeoi?ia ?enea iicaieeei, a n?aaiaiee n o?aaeeoeeiiiuie niiniaaie, cia/eoaeueii oeo/oeoue ?acoeueoaou oe?o?ae/aneiai ea/aiey aieueiuo n i/aaiaie iaoieiaeae ia/aie. Eeth/aaua neiaa: ?acaeoeey ia/aie, iaeio?aaiaoe/iue niinia, oaeoi?u ?enea, ooieoeeiiaeueiue ?aca?a. SUMMARY Julay V.V. Comparative evaluation of liver resection techniques.- Manuscript. The thesis for a Degree of a Candidate of Medical Sciences on specialty 14.01.03 - surgery. Kiev Medical Academy of Post-Graduate Education of Ministry of Health of Ukraine, Kiev, 1998. The thesis is devoted to surgical treatment of 107 patients with focal liver lesions. Morphological studies of liver regeneration following resection were performed experimentally. Alterations of liver functional reserve after various methods of resection were investigated. Significant prognostic factors of fatal outcome owing to extended hepatectomies were elucidated. Miniinvasive combined technique of liver resection is elaborated to decrease intraoperative blood loss. A new surgical method is proposed for patients with obstructive jaundice secondary to liver tumour. When compared with conventional approach, the new miniinvasive techniques proved to be safe and effective, providing considerable improvement in results of surgical treatment of patients with focal liver lesions. Key words: liver resection, miniinvasive technique, risk factors, functional reserve. PAGE PAGE 2

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