Острые тром-бозы шунта являются нехарактерным осложнением ТИПС. В 2% случаев развиваются ранние тромбозы в сроки до 30 суток послеоперационного периода.


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EDITOR-IN-CHIEF:
MD, Professor, Honoured Doctor of the Russian Federation O. E. LUTSEVICH
DE
U
EDITOR
MD, Professor . M. S
UT
K
EDITORI
B
O
RD
:
Anishenko V. V., MD, Professor; Bondarenko V. O., MD, Professor, Honoured Doctor of the Russian Federation;
Vinnik Yu. S., MD, Professor; Vtorenko V. I., MD, Professor; Gallyamov E. A., MD, Professor; Dubrov V. E., MD, Professor;
anov F. S., MD, Professor; Lyadov V.
K
., Ph.D; Puchkov
K
.V., MD, Professor; Tolstych M. P., MD, Professor;
Fedorov I. V., MD, Professor; Shumakov D. V., MD, Professor; Tcar
kov P. V., MD, Professor; Shabunin A. V., MD, Professor;
Shirinskiy V. G., MD, Professor; Yashkov Yu. I., MD, Professor
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О Рпттйктлйк Уойгжстйужу
Цжоусбмьобя впмьойчб д. Бблу, Аижсвбкезботлбя сжтрувмйлб
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COMBINED TREATMENT OF RE
TAL
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The Department of hospital surgery with the course of pediatric surgery of the RUDN University,
Central Clinical Hospital of the Russian Academy of Sciences, Moscow
Central hospital Baku city, Azerbaijan Republic
Summary:
Presents a clinical case describing the possibility of combined treatment the patient 67 years old with severe premorbidal background, which was
successfully performed transanal resection of the rectum a¢er e£ective preoperative chemoradiotherapy. •e conclusion about the e£ectiveness of the combined
treatment of patients with rectal cancer in older age groups.
Key words:
rectal cancer, chemoradiotherapy, transanal resection of the rectum.
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emal A., Bray F., Center M.M., Ferlay J., Ward E., Forman D.
Global cancer statistics. CA Cancer J Clin. 2011; 61(2):69-90. doi: 10.3322/
caac.20107.

orre L.A., Bray F., Siegel R.L. Ferlay J., Lortet-Tieulent J.,
Jemal A.
Global cancer statistics, 2012. CA Cancer J Clin. 2015; 65(2):87-
108. doi: 10.3322/caac.21262

ƒ „.., \t ….„.
 Œ\n\f† 
\n‚Œ\n \n   †   \n 2009 Ž.   Ž
ŽŽ Ž   . . † . .,
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 .†., \r „.‡.
\nŠ\n\n †
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  …..
˜\n   ­ Š. //
„­ Ž­. - 2008 ¥ ….9, §1 ¥ . 31-38.

odel \n., Sauer R.,
Radiotherapy and concurrent radiochemother
\n
Ž

apy for rectal cancer. // Surg Oncol. - 2004. - v.13 (2-3). - . 93-101 DOI:
10.1016/j.suronc.2004.08.012

anian N., Crane \n., Feig ˆ.
Improved overall survival among re
sponders to preoperative chemoradiation for locally advanced rectal cancer.
// Am. J. Clin. Oncol. - 2001. - v.24. - p. 107-112

cCoy M.J., Hemmings C., Hillery S., Penter C., Bulsara M.K.,
Zeps N., Platell C.F.
N
oadjuvant chemoradiotherapy for rectal cancer:
how important is tumour regression? // A
NZ
J Surg. ¥ 2017. ¥ v.87, (12). ¥
. 233-239. doi: 10.1111/ans.13394. Epub 2015 Dec 3.

itt M., DeVries A.,  aler J., Ka‰a-Ritsch R., Eisterer W., Lukas
P., Öfner D.
Long-term surveillance of locally advanced rectal cancer pa
tients with neoadjuvant chemoradiation and aggressive surgical treatment
of recurrent disease: a consecutive single-centre experience. // Int J Colorec
tal Dis. ¥ 2015. ¥ v.30, (12). ¥ . 1705-14. doi: 10.1007/s00384-015-2366-8.
Epub 2015 Aug 21.

hoi Y, Kim JH, Kim JW, Kim JW, Lee KW, Oh HK3, Kim DW,
Kang SB, Song C, Kim JS.
Preoperative chemoradiotherapy for elderly
patients with locally advanced rectal cancer-a real-world outcome study.
Jpn J Clin Oncol. 2016 Dec;46(12):1108-1117. Epub 2016 Sep 21.
References
emal A., Bray F., Center M.M., Ferlay J., Ward E., Forman D.
Global cancer statistics. CA Cancer J Clin. 2011; 61(2):69-90. doi: 10.3322/
caac.20107.

orre L.A., Bray F., Siegel R.L. Ferlay J., Lortet-Tieulent J.,
Jemal A.
Global cancer statistics, 2012. CA Cancer J Clin. 2015; 65(2):87-
108. doi: 10.3322/caac.21262

avydov M.I., Aksel’ E M.
Statistika zlokachestvennykh novoo
brazovanii v Rossii i stranakh S
. Vestnik Rossiiskogo onkol
ogicheskogo nauchnogo tsentra imeni
.
. Blokhina RAM
N
. 2011; 22, 3
(85). (In Russ.).

ingaevskii A.B., Tsikoridze M.Yu.
Sovershenstvovanie khirur
gicheskoi taktiki pri oslozhnennom rake tolstoi kishki v mnogopro–l¨nom
statsionare. Vestnik Severo-
Z
padnogo gosudarstvennogo meditsinskogo

yuryaeva E.I.
K
luchevoe lechenie raka pryamoi kishki. //
Prakticheskaya onkologiya. - 2008 ¥ T.9, §1 ¥ S. 31-38. (In Russ.).

odel \n., Sauer R.,
Radiotherapy and concurrent radiochemother
apy for rectal cancer. // Surg Oncol. - 2004. - v.13 (2-3). - . 93-101 DOI:
10.1016/j.suronc.2004.08.012

anian N., Crane \n., Feig ˆ.
Improved overall survival among re
sponders to preoperative chemoradiation for locally advanced rectal cancer.
// Am. J. Clin. Oncol. - 2001. - v.24. - p. 107-112

cCoy M.J., Hemmings C., Hillery S., Penter C., Bulsara M.K.,
Zeps N., Platell C.F.
N
oadjuvant chemoradiotherapy for rectal cancer:
how important is tumour regression? // A
NZ
J Surg. ¥ 2017. ¥ v.87, (12). ¥
. 233-239. doi: 10.1111/ans.13394. Epub 2015 Dec 3.

itt M., DeVries A.,  aler J., Ka‰a-Ritsch R., Eisterer W., Lukas
P., Öfner D.
Long-term surveillance of locally advanced rectal cancer pa
tients with neoadjuvant chemoradiation and aggressive surgical treatment
of recurrent disease: a consecutive single-centre experience. // Int J Colorec
tal Dis. ¥ 2015. ¥ v.30, (12). ¥ . 1705-14. doi: 10.1007/s00384-015-2366-8.
Epub 2015 Aug 21.

hoi Y, Kim JH, Kim JW, Kim JW, Lee KW, Oh HK, Kim DW,
Kang SB, Song C, Kim JS.
Preoperative chemoradiotherapy for elderly
patients with locally advanced rectal cancer-a real-world outcome study.
Jpn J Clin Oncol. 2016 Dec;46(12):1108-1117. Epub 2016 Sep 21.
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Information about the authors
Khalilov Zaur Bahman –
PhD in Medical sciences, Head of the
surgical Department at the Central hospital Baku city.
E-mail: [email protected]
Kalinichenko Alexandr Yuryevich –
assistant professor at the
Department of hospital surgery with the course of pediatric surgery of
the RUD
University,
E-mail: [email protected]
Azimov Rustam Hasanovich –
PhD in Medical sciences, Head of
the surgical Department at the Central Clinical Hospital of the Russian
Academy of Sciences
E-mail: [email protected]
Chinikov Maxim Alekseevich –
PhD in Medical sciences, aassoci
ate professor at the Department of hospital surgery with the course of
pediatric surgery of the RUD
University.
l. 8-926-152-00-04,
E-mail:[email protected].com
Panteleeva Ilona Sergeevna –
PhD in Medical sciences, assistant
professor at the Department of hospital surgery with the course of
pediatric surgery of the RUD
University.
Kurbanov Fazil Samed –
Doctor of Medicine, professor at the
Department of hospital surgery with the course of pediatric surgery of
the RUD
University?
E-mail [email protected]
 :
117198, ­, Ž. \n, . †-
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Post address:
117198, Russia, Moscow, Miklukho-Maklay str.,
•e Department of hospital surgery with the course of pediatric
surgery of the RUD
University
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APAROS
SURGERY
APABILITIES
AL
BAS
SH
,
N.Y.
, T
T
E
A D.K.
State Clinical Hospital named after V. Vinogradov, Moscow
RUDN University, Moscow
Abstract:
Laparoscopic interventions a¢er earlier performed open abdominal operations are becoming more common these days. However, a laparoscopic
cholecystectomy a¢er an inferior vena cava plication performed from a wide oblique approach in the right hypochondrium is not frequently found. Since the ap
proach to inferior vena cava is carried out by the mobilisation of the duodenum, it causes a massive adhesive process in the area of hepatoduodenal ligament and in
the right subhepatic space.
•is article describes a clinical case of a successful application of laparoscopy capabilities in a patient, who had undergone an inferior vena cava plication for its
thrombosis associated with hormonal medication.
Key words:
Laparoscopy, laparoscopic cholecystectomy, inferior vena cava thrombosis, inferior vena cava plication, adhesive disease of the abdominal cavity.
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 , 34 , ­    \n  
Ž\f† Œ\n Ž† \n. „  ­
\r ˆ‚ .  11  \n \n­  \n \f 
Žˆ  Ž   \n\r Ž
Ž, ŽŽ Œ\n. ƒ \r“,  ­ 
    Ž \nˆ  Ž ¥ Œ\nˆ  ­ \r­­
Ž­  Š  Œ\n\f† Ž\n.
 2003 Ž    ‚Œ Œ\n­
\f Ž \f  \n,  ‚\n 
­ \n .
\n
Ž

 2006 Ž    Žˆ\f† \n
¥ ‚Œ Ž‚ \nŒ \f  ‚Œ \r
 \n\f. …Ž \r ‚\f \n \n-ˆ, Œ \n\f
 ­ \r  \n\f Š \f 
\f  \n \n ‚ˆ.
  ˆ†    ‚
\n \n ‚ˆ,  ‚\n \n\f­\n\f  \n
\r Œ\f. … \r \n  2017 Ž ­ ¤
D-  1800 Ž/.
  ‹ ‚ 29 ­\n­ 2018 Ž,  Ž
\f† Œ\n \n \f† † Ž. \n\f, 
‚ˆ  .
 ˆ ­  ˆ ‚\n, 
 \n : -\f †
Ž, Ž, \n, ŒŽ-Ž.
  \r :
  :
 \f 9,5 † 10*9/; ‹\f
5,32 † 10*12/; ŽŽ‚ 154 Ž/; Ž 47 %; ‚
\f 288 † 10*9/;
:
… 28,4 ; ‚\n \n­:
11,6 ; \b: 1,06 

/; ‚\n\f  93%;
‚Ž 3,6 Ž/; €-\f 409 Ž/.
\r\f :
ŒŽ­­.
\n\t\b\f  :
… 49,

/; ­
Π122

/; … 30,5

/; Π74

/; ‚
85,1 Ž/; ­ ‚‚ 1,3 ˆ/; ‚ ‚‚
6,8 ˆ/;  58 ˆ/; Ž“Œ 5,45 ˆ/;
\n 6,2 ˆ/.
  \b:
ˆ ¥ \n;  \f
35-40 \n /Œ; ‹\f 3-5 \n ; \f Ž
\n\f -  ‚\r\f; \f Œ\f ¥ \n;
\f \n\n\f -  ‚\r\f; Œˆ ¥ \n
; Ph  5; ˆ­ ˆ 1,02 1; Ž“Œ 
\n; ‚ ¥ \n; \n- -\r­.
     :
Ž\f  
Œ. ƒ Š\f, \f. \f \n‚\f.
ƒ Ž\f \n\f , ¦ . …ˆ ­ Œ
  \r,  Š.  Š
\n , ­ Ž\r,  \n † \nŒ
\f.
:
 \nˆ\f , \n\f .
   \f :
 ‚Œ 
\b„ \n‚Ž ŽŒ \n ‚“Š , \n \r
\n ­† Š  \n\f­\n.
\f \f:
\n†\f Ž.
    \f :
‹†-Œ Œ\f†
Œ   \r \rŒ\f, †
Œ, †Œ  \rŽ Œ\f­. ƒ \r
Š \n \n . Œˆ­ \n­
Ž­ \n .
­  \f \f 
 € ‚     \b\f\t 
ƒ\t \b\f   ƒ  ‚:
‹†-Œ
‚† Œ \n Ž‚† \n† \r†
 . ˜Š­  ­­ ˆ Œ 
\nˆŽ Ž \n. ­­ Œ­ \n-
ˆ. ˜­ “Œ­ \nŒŠ\f \n \n.
­  \f\f \f€ (\r\t):
 \n ˆŽ, ˆŽ \n.  
­ \nŽ \r. „   Š\f.
ˆ­ ‚ˆ ” \n\nˆ­. 
ˆ ˆŽ  0-1 . ˆ
ˆŽ  1-2 .
‚† ˆ,    ‚\f \r
, …- 41, ‚Œ\n­.
 \n Œˆ\n ˆ\f†  ‚
\f† \n  \n ­ Š
 \n \nŽ \nŠˆ\n.
„ … \n\f ŒŒ \r, \r 
 . \n Ž Š. \r \n
  10  . . …\f \n\n\f  ­ \n 
 . „Ž \r, Š, Ž\n Ž
Œ  \n\f­\n.   \n \n\f\r
\f \f  \r ‚ˆŠ ˆ, ˆ“,
\r   ‚“Š  (  
  „).   \f \n \r 
Ž­  Œ­. ”\f Œ\fˆ  ­\r, Œ
 10 † 6 † 4 , Œ ‚­­,   2, ­.
 \n \rŽ Œ\f­ \r\n\f 
\f ¥  10 . ”\f Œ\fˆ \n\f  \n  \n
, ­ \n\f, Ž\n  ­\r,
   \rŽ Œ\f­.  ‚ Š  
­ ‚Œ   Œ\fŽ . ­­
 Š  \rŽ Œ\f­ ­  Ž††
‚\n\f . „Œ\f\f  \n\f, 
 4 , \n:  ““­ ˆ ¥ 2 \f,  †
­“ ¥ . ”\f Œ\fˆ   \r \n \r
Ž­   Œ \f . \b­ \n\f
\r\f \f ‚Œ  \r \rŽ Œ\f­. ƒ
ˆ ŽŒ ¥ †. „\n ­. \nŒ
Š.

.   .
„\nˆ ­ ‚
:  1,0 \n/\n .
     
\n\n“ “, \n“““: “ 
“:  1,0 † 3 /; “ “: 
Œ 20 Ž † 2 /; : Œ 100 Ž † 3 /.
‘\f\n­ \f ‘, \n\f  ‚‹‚
† \r , Ž ­ Ž †
Ž, \nˆ Ž­­ ­ \n -  
 :
 0,4 \ Π12 \n  , ΠΠ12 
\n    0,8 \,   0,4 / 1 /
\n “   \n  3  .
…\r \nˆ ‹­ ­ \r† 
 , \r\n\f \n­Œ   
\f† \f† .
\n
Ž

\f  \r \n \r:
    \f :
­  
 †‹. \n‚  Ž
 \r \n ‚“Š   \n\f­\n.
‘
 ƒ\t \b\f :
‹†-Œ\n \n
\nŒŽ ‚Œ  \n\f­\n, †-Œ ‚
† Œ \n Ž‚† \n† \r†  .
˜Š­  ­­ ˆ Œ \nˆŽ
Ž \n. ­­ Œ­ \n-ˆ. ˜
­ “Œ­ \nŒŠ\f \n \n.
\t\r \r\r\b   \r \n
\r:
  :
 \f 7,7 † 10*9/; ‹-
\f 4,54 † 10*12/; ŽŽ‚ 135 Ž/; Ž 39,2 %; 
‚\f 260 † 10*9/
:
… 30,2 ; ‚\n \n­
12,8 ; \b 1,17 

/; ‚\n\f  82%;
€-\f 345 Ž/
\n\t\b\f  :
… 39,8

/; ­ 
Π83

/; … 28,3

/; ‚ 64,7 Ž/; ­ ‚-
‚ 1 ˆ/; ‚ ‚‚ 7,7 ˆ/; 
64 ˆ/; \n 4 ˆ/; Œ 56

ƒ-‚\f \f \nˆ\n“  Ž
  Ž . „ †
ˆ   ‚“ \n  
­. \f  3    \n \n\n
ˆ ­  ‚\f ‹ \n­.
‹\t
… ‚Œ,  \f \f\f \n
\f \nŠˆ\n  Ž† ‚“Š   Œ‚“
ŠŽ \n, \n   \n ‚ Ž
\nŽ \nŠˆ\n,  ­\n­“­ ‚“\f 
\nŒ  \n\f“  .
 Ž, \n ­ \n  ˆ, 
  \n\f, ‚\n“  ‚
.
\n­ ‚ \n†
“ ‹ ”\t
¥ ..., Œ\n“ †Ž
   ‘ « ƒ . .. Ž\n €», \n
\t. +7 (903)
ail: [email protected]
† •\t ‡
¥ \n †ŽŽ ­
 ‘ « ƒ . .. Ž\n €»,  \f 
ˆ †Ž  Ž \n \r‚\f 
\n, \n
-mail: [email protected]
 € ‚
¥  \f ˆ
†Ž  Ž \n \r‚\f \n, \n,
-mail: [email protected]
Information about the authors
Abashidze Zviadi Shamilovich
¥ Ph.D., M.D., Head of Surgical de
partment of State Clinical Hospital named a¢er V. Vinogradov, Moscow
Phone +7 (903) 508-08-07,
ail: [email protected]
Biteev Nikolay Yurievich
¥ Doctor of Surgical department of State
Clinical Hospital named a¢er V. Vinogradov, Moscow; Assistant of the
Faculty surgery department of RUD
University, Moscow
ail: [email protected]
Totaeva Dana Kazbekovna
¥ Ph.D. student of the Faculty surgery
department of RUD
University, Moscow
ail: [email protected]
\n
Ž

стабилизации межберцового синдесмоза
.. 

, .. 

. . \t

, .. 

, .. 

, .. 



:
„\n\r­ \r‚\nŽ Œ  \nŽ †   \f\r, †Œ \n\f \n ‚ˆŠ\n \n -
\r\f . \r‚\n\f Œ \r“ \n\r\f ­ ‚ˆ ŽŽ \n \n­Œ: ­­ \r‚\n­ \n­Œ,
Œ­­ \r‚\n­ \n­Œ  \r­ ‚. ­  Ž\f ‚†   \n­, \n­\f 
 \f\r,  \f†   \n ‚Œ \r‚\nŽ Œ  Œ\f† † \n. ‡ˆ .
 :
 \f\r, \r‚\n\f Œ, Œ\f \n.
ATIONS TO STABILIZATION OF TIBIOFIBULAR SYNDESMOSIS
ZKO
.
L
., K
NE
LL
ER
L
.O.
SE
M
ENO

A
.Y., R
NO
D.
A
.,
L
ZKO
M
.F., ZAG
ORODNY
V
RUDN university, Moscow. Vorokhobov City Hospital № 67, Moscow
Abstract:
Tibio–bular syndesmosis is one of the most important stability issues of the talocrural joint. Most commonly tibio–bular syndesmosis becomes
damaged in cases of pronation-external rotational mechanism of the malleolar fracture. •e issues on the necessity of stabilizing the tibio–bular syndesmosis were
repeatedly studied during multiple cadaver and clinical trials, however, no uniform recommendations were formulated at the present moment. •e aim of the present
review is to formulate the indications for the procedure of tibio–bular syndesmosis stabilization.
Key words:
nkle fracture, Tibio–bular syndesmosis, syndesmotic screw .
\r‚\n\f Œ \r  \r‚
\n , Œ \r‚\n \n­Œ  \r ‚
[2-7]. „­ ‚ˆŠ‚\n-‚\n­ \n­Œ \n 
\f† \n­† Œ\f\n­ \n  ,
\r“ \r‚\n\f Œ,  ‹ \n­Œ ­\n
­­    ­, ‚ˆŠ\n
\f†, \r Œ \r‚\n \n­Œ [5, 8-10].
€\f \n­Œ ­\n­“­ ‚Œ ‚\n 
 \n ‚\n \n\fŒ ‚ˆŠ‚\n .  75%
\n \n \r‚\n Œ ­  
‚ˆŠ‚\n  ‚\n , \f Ž
\n\f †­,   \n [11]. \f ,
 40% \n­  ˆŽ ­ ‚
\n  ‚  ‚­ Œ­­ \r‚\n­ \n­Œ, 35% 
­­ \r‚\n­ \n­Œ  22% \r­ ‚ [11].
\r‚\n\f \n \n\r ­ ‚ˆ Ž
Ž \n, ‚ \n \n­ \n ŽŒ  †ˆ
‚ [12-14]. „ Ž‚ \n Ž \n \r\f
\r \n \n­ ‚ˆŠ, \r­ \f\r
­Ž\n­ \n†  \n \r ‚\f 
‚“ ŽŒˆ“ \nˆ. „ ŒŽ‚
\n Ž \n \r\f\r \n
ˆŠ­, \r­ \f\r ­, \n­Œ 
\n­­ \nˆ \n\f  † \r­
­ ‚\n  [13, 15, 16, 17]. ­ \f
ˆ ŒŽ  \r ‚
\f,  ‚\f Œ,   ­\n­­ \n\r ‚
Œ“  ŽŽ \n \n  ,
Ž \n\r ˆ\n­ \n­Œ,   \r ­­ 
Œ­­ \r‚\n­ \n­Œ [13, 18, 19, 20, 21, 22].
„‚Œˆ  10 % \n  \f 
\f\r \n\r­ \r‚\n\f Œ [23],  
20% \n \f \n\f­“ Ž\r Œ

\rŽ  100 \f. ­ \n­ 15 
\n \n\r [23, 26, 27, 28].
„\n\r \r‚\nŽ Œ  \nŽ 
†  \r  \f [3, 4, 5, 9, 29], ‹\n
   \n Ž \n [9, 29]  Œ
 Ž‚ [3, 4, 9]. ƒ‚­ ‹† Ž†
\n\r \n  \n\r­      
 AO/ASIF. „-\r\f
\f Œ“ 15-45%  \n† \n \f\r
[31, 32]. Lauge-Hansen \n\f­ “  
-\rŽ  : \n \n“ ˆ
\n\r­ ˆ\n­ \n­Œ  † \f\n
  \n \f\r, \n\r­ ­­
\n
Ž

\r‚\n­ \n­Œ  \r­ ‚, ­ 
‚\n­ ˆ  \n  \n\fŠ \r‚\nŽ 
Œ, †  ŒŽ ­ ‚ˆŠ‚\n 
 \n­ Œ­­ \r‚\n­ \n­Œ [31,33].
ƒ \f ­ \n\r­ \n\r­ \n­
Œ \r‚\nŽ Œ \nŒ\r ˆ, Ž
\n\r­ \n­Œ \r‚\nŽ Œ \n\r
“­  \f\r,   ‚ˆ,   
\n\f\r\f Œ  . \f -Œ 
 \n  20 Ž\n ŽŽ\f Ž
‚\fˆ ˆŒ\n\f ­ ­ \n‚Ž \r‚
\nŽ \n  ‚‚­  [34].
ŽŽ\f,  \f† †\r \n ‚ \r
‚\nŽ Œ ‚ 1 , Ž \nˆ\n\nˆ 
‚† ‚Œ \r‚\nŽ Œ [8].
…  ‚ˆŠ\n \n  ŽŽ \n 
   ­\n­“­ \r\f [35], ­ \n\r
­ \r‚\n ‚ˆ,  Œ
\n\f­“­ -\f  Ž 
 [1, 36, 37, 38, 39, 40, 41, 42]. \f -
\f ˆ \n\r\f ­ ­  \r‚
\nŽ Œ [43, 44, 45, 46, 47]. \n\f
\r\f otton  ­\n­­ Œ\n
\f [48]. \r‚\n\f Œ \r \nˆ
 ŽŽ,   ­ \r‚\nŽ 
Œ \n‚ˆ [13, 31, 49]. ­ Ž
Ž \n \r \r ‚\fˆ Œ ­ 
Œ\f\n \r‚\nŽ Œ  ˆ \n 
 Π[45,46].
‚Œ­ \n\rŽ \r‚\nŽ Œ
\r ‚\fˆ \n\f  Œ ‚\n
, \n\n­ \f\n\f† \n ‚Ž\n,  
\f ­­ \r‚\n\f \n­Œ, Œ \n
 \f\r.
š
 \nŽ ˆŒ­ ˆ\f 3,5 
\n,  “­ \f ˆ\n\f [50]: ‚‚
‚\f \n\f [51, 52, 53, 54, 55], \r‚\n\f ‚
š
ƒ€\b  Œ\n [62], \f
ƒŠ [16], \f   [25, 63, 64,
65], ‚-­\r [69],  \n­Œ [5, 76, 77, 78].
 Ž ­  ‚† \n 
ˆ\f† \n, \f \r Œ†\n\f\nˆ Œ\f
\n, Œ \n, \r \f, \n \n­ \n
\n, ‚† ˆŒ\nˆ 1  2 \n, Œ
\n\n ˆ ŽŽ \n; Ž \nŒ
\r \n­ ŽŒ, ‚†  ­ˆ \n 
\n ŽŒ . „‚\f, \n­Œ\f  Œ\f
\n, Ž ‚\fˆ “:  \n, ‚ˆ
ˆ \n,  ŽŽ \n \n­Œ­
 \n \n ŽŒ, Œ \n ‚ \r‚
\nŽ \n, ‚†ˆ \n  ­ 
­ \n   ­ \n­ \r‚\nŽ Œ
\n­Œ\f    \n [13, 15, 16, 17, 24, 25, 36,
79-90]. …\r  ­, \n­“  ‹ † \f 
\f  Œˆ.
­  Ž\f ‚†  
 \n­, \n­¦\f  \f\r, 
\f†   ‚Œ \r‚\nŽ 
Œ \n Œ\n    [13, 79, 92, 93, 94, 95].
 \n ‚† ‚ˆ,  ‚Œ­ \r‚\n
Ž Œ Œ\nˆ \n 40% \n  
   \n 80% \n      
 \b/ASIF [96].
Œ\n,  ­ Œ­ \f\r  \r
‚\nŽ Œ \n  †Š ¦
 Œˆ [43,97]. \n­ \n†ˆ
    ‚­ ŽŒ ‚ˆŠ  “
‚ Ž \n, \n\n  ˆ \n\n 
Ž‹ \n \n† [98, 99]. \f 
Œ,  \r   1  \n  \n
“ ŽŒ  “ ˆ  42%, , \n\n
, \n  ‚ ‚\f Œ\n“ Œ (100).
Weening and Bhandari [91], ‚\n ‚, \n 
 Œ\f\n­,  ˆ   †
Š Œˆ \nŒ\r ˆ   Œ
Œ,  ‚\f \r Œ
K
edy  \n
[96], \f “,  ­ ­­ Œ\nˆ 
 Œ Œ  † 
Œˆ. „ \f \f, ­ 
Œ­ \r‚\nŽ Œ \n­ \n 16 % \n
\r­ \f\r   \n­Œ ­\n­­ \n\r 
  ‚Œ“  Ž
Ž \n [13, 15, 99]. Leeds and Ehrlich [109] Œ\f\n“ \n
\n† ‚†,  ­ Œ­ Œ 
\nŒ\r,  Œ­ \r \f\r \n\f
. €ˆ\n­ \n­Œ ­\n­­ ˆ 
\n­Œ  \n\f\r\n ŽŒ  714
N
[110, 111]. 
ˆ ˆ   ,  
 ˆ\n \n­Œ, \n­­ 2  [13, 15, 112].
­­ \f\r  ˆ\n­ \n­Œ ­\n­“­ \n\r
 Š ‚Œ ŽŽ \n [13, 15,
113]. Parfenchuck  \n “,  ‚Œ­
\r‚\nŽ Œ \r \n\f­ˆ­  
     AO/ASIF c \n\r
 ˆ\n \n­Œ, \n Œ\n  \n­ 
 ‚\n  [14].
Solari  \n\f ˆŒ\n “ ˆ
­ Œ  ‚ˆ ‚ˆŠ‚\n
  †     AO/ASIF.
\f \n\f­\n,  Œ\n\f Œ \n
 \f\r \nŒ\n ‚ˆˆ  57%, Œ
\r \f\r 32%, ‚Œ­ \r‚\nŽ 
Π51% [113].
K
sner, Œ\n\n 403 ­ 
 \f\r, Š  \n\f\n,  \r\f \n\f\n†
\n
Ž

   †  \nˆ \n\n
 \n \f\r.  ­†, Ž ˆ\n­
\n­Œ ‚\f \n\r,  26% \n ­ \r
\f \n\f\n†  ,  \n \n
,  “ \n.

ˆ\n­ \n­Œ ‚\f
  \n\f­­ Œ ‚\n  \n
 \f\r, ‚Œ­ Œ  \n\f­ˆ
˜­, Œ­   ŒŽ ­ ‚ˆŠ‚
\n  \n\n\f, Ž \n\f †­  
“,  ‚† \n\f­ˆ “  
\n\r­ ‚ 25% \n \n† ‚ˆŠ‚
\n  [117, 118, 119, 120, 121, 122, 123, 124].  
 \n\f  ‚†† \n­† 
‚ˆ ŽŽ \n,   -Œ
[117, 119, 122].
…\r ‚† ˆ,  Œ Ž 
\n \n† ‚ˆŠ‚\n  \r ‚\fˆ
\n \n­Œ  Œ \r‚\n \n­Œ ,
­ \r ­ˆ­   Ž.
­­ \r‚\n­ \n­Œ \n ‚ˆŠ \n \n
‚ˆˆ \r‚\nŽ Œ [13, 93, 118, 125].
Gardner  \n\f \n 15 \n  
-\r\f †Œ \n \f\r
 \n\r ŒŽ ­ ‚ˆŠ‚\n . 
 \n\f­ˆ ŽŽ \n­
 …,  \f† ‚\f \n\r  Œ­­ \r‚
\n­ \nˆ ­  ‚\f   Œ
“. ƒ Ž,  \n \n \n 
10 \f† \r† ­†  \n 
-\r\f \f, Ž \n, 
Œ­­ \r‚\n­ \n­Œ \r ‚\fˆ   \r
‚\fˆ   Œ Ž.  \n\f­­
ˆ Œ ŒŽ ­ ‚ˆŠ‚\n 
 ‚Œ­ \r‚\nŽ Œ Œ\f
\n,  ‚\f \n\f­\n,    ŒŽ ­,
‚ˆˆ \n\n­  70%,    Œ
\f \n  40 %. Œ Ž ‚\f  \n\f\n,  ‚
‹\n ­ ‚Œ ŽŽ \n \n\f
­ˆ Œ ŒŽ ­,  ­ Œ
Œ\f \n [126].
\b\n,      “­ \n\r
\n \n­Œ ‚ \r‚\nŽ Œ, \n Œ\n
 \n­   ˆ ‚\n­ ˆ [44, 127].
\b \nˆ \n\r­ \r ‚\f, 
­“ Œ\n  ‚ˆ ŽŽ \n.
 ˆ,  \nˆ \n\r­ \r 
‚\f Œ\n    ‚\n  [6].
\b   ‚\f Œ,  \nˆ \n\r­
\r ‚\f    \n 
‚\n , ‹ ‚\f Œ   …
\n \n   \f\r [38].
Boden  \n\f \n \n \n, Ž
\n\f­ˆ \r­ ­ ŽŽ \n,
‚Œ ­ \n ŽŒ. „ \n \n
­ ŽŽ ˆ, \n  \n­
\nˆ  ‚\n   †\r \r
‚\nŽ Œ.  Œˆ \n­ Š 
\n\f\n,   ‚\n  \n\fŠ \n­ Ž
Ž \n  3-4,5   \n\r ˆ\f†
, \f \nŒ\r Œ\nˆ ‚ˆ,
\r‚\n\f Œ \r ‚\fˆ ‚Œ\n. „
‚ˆ  \n \f\r  \n\n
 ˆ\n \n­Œ \n ‚  ‚ˆ
 \r \f\r, \n ‚ˆŠ\n \n 
‚† \nˆ \r‚\n\f Œ  ‚\f.
„\f \r \f\r  \n 4,5  \n\fŠ Ž
Ž \n  \n\r \r‚\n ‚\f
­\n­“­ ‚ˆ\f, ­ \r‚\nŽ 
Œ ­\n­­ ‚† [12, 128, 129].
Yamaguchi  \n\f ˆŒ\n \n\fŠ­\f
  21 , \nŠŽ    
    . \b\n\f\n­ˆ    
 ‚\n “ \r‚\nŽ 
Œ \n \n 3 ­†.    
\n Ž \n Ž\n Ž  4   Œ
\n ŽŒ.
š
Œ 4   ŒŠ \n“ 
ŽŒ \n Ž\n Ž \n  2-4 ˆ. ‚“
Œ  \rˆ  1 Ž  3 , †\r­
\r‚\nŽ Œ  ‚\f \n\f­\n [102].
Parfenchuck  \n\f ‚\n \n, \n
  \n \n  18 
 -\r\f  ,
  ‚“­ \n­ 2,5 Ž. Œˆ\f
\n­ Œ\f\n“,  \f  \n\r
ˆ\n \n­Œ, \f  \n\f­ˆ ­
\r‚\nŽ Œ, \n\n\nˆ †\r,  
\f,  \f† ‚\f  \n \f\r [114].
\r‚\n\f Œ  \n­  †
‚\n , \r\f† \r 5  Ž
Ž \n,   ‹ \f  \n\r“­
\n\r \r‚\n ‚\f [116]. „ Œ
Ž ­ \n  ‚ˆ Œ [126].  
 †Ž\n, Œ“†­  Ž 
\n, \n ,  ­ \r‚\nŽ 
Œ      ‚­, Ž Œ\n
­ Œ­,  \n\f\n† .  
‚\f \n\r \n
K
edy  \n,
\f Œ 45 \n  2 Ž\f  \n\f
\n\r­. 26  ‚\f \n\f \f­ 
Œ­  ­ \r‚\nŽ Œ Œ\f
\n,  19  \n\f­ˆ ­ \r ,
ˆ \r‚\n\f Œ  ‚\f \n.  ‚†
Ž†  ‚\f ŒŽ\n Œˆ Œ\f \n
\n
Ž

 ‚, †, \nŒ\n  \n ­
ˆ [96].
 ­\n­ˆ \rˆ  ‹­
\f† \n†\f†  ‚†† \n , †­
  ­\n­“­ \n\f ŠŽ   ­
­ \n\n . -\n\f†, ­ \r‚
\nŽ Œ  Œ† † ‚\n
  \n  Œ Š  
Œˆ,  \n  ˆ   
 \nŠˆ\n,  \r \n
 ˆ\f \f \r­. -
\n\f†,  ‚† \nˆ \r‚\n\f 
Œ  Œ† † ‚\n , 
† \n \f\r   ˆ\n \n­Œ,
  Œ  ‚ˆ . 
 ˆ,   \n\r ˆ\n \n­Œ 
\n \nŒ\r \nˆ  ‚ˆ, ‚†
 \n\f­ˆ “ \r‚\nŽ Œ. „
† ŒŽ ­ Œ­­ \r‚\n­ \n­Œ ­
 \n\r ,   ­ \n  Œ
Ž, ­ ‚Œ Œ ˆ
\nˆ Œ Ž,   ˆ †
   ˆ Œ Ž \nˆ Ž
\nŒ\r  ‚Œ­ \r‚\nŽ Œ 
‚†. -ˆ†,  \n\f†  ‚\n
 ( 5  \n\fŠ ŽŽ \n)  \n\r
\r ‚\f, ‚†\f \n ­ ‚
Œ­ \r‚\nŽ Œ ­\n­­ ­
Œ­  ‚ˆ­ ­ ‚\n  
\n \f\r(   ˆ\n \n­Œ).
 ­†, Ž  ‚\n  †­ \n
\n† , Œ  \n\f­­ Œ-Œ \n\f
Ž  \n\r­ ‚\nŽ \n. „\n\r­
\r‚\nŽ Œ  \nŽ †  
 \f\r, †Œ \n\f \n ‚ˆŠ\n \n
-\r\f . \r‚\n\f 
Œ \r“ \n\r\f ­ ‚ˆ ŽŽ
\n \n­Œ: ­­ \r‚\n­ \n­Œ, Œ­­ \r
‚\n­ \n­Œ  \r­ ‚. ­  
Ž\f ‚†   \n­,
\n­\f  \f\r,  \f† 
 \n ‚Œ \r‚\nŽ Œ 
Œ\f† † \n. ‡ˆ Ž ‚Œ  \n
\n Œ ­ ‚Œ \r‚\nŽ
Œ.
­ \n† \n \n­­ Œ
 Π\n \f\r, Π\r
‚\fˆ  \n †Ž .
 Œ“ ˆ  ˆ,  ­ 
ˆŽ ­­ Š­  ‚† 
\r‚\nŽ Œ  \n­ 
Ž \n­. €­ ­­ Š­ ‚­
Œˆ  \nˆ \f \f  
‚ˆˆ \r‚\nŽ Œ  \b„ ,
 :  \rŽ ­ ‚\n  
Œ‚\f “,  \r  \f (
\n\f  Cotton).  \r\f Œ, Ž ­
ˆ  ‚ˆˆ \r‚\nŽ Œ
\n\fŒ\f\n ­, ‚† \n\f­ˆ ‚Œ“
\r‚\nŽ Œ
 \f
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eyer TL Jr, Kumler KW.
A.S.I.F. technique and ankle fractures.
Clin Orthop Relat Res 150:211¥216, 1980.
tormont DM, Morrey BF, An KN, Cass JR.
Stability of the load
ardner MJ, Brodsky A, Briggs SM, Nielson JH, Lorich DG.
Fixation of posterior malleolar fractures provides greater syndesmotic sta
bility. Clin Orthop Relat Res 447:165¥171, 2006.
auge Hansen N, Ankelbrurd L.
allat L, Grimm DJ, Saracco JA.
Sprained ankle syndrome: prev
alence and analysis of 639 acute injuries. J Foot Ankle Surg 37:280¥ 285,
eumer A, Valstar ER, Garling EH, Niesing R, Ginai AZ, Rans
tam J, Swierstra BA.
E£ects of ligament sectioning on the kinematics of the
ail: [email protected]
‚\t\t ˜ \t\f
¥  \nŽ   ƒ 67,
\n, ­.
ail: Okneller90gmail.com
\n \t ‡
¥ ... \n“ 
 \nŽ  ƒ 67, \n, ­.
ail: Semeono£[email protected]
 € \t
¥ \b \f \n
Ž  , „\n\f  ‘  .. \n, \n,
­.
ail: [email protected]
˜ „ 
¥  \f \n
Ž  , ‘€, \n, ­.
ail: [email protected]
‹\f •\t ˆ\t
¥ Œ\n.  \n
Ž   - -. , \n, ­.
\t (   \r\n):
‚\t\t ˜ \t\f
: ­, 127562, Ž. \n, ‘ ˜­ 12-2-3
ail: Okneller90gmail.com
Information about the authors
Lazko Fedor Leonidovich
¥ Doctor of medical sciences, Professor
RUD
university, Moscow.
ail: [email protected]
Kneller Lev Olegovich
¥ orthopedic surgeon Vorokhobov City
Hospital § 67, Moscow.
ail: Okneller90gmail.com
Semenov Alexander Yuryevich
¥ Candidate of medical sciences,
Head of Traumatology Department Vorokhobov City Hospital § 67,
Moscow.
ail: Semeono£[email protected]
Romanov Dmitry Alekseevich
¥ Resident of Sechenov University
ail: [email protected]
Lazko Maksim Fedorovich
¥ Graduate student at RUD
univer
sity, Moscow.
ail: [email protected]
Zagorodny Nikolai Vasilyevich
¥ Doctor of medical sciences,
Professor, Head of the Department of Orthopedics and Traumatology
RUD
university, Moscow.
ail: [email protected]
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пухоль тон
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ДЕЛАМИ РРЕИИДЕОТА РФ
:
\nŽ­ Š ¥ Š\f \n Š †, ‚\n\f Œˆ \n 
ˆŽ  Š \n ˆ\f (   - ‚).
ƒŠ­ †ˆ †\nŽ ŽŒ —  †Œ“ ­ Š \n\r­ \rŽ  \nˆ
  ‚\n\f † ­\n, \f ­\n­­ Œ\n  ‚\n \n‚Œ\n Š
ˆˆ  ˆ Œ“­ \n \n \f† †Ž\n  †, \n†  \f, \r­†, 
† Ž  ­ \nŽ Š.
 :
 ‹­ †ˆ, ­ Š, †Ž­, ­, \nŽ­, ­.
INTESTINE AS A
C
AUSE
OF INTUSSUS
C
EPTION IN MIDDLE AGE
HOD
A
.
A
., Z
N
EN
S
A
.
A
., N
IKONO

A
.
A
.
FEDERAL STATE INSTITUTION CENTRAL CLINICAL HOSPITAL OF PRESIDENT ADMINISTRATION OF THE RUSSIAN FEDERATION
Abstract:
Intussusception of the intestine ¥ a mixture of intestinal obstruction due to isoperistaltic introduction of the proximal section of the intestine distally
(rarely Vice versa).
Intestinal obstruction of tumor Genesis is a syndrome characterized by disturbance of promotion of the content through the digestive tract and are caused by
mechanical obstacle, which is a malignant or benign neoplasm of the intestines
ƒŠ­ †ˆ \f\nˆ ¦ \n †
    .    †Œ ‹ 
Ž“: «ƒŠ \n\f\f†  Œ­  \n­ , 
   ŽŒ\n,  . ”\n ­ \n¦\f,
 \n \n \n\f\f,  \rˆ“ , ,
». ‘ Œ\f† \n\n  ‹Ž \n †
 ‚ˆ  1,06  20,2% [1]. ‚ˆŠ  
‚“ \nŽ Š \n­ . „. ‚\n
(1969) ¥ 409, . €. ƒ‚ˆ\n (1973) ¥ 240, . „. \n
 . (1973) ¥ 187, . . ƒ\n  . (1973) ¥ 175.
„ŽŒ Œ\n­ \nŽ \r. „\r
ˆ  , ‚¤­­“† \nŒ\n ‹Ž Œ
‚\n­. ‚ \f Œ † ­\n­“­
­, ­  †­.  \n ‹†
 \r  †Œ ¥ Š ˆ
ˆ\f† Ž\n Š. \b \r ­\n­ˆ
­ Œ  Š,  Ž ‹ Ž \n­­
\n  ,  \n, ˆ \r\f 
\n
Ž

Š, “ ˆ\f . Š 
 \r ­\nˆ­ Œ Ž,  Ž \n Ž
\n­­ \r\f \n\fŠ  Š. Ž
‚““­ \n ‚ ‹ :  
 Š, Ž , ­ \r\f ,
 \r.  ‹† \n­† Ž \r Œ 
\n Ž Ž \n Ž . … ‚\n
\f , Œ , ŽŒ Œ\n­ \nŽ
  \n ­ \n­ ‚ˆŠ Œ 
‚¤­­­ Ž‚  \r\f †Œ 
\n Š. \nŽ­  ‚\f\n †­ ,
Ž \n† Ž \n­­ \n \r\r\f ,
 \r ¥ \n†­ , Ž \n­­ ˆ\f 
\n ˆ\f . †­ ­ Œ\n­ \nŽ
 ˆ \n   Ž  \n 
, † \n“Ž  Ž Š
\n Ž (\f , ‚ Ž\n, †ˆ),  Œ 
\n ‹† \n­† \n ‹ Œ\f\n Š 
ˆ.  \r ˆ   ‚\f\n
   \n †Œ, \f \n  Š“
ˆ. [4]
\nŽ­ Š  Œ\n\n­  “ ,
“† - -ŒŽ ‚
­ Š   \r\n“Ž : “
‚\f\r ,  \nŽ Š  ˆ\f† Ž
Ž\n,  ˆ\f Ž, ˆ \r
 Œ\f† \n Š  . ˆ\f
Œ­ \n Š, \n \n‚Œ , \n ‚\f
\r  Š,  ­Œ\n, ‚\n Ž ‚\fˆ 
\nŽ. \b†ˆ Š \nˆ  ‚\n
\n“ Ž  Š \n Ž .  ‹† ­†
†ˆ  \n­  ˆ, \n­
­ˆ \n \r\r\f \f, \n Œ ‚ 
Š  \n  \nŽ. [8]
K
rarousis  \n.
(1974), 80-100% \nŽ  \nŒ\f† ‚\n\f Ž
 \r­ Š ,  
 \n  Š.  Ž\n \n Š
, \n  Œ, \r \rˆ  \nŽ
. †    \n Œ\n 
\r \nŽ \n  Š“ ˆ Š,
Œ\n“ Œ \n † †, Œ \n Ž†,   ­\n
­­  \nŽ. Š“ ˆ,
 \nˆ,  Œ\n“ \nŽ Ž ‚\n
\nˆ   \f,   ‚ˆŠŽ \n 
ˆ Ž‚ ,  \f†  \n Š,
 \n \n‚\r­ ˆ\f† \n Š,
\n, \n    ­, ‚“Š . [8]
 \f† ­†  ­ \nˆ \n
““ . „ \n  Š \n Ž“
\nŽ ‚Œ­    Œ Š\f†
. \r\f  Œ\f\n“ \n“
(intussuscipiens), \n   \f ‚Œ“
\nŽ (invaginatum  intussusceptum).  \nŽ
Œ“ Ž\n, ‹  † \nŽ 
 \n  ,  Š  ¥  † Ž \n 
\r\f . Ž ‚\f\n“ \n \f,  \f \n
Ž, Ž  \n \r ‚\fˆ 5-7  \r 9.
\nŽ Š ­  Š\f 
Š †. „ † Ž  \n\nˆ 
‚“ ,   Ž­\f †Œ\f,  
\r  ,  Ž . [9]
­ Š  Ž  \r \n\fŒ\nˆ ‚
“ \n, ‚  ­­  \n
ˆ\f . \b\n \n   Š
\n‚­ \n\n \n­\r­ ‚\f\r  \n
 \nŽ. \b‚ ‹  \n­  Œ 
 Š †  Š“ \rŒ
‚ \nŽ, \nˆ  Œ. [10]
‚\t\b
Œ Ž\f†  \nŽ  
Œ ‚ˆŠ  Œ,  †,
\r­ . . -  (1958), \n \n\n  
 \n\f­“ Š“, \nŒŠ-‚“
(ˆ­ \nŽ­)  Š“ \nŽ
. Œ \n“­  Ž \n\f \nŽ
(“Žˆ­, \nŠ­, ˆ
­),    “ ‚ˆŠŽ Ž Œ­.
‚ \f \n \nŽ ­\n­­ 
‚­ (ˆ­ \nŽ­), ­ \n­
45-63%.   Š \n \n†­“ ‚“
 “ \n\n \n \nŽ \nŒŠ Š
  Ž\n Œ («Ž\n \nŽ» ¥ ­
Š)  \nŒŠ-‚ ¥ \n \nŒŠ
 Š \n \n†­“ ‚“ Œ Ž\n Œ
 («Ž\n \nŽ» - \nŒŠ­ Š). \b
\r \n­ˆ Œ ‚  \nŒŠ“ Š,  Ž\nˆ
‚ \nŽ  ˆŒ­    \nŒŠ­
Š  \n­­ Œ ˆ\f  \n “
Š. [5]
„\nŒŠ-‚­ \nŽ­ \n­ 12- 17%.
 ¥ ­\r­  Œ‚\n­,   \nŒŠ­
Š † Œ ˆ \n, Ž  ‚\f
\r ,    Š \nŽ“­ Œˆ \n
“,  Œ‚\n    Ž­
†.
…Š­ \nŽ­, Ž   
Š \n­­ \n Ž Ž  \r Š, \n
­ 8-15%.  \n †    
† , ­ \n\n\f ­­.
…Š­ \nŽ­ Œ“­ \n \n
 Ž   Š \n Ž   \r
Š. \b \r ‚“ˆ­  \n ­\r 
\n
Ž

Š,     Ž­ †
.
š
  \n­ 10-18%.
„ \f €. „.
š
† (1960),  ˆ
\nŽ Ž\n \nŽ \n 68,2% \n †
­ \n \n†­ ‚ Š, \n 31,8% ¥ \n ‚ 
ˆ\f† † ‚ Š.  Š\f†
\nŽ \n­“   Ž\n
\nŽ \n ­“ Š (ˆ­ \nŽ­),
 \r \nŽ­  \n\f† Ž\n \nŽ Œ
­“ Š (ˆ­ \nŽ­). „ \n
\nŽ \n­ . . „. ‚\n (1969) Š \n
\n  20 \n   3 \n† ‚“
­. „ \f J. Lataste  \n. (1975), \n Œ
  ‚\n\f ‚­  ‚ˆ\f†
 \n\f \nŽ Œ ­“ Š  11 \n
ˆ\f† \nŽ . „ \nŽ  
\nŽ ­\n­­ †ˆ Š. € \n\f\nŠ 
\nŽ Ž 30 .  ­“ Š Ž 
ˆ­  ˆ \n\f \f ‚ Š,   
­ ‚­ Š  \r \n­ \n ‚
Š. \b Œ †\n \nŽ \r ‚\fˆ Œ
\nŽ  \r Ž Œ ­“ Š. W. Robb
 \n. (1962) Š \n  28 \n Ž
­ \nŽ  Œ­ \nŽ.
š
 
† ‚“­  \nŒ\f†  Š \nŽ
. ƒ. Schulze  \n.. (1979), G. Gomez  \n. (1984) 
‚“ \r \nŽ Ž\n Š. €
Ž \n­ ‚\f \f \n\r  , 
\nŽ­ Š  \n­   .   
\n­  \f, \n\r“ ‹ 
\r. \b   \n  \nŽ­ Œˆ
  \nˆ­  \nŒ\f† “ Š 20 .
„ \f . „. ‚\n (1969), 56,4%  \n† ‚ˆ\f†  
\nŽ ‚\f Š 20 . ‘ \r ‹ Œ‚\n
\n­ \n 1,5-2 Œ 
€\f
ƒ \nŽ Œ‚Œ  ­­
Ž , ,  Œ­  \n \n
Ž, ˆ Š­ \n‚\r­ \n \nŽ,
\nˆ Œ‚\n­, ­  \nŒ ‚ˆŽ. \b
\n ‚ˆŠ\n \n \r ‚“ˆ \n\f Œ
 Š †: ‚ \n \r\n, Š 
\n, Œ\r   ŽŒ\n. [4]
‚ ­\f , \f \n­
 \n† \n† \nŽ , ­\n­­ ‚ˆ. ƒ \n, 
Ž  ‚ˆ  †\n‚Œ\f †, 
\f \n­“­ Œ \r\f 10- 15 . „ 
Š  \nŒŠ-‚ \nŽ ‚
“ \nŒ,  Œ ˆ\f  “. „
Š \nŽ ‚ \nŒ“ ,
  ­\f, ˆ  ˆ \r\n Ž
­ˆ †\n‚Œ\f †. [10]
\f  ­\n­­ Ž­,  ­
­ ‚Ž­ \n, ­ ‚“­  70-80% ‚ˆ
\f†.  Œ\f† ­† \n \r ˆ \n\f †
. \r   ŽŒ\n ¥  ­\f . [10]
„ Š  \nŒŠ-‚ \nŽ
  \r ‚\fˆ,   \n­ ­ Š †
. „ Š \nŽ ­ ‚­
Œ\n\n­ ,  \n, ­ \n \n Š
 \n \nŽ,  \r Œ\n­ ˆ . \b
 \f Œ Š  \n\n 
­ \r\n   \nŒ \r\n \nˆ\n
 Œ\r ŠŽ \rŽ.   \r \n 
Œ‚\n­ ‚\f  ,  \n ‚\r Š \r \f 
­\n­­ Œ\r ŽŒ\n  ,   Š 
\nŽ ¥ Œ\f. [10]
\f  \nŽ ­\n­“­ \n­\f
\n\f­ Œ ­ Š.  \n­
\r Œ­ ‚ \nŽ, ‹ †
\n\f­ \n Œ\n  Ž Œ.   
, Œ ˆ \n, ‹ Œ ­\n­­  
Š  -‚ \nŽ  Ž \r
 ‚\fˆ  Š \n.  \n† ‚ˆ\f†
 \nŽ \n\f \n Œ ­ Š ‚“
­  42%. [10]
„  \r\n \r ˆ  \nŒ
Ž  ­Ž ‚“Š .  \f† ­† Œ
 Œ \n \nŒŠ ‚ ( €).
 ‚ \n\r\f Œ \nŽ \r 
\f\n \n ‚“Š  †\n ‚Œ\n
. \b ‹   Ž 
\n†ˆ“, Ž  Ž\n \f, 
‚Œ  Ž \n\r. [4]
\r\f Œ \nŽ, “ Ž  
\f† † , ­\n­­   Ž \n
\n­ ˆ,  ‚ \n Œˆ ­\n­ 
ˆ,  \n \f† ­† \n \nŽ
  Œ\n \nŽ. [4]
Œ­ ‚Œ\n­ \r ‚\fˆ Œ  Œ
\n  \n \nŽ.  ˆ,  \nŽ
\r ˆ­  ‚“Š . „  \n ‚ˆ
ŠŽ \n­  \nŽ­  †  Š. 
\n­Œ  ‹  \f† ‚ˆ\f† \nŽ \r 
ˆ  ˆ\n \n ­ Š. \b 
Ž“ \n†ˆ, \f Œ Œ ‚
 , \n\r, Ž ‚Œ\f .


‹Ž, ‚““­ \f †\n‚Œ\f ‚ \n \r
\n  \n­\f \n\f­ Œ ­ Š,  
ˆ  ‚Œ\n  ‚“ Œ\n
† \r ˆ  ŽŽ \f.
„ ŽŽ \n ‚“Š 
\n Œ\n  \n\f\r  \r ‚\rˆ
\n  \f Œ Š †: 
\n
Ž

 ŽŒ \n Œ\f† † Š, ŽŒˆ\f
\n \r, Š ƒ ‚, Œ ˆ\f†
 \nŽ \n Š.  Œ Ž 
\nˆ  Œ   †
 ,  ‚Œ, ‚  ˆ \n\f‚ ‚
 .  ˆ\f† ­†  ˆŒ\nˆ
ŽŽ \n  \f \n\n.
„ \n† \n† \nŽ ,  Š , Ž
­ \r Œˆ­ \n\f‹\n \n \n
ŽŒ. „ ‹ \r ˆ, ­  ­ ‚
­  Š   ­   
\nŽ. €  \n\f \f, \n\f \n \n
Š \n \n «\f», «». „ ‚­ \r 
\r\f    \r ˆ  \nŒ‚
,      \n \n , 
‚Œ­ Ž Œ‚.
ƒ­   \nŽ \r Œ\n\nˆ
­     Œ\r ‚ˆ †
 \n“ . \b  †
­ Š  \nŒŠ-‚ \nŽ,
 \n ‚ˆŠ\n \n \n ˆ Š Œ‚\n 
Ž. \b  \f† ‚ˆ\f†  \r
ˆŽ  \f† ‚  \n \nˆ
Œ\n \r­  Œ‚\n  †
  , Œ Œ\f \r \n
, \f ‚­.
\f †Ž Ž“ Œˆ †“
 \n““ \nŽ“.  \n  ¥ 
Š­ †ˆ Ž \n­ †­ \n 
­. „ ‹ †­­ †ˆ \n
Š    \n\f\rŽ Š­ \n‚
\r­ \nŽ. ƒ ­ \nŽ­ 
    Š †. „ 
\n“  Œ  \n­  \n­
Š  ­ˆ­   \n­ 
\n\nŽ ­ Œ\nŽ­,  \n \n 
† \nŽ­. … \r \n­ˆ­ ˆ Œ,
 \n Š  Œ\nˆ“­ Œ­, \f  Œ\n­
 Œ\nŽ\nˆ­.
˜  \f
 \n ­ ­ ­ \n, Œ\f.  
­†, « Œ  \r\n­,  † \n\nˆ
\nŒ† \n Œ †,  Œ \n \nˆ Œ.

“ \r­, ‚ˆ \n\fŒ\n\n». †Ž
( \n \nŽ ­ .‹.) \f\n  ­\r¦
 ‚ˆŠ ˆ“ ˆ Œ‚\n. „ Ž
«\r ‚ˆ­, ­   ˆ¦, †\r \r
\n,  \r\n». [5]
 ‚ˆ\f†  \nŽ \r ‚\fˆ \n
\n\f  †Ž. ˜ŠŽ Œˆ  \n
\n  \r \rˆ ˆ  ˆ
 Š \nŽ  ˆ \n \n\f \f
Œ\n­ ‹Ž Œ‚\n­, Ž   ‚Œ\nˆ \n
ˆ\f ­ \r . \b  
Ž“  Œ‚\n­  ˆ 
\nŒ  \n\n . ƒ\n\n
\n \nŽ \nŒ\r  ˆ“ \f†
Œ, \n\n­ \n ­“ Š \nŒ†  Ž
\n\n   ˆ“ ‚.  ‹ 
­  ˆ ˆ \r,  \n­, ­
 \nŒ\r\f† ‚\f† Œ­† \n \nŽ.

\r\n †­“­ ­\f ‚,   ‚ †\n
‚Œ\f,  \f\n­ \nŽ \n ‚“Š ,
‹ \r Œ  \n \nŠˆ\n. [6]
„­ Ž\n,  \n\f†
\n\n\f† ­ , \r \n“ˆ \n\n
 \n\n \r, \n   \f† \n\n,
Ž‚ ­, \f† \n, ŒŽ
Ž\n, ‚\n, † \n, \f\n
 \r. \b“ ‚† \nˆ  ‚
Œ Œ Š“ “ “. „
\n\f­ ‚“Š  ‚­Œˆ \n\n 0,25% 
\n \n \n ‚\f\r  \nŽ\nŽ  
\n ˆ  Š.  ­ \n­  \nŽ
 ­“ \n \n\f† : Œ\nŽ“
 Œ“ \rŽ  Š. €Œ\nŽ­
\nŒ\r ˆ \n     Œ‚\n­.
…,  Œˆ Š  94,3% ‚ˆ\f†  \r
ˆˆ“ Œ‚\n­  ‚ˆŠ 1 ,  65,4% ¥  Œ‚
\n  36   ˆ  30,4% ¥   3 . \n
“ Œ\f  Œ\nŽ.  \r ‚\fˆ
Ž ­, ˆŒ­ \n\f­Ž\nˆ \n\nŠ“­ Š
Œ \nŽ. €Œ\nŽ“  Œ\nˆ 
ŽŽ \n\n­  Ž\n \nŽ.  \r
Œ\nˆ \n­ \f ˆ  
ˆ\n ‚ \r­ Ž\n ˆ“.  \n† ­† ‹
 ˆ \r.   \r\n“ \n\f\n
“ Š  , ‚\f \r ‚\f Œ   \n† 
 ˆ . €Œ\nŽ“  Œ\nˆ 
†Š Ž \rŽ   \n‚
‚“Š .

\r \r\f   
 “­ ­  Š  \n\f\n­,  Š
\nˆ ‹   ˆ  Œ. „ Œ
\nŽ  \nˆ ˆ \n\f\n“ Š
 ˆ  \rŒ‚ˆ.

‚,
  ˆ \nŽ \n \n  
  Š   \n‚ŒŽ .
\t“  Š Š Œ\nˆ  
ˆ  € ¥ . €Œ\nŽ\n“ \rŒ
‚“ Š  Š  Š
\nŽ  \n\n­ \n † ‚\f\r  0,25% \n
\n “ \n ‚“Š“ ˆ,  Œ\n­ 
†-‚ “†  . [5]
\n
Ž

 ­ \nˆ \nŽ“   
Œ\n­ Š Œˆ   Œ,  
ˆ Œ“ \rŽ Ž. „ ˆ
\nŽ ­ Œ“­ \n \n Ž
‹  \r \nŒŒ. „
 ‚ˆŠ† \n Œ   Š \r
Žˆ­ Œ  .   ­ˆ 
Œ“ ˆŽ Ž  \n \n†­ ‚
 Š,   Œ \nŽ ­\n­
­ ‚\f .  ‚¤­­­ \nŒ\r\f Š
\n‚\r­  \n­Œ \nŒŠ-‚
Š, Š\n\f   Ž ˆ \n  \n.  \n­
Œ  ‹  Ž Œ \n   \n†­
‚ Š  \n ˆ  \nŒŠ
Š Šˆ “  \n Ž‹
.  † ­†, Ž  \nŒŠ-Š
\n  ­ Œ\n Œ\nŽ“, . Grob
(1957) \r \n\f­ˆ Œ“ \nŽ\nŽ
 Œ “ Š. „ \n­ Œ
  Œ \n“ \nŒŠ“ Š Š
\n“    \n \r.  “ ŒŒ 
  Š, \nŽ \n\f\n­ \r  “
 \n ˆ  1-1,5 .  ˆ, ‚\f
 ˆ ‚\f \rŒ‚\f. „ “ ŒŒ 
\f\n“ Ž\n\f Š\n\f, “ Œ. €­
\r­  Š \n  Œ Œ \n
­ \r“ ‚, \r\f   Œ 
 Š \n\f\n­  ““ ‚“Š“ . ƒ­
\f  Š Ž Š\n“  ˆ
‚“Š. „ “ \n, ­ ­  \n
  Ž ­ \r ˆ. €\r ­“  4-5-
 . ‡ ‚\f Œ\f\n­ ­ˆ.
…­ \r \nŠ­ Œ­ \nŽ  -
Š \nŽ ‚  \t. \r
 (1941). \b \n ‹† ­†  \n\f\n \r
\nŽ. „ ‚ˆŠ† Ž Œ†  ˆ \f
ŒŒ  Š,  \n\fŒ\n Œ­  \n
‹Ž . ƒ Ž,   Œ Ž Œ
\n\nˆ­ ‚\n\f \f. „ Œ  Š
 \r\nˆ­ \n ­ 30-40  \n­
Ž  15-20  \n­Ž \n.   ˆ 
,  Œ Š,   \n­ Ž­
†, \r ­ˆ­ ˆŠ \n\f†
Ž.  \r \f\nˆ \nŒ\rˆ \r
Ž ‚Œ \n ‚\f\r .   Š Œ
 Œ “   « \n ». „
Œ  Š \r Œ\n­ Œ“ Ž
 Š, \n\nŽ \n \nŽ,  Œ «
\n ». \b \n \f† ­† ‚Œ 
Œˆ­  \nŽ ˆ­,  Œˆ “ \n\f\n
 ‚†  Ž ˆŽ  Š. 
‚† ˆ  ­\r ‚ ­ ‚ˆŽ,
 , †† ­† \r­
Œ. €­ Œ  Š \r ˆ
 \bˆ, Œ““ ­ \n Œ  Š
   \nŽ Œ Œ †.[11]
„ \n­Œ  ­ ‚\f\r  \nŽ
Œ\n­ Œ“  Š \n  Š  
\nŽ. \n‚\f \nŽ † \n ˆ\f 
Š   ­ˆ † Œ Œ 
†.

Ž \r Œ\nˆ Œ Š  ˆ Œ . „
‹Ž “ Œ « \n ». .

. 
‚Ž-
š
\n (1969) \n ‚Œˆ 
­  \bˆ. … Šˆ \n  
  \n\f \nŽ Œ Œ †.
\n
Ž

Рис. 4. Резекция толстой кишки при ее инвагинации: а – границы
\n Ž \nŽ  “ Œ
\nŽ  \f \n ­ Š, Ž
 ˆ“ , \n­ ‚ˆŠ †
: \nŒ\r ˆ \n  , ­\r
 ˆ“ \rŽ \n\n­ ,  \n, Œ\n
­ \n Œ‚\n­. \b \n\f\nŠŽ \nŽ
   \n Œ\n ­\r\f† \r
(\n­, )   \n\f“ 
“ ˆˆ. „-\n, ‚  
 \n ‹† ­† \r ‚\fˆ Œ­ \rŽ
  Š, Œ‚“Š­  ‚“Š-ˆ­
Œ­ ­ Š \n  \nŽ. „ \f
J. Lataste  \n. (1975)  . Schaube  \n. (1985),  2 ‚ˆ
\f†  Žˆ \nŽ \n \n­ 
\n Œ\n Œ\nŽ“,  Œ Œ“ Ž
\n ‚ Š  Ž\nŽ 
­ Š.  \r \r  †Ž, 
 Œ\nŽ ‚\r\n †ˆ \n ‚ Ž
\n \nŽ. „ \rŒ‚ Š Œ­
 Œ ¥ ‚“\f,  \n ‹† \n­† †ˆ ­
“ \n  Š .

‚,  †
 ­­ ­ ‚ˆŽ  
†. ‘\n\nˆ ­ ‚ˆŽ  
Œˆ­  Œ\n\f  †ˆ \n ‚ˆŠ
 ­\n­“­ Œ­  \n Œ Š
­ ‚ˆŽ ­\r,   †
 \rˆ  \n ‹. „ ‚\n
† †  ˆ  \nŒ\r ­
 Œ ‚,  ‚Œ ˆ Œ
10-12   \n . D. Weilbaecher  \n.
(1971) ,   \nŒ\f† \n 24% \n Š
\f†  \n 54% \n Š\f† \nŽ  ‚
\n\f  Œ\n\f† † , \n \n­Œ  
\n\f \n \n\f­ˆ Œ“ Š. 
Œ\f† \n ­ \nŽ Š ‚
  ­“ Œ\nŽ“. „ \f . „. 
‚\n (1969), Œ 349 \n\f† ‚ˆ\f†  265 (75,93%)
\n\f Œ\nŽ­,  62 (17,76%) ¥ Œ­ Š
   22 (6,3%) ¥ Ž . „ ‚ 

. ‚Ž-
š
\n (1969),  74,8% \n\f†
‚ˆ\f† Œ\n Œ\nŽ­,  22,7% ¥ Œ­
Š,  2,5% ¥  . „ Š \f, Œ 12
‚ˆ\f†  -Š \nŽ  4 ‚
\nˆ Œ­  Š. ‘ 1 Œ † \n ­
Œ ­\nˆ Ž­\f Œ­ \n 
\n Œˆ Ž­   3 Œ­ ‚\f ­
 ˆ“ ­ ‚\n\f† †\n\f† ‚Œ
\n . ˆ\f† †\n \n ‹ Ž ‚ˆ\f†  ‚\f.
„ Š \nŽ \n ‚ˆ\f 
ˆ Œ\n Œ\nŽ“  †Š †. ˜
Š Œˆ\f \f  -Š 
\nŽ. ‘ 4 ‚ˆ\f† \n\f Œ­ Ž\n
‚ Š \n  \nŽ   . €\n
‚ˆ\f  ˆ \nŽ Œ\n 
\r \nŒŠ \f,   Ž \nŽ
‚\f ­ Œ ‚ˆ“ \n“ †ˆ,   \nŽ
¥ ‚\f \n \n \f Œ. \b‚ ‚ˆ\f†   
. ˆˆ    \n \nŽ
Š \n­ 13-19%. „ Œ\nŽ 
 8-12%,  Œ Š ¥ 27-36% \n\f†
‚ˆ\f†.[12]
‚\t 
„ . 1979 Ž.., †­   
\n †Ž   10.09.2017 Ž  25.09.2017 Ž.
 :
\b\n : \nŽ­  Š. \b‚Œ\n
 Š.
\b\r­ \nŽ: \b­ Š­ 
†ˆ.
\n“ :  \r. ­  
\nŽ ­  2013Ž
 :
 ‚­ ‚ˆ\f \n  ­ Ž ­\n­
 \n \r\n.     ‚“
 ,  ˆŒ, Œ, “ ¥ ‚Œ ‹
.   3 ­ ‚ ˆ, ‚\f \n. \b
\n    \n  2-†  . \b‚­ \n ‡ƒ
 „.  Œ\n \n \n , Ž
‚\f ‚\n. ƒ… ¥ ­ Š­ \nŽ­,
Š­ †ˆ. \fŒ\n  ˆ“ †Ž.
\n
Ž

„\n \n †Ž  ­ Ž 
\nŽ ­.

ˆŒ\n
CITO! \n  23:45 10.09.2017 Ž. \n
\n   \n\f\rŽ Œ. „ˆ \n Œ
†  \n: \nˆ\f Œ \n  13,2,
-Œ Œ \n  7,5. ƒ\f \n\f,
. ƒ  ‚\f\f .  †\f 
­. †Žˆ ‚\f­. \f \r\n\f
\n­   Š\f. € \nŽ \n
\n \n\f 1,0 ( 1,25). € \f† \n
 Š. ˜ \n\f† \f†  
 Š. ”\f Œ\fˆ ‚\f \f, Œ
8,3†3,4.   ,  . „ Œ 
 \n Ž ‚Œ\n  0,9 
(? ‚\f \r?) „\n ŽŽ\f Œ 
Ž‹†Ž  \nŒ\n. ˜†  \nŒ
Œ­. „\r­ \rŒ  \nŒŒ­. 
Œ Œ 10,7†3,7,  \n. ƒ\f \n
\f, .  †\f ­. †Žˆ
‚\f­. ˜ \n\f† \f†  Œ 
Š.   Œ  10  \n‚ \r.
\rˆ  5  \n‚ \r. \n \n Œ
Ž ­­ \nˆ ‚Œ\n ˆ Ž
Š,    0,7 , Œ  ŒŽ ­,
 ‡€ƒ \n † “­ \r\n\f \f. 
Ž ‚Œ\n­  ­­ Ž‹†Ž
\f  Œ 3,8†2,6†2,5 ,  ‡€ƒ ‚Œ \n\f†
\n (\n‚­ \rˆ? ‚?).   
Ž ‚Œ\n­  Ž Š Š\f 
4,3  \n , \r  Ž‹†Ž
  . “: ‘  \r
\n\n\nˆ \nŽ Ž Š, ˆŒ­
“ˆ ‚, Š †. ‘ Œ
‚Ž \r 2 , ? \rŽ Œ\f­.

ƒ… \b \b \b

„\b\b…  \b \b
… \b­­ \nŽ­  Š ­\r
ˆ“  120 . ƒŠ­   ‹ \n 
  . \b­ \n\f  † \nŽ\n
Ž   Š  \n  Ž Œ. \b“­
Œ\f   Š ( 40 )   
 «Š\f† »  ŽŒˆ\f† \n \r.
ƒ\n \n Œˆ\f† Œ\n,
‚ \f ¥  7    . „ˆ ‚\f
\r, \n Π  \n,  \n\f, 
.  †\f  ŽŽ Œ
  Ž\nŽ \r\nŽ ŽŒ Œ 16†17
. -  \n\f \r\f   Š
\f. ”\f Œ\fˆ  \n, \f Ž ,
\n\f,   \f, \n \n   7 .
  \n\f\r\f† \n  ŠŽ \r
Ž \n \n \r\f† \n Ž\f† 
\n  \n\f­\n. Œ ‚\f \r, 
\n, \f , \n\f,  ­.
„\r­ \rŒ ‚\f \r, ˆ\f†
Œ\n, ˆ \f,  \n\f , 
 \f. Ž\n   Š. „
­   Œ. „\r, 
 Œ\f \n  Œ\f. † \f \n\f,
,  . „ ‚\fŽ \r­ 
Œ\n,  , \n\f . „­ 
†  ˆ“ Š   \n.  \r
 Ž \n ­   4 .
š
Š-†
­  ‚\f Ž,  Š, \n 
\n \n  \n\f­\n.   
\n \n  Š\f. „ˆ­ 
 . „ \n ¥ \n-ŒŽ\n­
­ †, \r ­
Ž \n\n­ \n\n. \fˆ­ ­
 ­, ­, \n\n­. 
 \r­­ ­ \n  \n\f† \n­† Ž
  Œ\f. \f  ­Ž†   Ž†
¥ ‚Œ Ž† Œ . €\f† Œ  
-\n\f† Œ  . ƒ


:
ƒ…- \nŽ  Š, Š
†, \n\f \n ‚“Š    Œ.
ƒ \rŽ Œ\f­. ­  \n .
11.09.17 \n ‹ ­ \n\f ­: €
Ž­ ­, ­, \n­ 
\nŽ  Š, Œ­   Š 
‚Œ\n  Œ «‚ \n ‚».
\r \f :
„ … (. Œˆ ŒŽ) \n \r ‚ˆ
 \r  , Œ . \n 10 
 \n  ƒˆ  . \n\f  2 
\n \n ‚ˆ  \n ŒŽ. „ \nŒ: \f
 \n ‚“Š  Œ\f Œ\f  50 . Œ­
\n. “Š Ž­ ‚­­. \f­\n  \n
Ž  Š. „ \n  \n\f­\n
†ˆ  Š  4,0 , ˆ­ \n \nŠ­
­. Š    “  \n\fˆ
Œ“   Š  ‚Œ\n  
\n Œ «‚ \n ‚». „ˆ, \r, \r\f
Œ\fˆ, Œ¦  ­ Š ¥ ‚Œ Ž. €Ž
Ž Ž  \n\f \n ‚“Š  .
\r\f \n : \t \b \r 
, \f \r \b\t \f \r , 
\b \r\b \f\r.
\f ­ ­,   10 .  -
 \n\f\n   Š \r †ˆ. \f
 Œ­   Š  20  \n\fŠ ‚
\n
Ž

Œ\n­   40  \r - \f Š\n. \f\r 
‚Œ\n  Œ\r†, \n­Œ \n 2-0. 
\r \f ‹-‹ Œ ‚-\n-‚ 
7  \n Œˆ \n. ƒˆ­ Š
Ž\r -Œ\f Š\n. \b \n ‚\f\r  Š.
ƒŠ Ž\r \n ‚“Š“ ˆ. “Š­ ˆ 
\n.  Œ ¥ †.  \f Œ Œ 
\n \n \nŒŠ ‚ \n \r. \t
\n  \r Œ\n\f Š\n. \nŒ Š \f\n 
ˆ“ PDS 1. \b\f \f Š\f Ž†. \n.
 \n­Œ.
Рис. 6. Общий вид опухоли тощей кишки, послужившей причиной
\f \t  11188 \r 12.09.2017
\f:
\bŒ  Š . 62, ­ Š\f Ž† 
\f Š\n.  ­ 25  Ž Œ \n
Š ‚Œ \n\f ŒŽ‚, Œ\f \n
Œˆ ‚\n\f , \n ˆ\f† † \n-Œ\n\f ,
\n“ ‚­ .  ŒŒ \n ‚ ŒŽ‚ \f 
†\n\f Œ 3,5†3, . 1,5,  Š \n,
Œ“ \n. …ˆ † ‚\n­, \n 
\n†\f† † -Œ­, \n Ž‚† 
Ž \n. „\r­  Š \n­, Œ \f
ŒŽ \n †ˆ \nŒˆ  . 
†  Š 8 - 7,  \n­, Œ
­ ­, Œ\n­, \n ­ \n 
Œ \n, \r  †. \f\r  Š 
6, . 0,5,  ‚“Š\f   -Œ
Ž \n, \r\n­ ˆ, ­Ž­,  ˆ“ \n\f†
\n. “­ \f  \n\f Œ\f
(5). \bˆ Œ Š («­ Œ») . 6, 
 1,5  Œ \n , Š\f \f
Š\n  ˆ  \f \f Š\n 
\n .  Š  \f Ž ŽŽ
 ‚‚.
\f:
\b†ˆ \n  Š -ˆ\n­Ž 
­,  Œ \f†   \n\f\r\f 
Œ ­, ‚ Ž† Œ\n, ‚
Š Œ , Œ. \b†ˆ 
Œ\f , Œ\f  \fŠ\f   Š, \n
\n
Ž

Œ\f \n  Œ Ž \f  ­­. 
“­ Œ -\n­Ž, \nˆŽ
 †.  †   Š ‚\fŽ
­, \f \f \n ˆ\f†  \n\f†
‚­Š†  ŽŒ\n\f. ‘ \n\f\r
 ŒŽ ­ , Ž\n  \nŒ
\n. \f\r  ‚\fŽ ­, \n‚Œ †
  Ž \nŒŽ \n­  \n­
Ž . Œ\f ‚\f\r  (5)  \n\f\r\f 
ŒŽ\nŽ ­,  ­ ŽŒ .
«ƒ­ Œ»: Ž   Š  Œ
 Ž \nŒŽ \n­, Œ\f \n\r
\nŒ­­,  \n ‚­Š   Ž
Œ \f† \n.
:
\b†ˆ \n  Š ‚ \n­ \n\n
  ‹     Š
 ŒŽ \n.  ­† Œ, ‚\f\r , 
Œ† †\n   ‚\r. €­ \n\r­
ŽŽŒ  ­  Œ\n ‚
\n Ž† \n †.
\f \t  11586 \r 20.09.2017
\f:
 Ž  Ž† 
\f § 11188/17 ˆ\n\f \n ‚ˆ §62: \n  ˜-
† \n †  \n\f­\n ‹ ƒ7, ƒ20,
†Ž  Œ,
K
 70%.  \n­Œ 
‹ \n ˆ  ˜-\n §17/4-
152797: S-100 = Œ\n­ (Œ­ \n\f\r­ ­
-Œ­ ‹­). Melanoma Marker =
Œ\n­ (Œ­ \n\f\r­ Œ­
‹­). Mlan A = Œ\n­ (Œ­ \n\f\r­
Œ­ ‹­).  †
\n\n  \f.
:
  \r  Š (‚ \n
­ - Œ,   \n\n“† 
† \f†).
„\f   Ž.
\n\f ­\f  7 , \f \f Œ\r
\n\f ­\r.
‹\t
„\n  ‚“ Œ\f\n 
ˆ “  \nŽ  Š \n
 \nŒ,    †ˆ 
Š. \b‚  ‚­ \n ¦ˆ 
\f    \n . ‘\r 
,  \n\n\f  ‘ \r \n
 \nŒŒ\nˆ \f  Š  Œˆ  \nŒ
\r\f ŽŒ, \n\r¦\f  \f ƒ… \b„. 
   \n\f \n 
\n \n ‚¤¦  \f    Œ‚
\n­.
 \f
 ™..
\r­ †Ž­  . . «», 1973.
¥ 470 .

\t „..,  ˆ.ˆ., ‘ ˆ.., \n\t\b „.„.,
‚­   \nŽ Š   . // 
 \n \nŽ ƒ\nŒ. § 1 ¥ 2009 ¥ . 26.

 ‡..
€­ †Ž­: ˆ \n\n /
 . .\t. \n, .\t. €\n. ¥ .:  \b…-, 2009. ¥
1168 .

 .., ‘Œ ˆ.., \n ˆ.•., ‚ ˆ.‡.
ˆ­ ‚-Ž­   \nŽ
Š //  \n \nŽ ƒ\nŒ. § 1 ¥ 2009
¥ . 41.

 €.., ™ \n.‡., \t ‡.ˆ., \n-
 ™..
\nŽ­ Š: \r  \nˆ \n\n
  Œ\n  ˆ Œ‚\n­. // 
\n  †Ž ŒŽ  Ž. …. II. -
§ 4. ¥ 2012 ¥ . 17-20.

 €.., ™ \n.‡., \t ‡.ˆ., \n-
 ™..
\nˆ \n Œ\nŽ  \n
 Œ ­ 1000 ‚ˆ\f†. //  \n \n
Ž ƒ\nŒ. § 1 ¥ 2009 ¥ . 43.

 €.., \t ‡.ˆ., \n ™.., ™-
 \n.‡., •\t .ˆ., ˜Œ  ….., „ ˆ.™.
„
\rˆˆ \n\f­ \n Œ ­ Š - \n 
 \n\f‚ ‚ ­ \nŽ Š. //€­ †
Ž­. 2010. § 6. . 29-32.

Ž ..,  ˆ.., Š „.€.
ƒŠ­ †
ˆ. \n\n ­ \n / «„», -„‚Ž, 1999.
443 .

, .ˆ.
ƒ    †Ž / .. ,
.. . : \b\b\b «», 2004. 528 .

 ŽŒ\f .
‘‚ ­ \nŒ\n  .
š
-
. ,  .. \n / „‚: «ˆ­ »,
1998. 478 .

\t ..,
 .\t. ˜Ž­ Š / ƒ\n,
«\nˆ­», 1977. 247 .

 •.•.
˜Ž ‚Œ / \n, «»,

iera A., Hsiao A.L., Langhan M.L., Goodman T.R., Chen L.
agnosis of Intussusception by Physician
N
vice Sonographers in the Emer
gency Department // Annals of Emergency Medicine. - Volume
XX
,
X
.
¥ 2012. ¥ P. 1-5.

illiams H.
Imaging and intussusception // Arch Dis Child
EducPract. ¥ 2008. Vol. 93. ¥ P. 30¥36.

hehata S., Kholi N. E., Sultan A., Sahwi E. E.
Hydrostatic reduction
of intussusception: barium, air, or saline? // PediatrSurg Int. ¥ 2000. - § 16.
¥ P 380-382.

enwick A. A., Beasley S. W., Phelan E.
Intussusception: recur
rence following gas (oxygen) enema reduction. // Pediatr. Surg. Int. ¥ 1992.
\n
Ž

\n­ ‚ \n†
„Ž Œ Œ
¥ \n-†Ž \t ‘ ‡ˆ
­ ƒ­ ‚ˆ ‘\n­ € „Œ \t.
E-mail: [email protected];
http://mimokhod.wixsite.com/hiryrg/, http://ckb-1surg.ru/ .
‹ \t \t
¥ Œ\n“ 1 †Ž
  \t ‘ ‡ˆ­ ƒ­ ‚ˆ
‘\n­ € „Œ \t.
E-mail: [email protected]
• \t \t
¥ \n-†Ž \t ‘ ‡ˆ
­ ƒ­ ‚ˆ ‘\n­ € „Œ \t.
E-mail: [email protected]
Information about the authors
Mimokhod Arthur Arturovich
¥ doctor-surgeon, Federal state in
stitution Central Clinical hospital of President¨s A£airs Administration
of the Russian Federation.
Phone +7(963)729-53-26
E-mail: [email protected]
http://mimokhod.wixsite.com/hiryrg/, http://ckb-1surg.ru/.
Znamensky Alexey Alekseevich
¥ head of the 1st surgical Depart
ment, Federal state institution Central Clinical hospital of President¨s Af
fairs Administration of the Russian Federation. Phone +7(903)7259150,
E-mail: [email protected]
Nikonov Aleksey Alekseevich
- doctor-surgeon, Federal state insti
tution Central Clinical hospital of President¨s A£airs Administration of
the Russian Federation. Phone +7(910)4265470,
E-mail: [email protected]
\n
Ž

€‚ 618.145-007
еров
при наружном генитальном
. 

, .. 

, .. 
ФГАОУ ВО «Рпттйктлйк уойгжстйужу есузвь обспепг», Мптлгб
:
ˆ­ \n­ ˆ Š -ˆ  -‹ ‚ \n ŽŽ-‚ ‹
Œ, \n   \n Ž Ž Œ‚\n­.
  \r\r­:
 ‚ ‹ ƒ    \r\f Žˆ\f ‹Œ.
€\r \r \t \r\r­:
\n\f 33 ‚Œ Œ\f \n   III-IV ­  33 ‚Œ Œ\f \n  
I-II ­ \rŽ ŽˆŽ ‹Œ,  \r 10 ‚Œ\n Œ\f Œ\n\f† \r \n \n ˆŽ ­. „\n
Œ ˆ ‹ “† ƒ \n Œ \n    
N
noDrop 1000 (
N
noDrop
Technologies Inc., USA).
 ‚  \r\r­.
 † \n­ ‚\f \n \n \n\fŠ ˆŽ \n­ ‹ ƒ-30 
ƒ-133  \r Žˆ ‹Œ \n   \nŽ \n Ž \n­ (p 0.05).
:
 \n \n  \r­ “† ƒ, \r \nˆ ƒ-30, ƒ-155, 
ƒ-574*, ƒ-425, ƒ-133 ­ \n“­ \n \n Ž  ‹Œ.
 :
‹Œ, Ž, \r\f Žˆ\f ‹Œ.
IN EXTERNAL
SHKRE
O
ZO

M
. R., DU
KHIN
A
. O.
Federal STATE Autonomous educational institution «Russian University of friendship of peoples»(RUDN- university), Moscow
Abstract:
N
N
s in plasma
N
noDrop 1000 machine (
N
noDrop Technologies Inc., USA).
ƒe results of the study.
•e research showed a signi–cant increase in the relative expression levels of microR
N
-30C and microR
N
-133a with external genital
N
e can recommend microR
N
-30C, microR
N
-155, microR
N
-574*,
microR
N
-425, microR
N
 \n 1998 ‚\f Œ,
 Ž­ ˆ Ž  \n
\nŒ  ­\r\f† (III-IV) ­† ‹Œ [2]. €
­ ŽŒ ‚\f \n\r Ž \n­.
­  \n““ “ Œ­, \n\f 
\n­ \r \n\r“ Ž“ Œˆ
‹Ž  ‚ \n  \n Œ
 \n Ž ‹­ [3].
\n
Ž

\nˆ ‚\r \n  ­\n­­ Œ
  Œ\f\n\f† ƒ - \f† “† 
 ƒ  18-25 \n, \f \n \n
   Ž­ ‹
 Œ\f† Ž\n. €Œ \n 
  ƒ \n Ž­ ‹ Œ\f†
Ž\n. „-\n, \n ƒ  
\n\n\f Œ \n \n ‹ Ž\n, 
\n­­ ­“ ‚  ‚† [4].
  \r \n­ \r Ž­ ƒ \r Žˆ \n\r
“ ˆ \n , ‚ ‚ Œ\f† Œ‚
\n .  ˆ“ ŠŽ ­ ŒŽ Œ
\f† Œ‚\n Ž \n\f \n ‹“
ƒ  Œ\f† Œ‚\n­†, \n   
-\f†, Ž†, ŽŽ† [5].
„\n  \n, \n­ ‹
Œ\f† \n ƒ  ‹Œ ‚\f \n
 \n 2009 Ž  \n\f 14 \n  ƒ  \n\fŠ
 ‹  8  \r [6].
… \r­ ƒ ­\n­“­ Ž Š
, \n“­ Œ\f Ž\f Ž­\f ‚
 (StAR), CYP19A1, ‡\b -2, ER¯, ER°, PR [7]. \f Ž
\f \n Œ ˆ“ ˆ ƒ
\n ŽŒ Œ\n­ ‹Œ. ƒ \r ‚\rˆ
\n\fŠ, ŽŒ Œ\n­ ‹\f† Ž\n \n­Œ 
 ,  ŽŽŒ, ­  Ž
­ , \n­ \rŽ . 
Ž\f \f† †­­ \n ,  ƒ Ž
“ ‹ \f. \n“ \n­, Œ\nŠ
Œ“ ‹“ ƒ  \n ‹
\f† Ž  ‹Ž ‹­ [6].
  ‚ ‚\f Œ Š ‹ 22 -
ƒ \n ‹\f† Ž­†,  ‹ 
ƒ-29 \n­ “\n­ ˆ \n Œ\n ‹
Œ [7,8]. … ‚Œ, ­  ­ ‹† 
 \r \rˆ  Œ\n­ ‹Œ[8]. „
‹  \f† \n ƒ  ˆ \r
Ž Œ † \n ŽŒ ‹Œ ­ Œ .
 \n ŒŽ \n­­ \n­, \n
\f  \n ‹ ƒ  Œ\n\f† \r
   ‹Œ [9].
 ‹   \n Œ  
\f† ‚\n, .. \f† \n, 
“  \n“ \f† \nŒ\r Œ\f\nˆ 
­  \nŽ ŽŒ \n ,   Ž\nˆ
 Ž-‚ Œ‚\n­.
€ ­Ž \n \n­, \n­\f 
 ‚\n \n ‹Œ, \nˆ Ž
\f.   \r \n­,  ˆ,   
† \n  Œ‚\n­,   Ž \n
‚ ˆ \n  Ž \n\f \n­ 
\n  Œ\n Œ‚\n­  † ˆŽ
­.
 
­\nˆ  ‚
‹ ƒ    \r\f Žˆ
\f ‹Œ.
„\t  ƒ \t
\n\f 33 ‚Œ Œ\f \n   III-IV
­  33 ‚Œ Œ\f \n   I-II 
­ \rŽ ŽˆŽ ‹Œ,  \r 10 ‚
Œ\n Œ\f Œ\n\f† \r \n \n ˆŽ
­.     Ž 
N
80.1-‹Œ ­\n),  
Ž \n\r\f ŽŒ, \n\f
\nŒ.
\t\r\r :
 ‹Œ Ž†
Œ ,  \n“† ŽŽ† Œ
‚\n \nˆ  \nˆ ‹Ž,
Œ\n\f † Ž\n \n \f.
\b‚ \n  ƒ  ˆ\f
 \n \n ­ \n­, ‚\f 
\n  \n \f† \f†.  Œˆ \f 
‚ 6 ‚ Ž\n\f† ƒ ­ ˆ
 ŠŽ Œ­  Š \n\f‚ \n, ­
\n“ \n ‚­ 33 ‚Œ Œ\f \n \n  III-IV
­  33 ‚Œ Œ\f \n \n  I-II 
­ ‹Œ,  \r 10 ‚Œ\n Œ\f Œ\n\f† 
\n \n \n ˆŽ ­
„
   ‚\t miRBase
hsa-mir-155-5p
MIMAT0004658
hsa-miR-30c-5p
MIMAT0000244
hsa-miR-133a-5p
hsa-miR-574-3p
MIMAT0003239
hsa-mir-425-5p
MIMAT0003393
hsa-mir-625-3p
MIMAT0004808
ƒ\nˆ \n ‚ˆ  , \n \n\f
‚ (7-9 ), \r €… \n \n Ž
­. ‡ˆ“ \nˆ Ž\n  
+4± \n  20   ‚† 300G, \n  30 
  Œ‚. ‡Ž\n Œ\nˆ  
ˆŒ\n Ž 5810 R (Eppendorf).  Œ
 \n \r\f ‚  \nŽ
\n Ž\n“   +4± \n 
 10   ‚† 14000G. \b“  
Ž ‚ Œ ‚ \n 2 ‚  
  †   -80±.
\n
Ž

„\nˆ “  ƒ Œ
­  
N
noDrop 1000 (
N
noDrop Tech-
nologies Inc., USA). †­ Œ \f† \f†, \n
‚ “     «Quibit 2.0»
(•ermo Fisher Scienti–c, ). …  Œ Œ\n­
  Ž ­, ‚Ž \n 
Œ\f† \n\f†  \n­Œ\f\nˆ­ ˆ  ƒ.
 \n \n Œ\n­ \n ˆ “ 
\n“ . ƒ\n \n\f ƒ \n 
‚Œ Agilent 2100 Bioanalyzer (Agilent Technologies,
\b\n  ²Ct, \f \n­ ‚
Œˆ Œ Ž\nŽ  (Ct) \r \n\f 
ˆ\f Ž,  ˆ \n \n\f Œ
­ Ct  (\n Š  Œ Ct ‹ŽŽ
­ U6), Œ \r “ ƒ,  
“ : ²Ct = Ct(miR
N
) ¥ Ct(U6). €
­ ˆ ‚\f ‚\f \n\f  ‚Œ ‚ ‡ƒ„
« »
 Œ \n­   
ŽˆŽ ŽŽ \r­ …  (Œ …
  \n), Œ‚Ž \n   (\nˆ\n
 Ž §2008612585, ), Œ\n­“Ž 
\f\nˆ  ‹\nˆ ,  \r \f
\nˆ    Œ­ Ž\nŽ  Ct. €­
  \r \n­ ‹ ƒ
\n † †  † \r ‚Œ\n \f\n ‹
 Ž\n ­ . €­ Œ p ( 
¦ ­ ,     Œ
\n­ ‹  ‘) ‚\f \n\n \n
  \r\n \n \r-˜†‚Ž
(FDR). €\f  \n\f  p 0.05.
Œ\tƒ \t
 \nŒ \r \n \n Ž \n
30,3´4,5 Ž, \n ˆ ¥ 29,8´3,9 Ž. ¥ \n\fŠ
\n­ ˆ ‹ ƒ-30 \n Ž 
‹Œ, \n \n  ˆ Ž \n 2 Œ
 ‚ˆŠ  ŽŒ\n\f† ‚ˆ\f† (88,3%)
‚\f \n\f Œ­ ­\n,   
\n ‚ˆ\f† (43,3%) ¥ \n­­, \n 
 (25,0%) ¥ \n­­.
‘ ­   (20,0%) ‹\f \f
‚\f \n\f­\n\f \n ‚† ­†,  ­\nˆ \n
­ \n­ Œ ­\n  ‚† . „
   \r\f Žˆ\f ‹Œ
III ¥ IV  \n\f\r ‹\f \f 
\n  Ž\nˆ \n \n ­ (p 0,05).
„  \n\f \n\f† ‚ˆ\f† (46,7%)
 ‚\f Ž\n \f 
II-IV ., \n \n­Œ  , \n \nŠˆ\n ‚\f 
 ˆŽ\nŒ. „  Œ
 \n ‚ \n\f† \n \nˆ  ­ 
 (21,7%),  ˆŽ\nŒ \n ¥ 
\n \r ¥ ˆ  10,0% ‚ˆ\f†.
 Œˆ ŠŽ \n­ ‚\f Œ,
 ˆ\f \nˆ ‹ ƒ-30 
ƒ-133 \n\fŠ­  ‹Œ  \n“
 , \n  \n­  ƒ-155, ƒ-574*
 ƒ-425 “ \r ˆŽ
\n­ ‹. „ˆ  ‹Œ ‚“
\f Œ­ ‹ \n\f   
\n Œ‚\n­,  Œ\n­“ \nˆ 
\f \f \n \n ˆ\f† Ž†
\n ‹Œ.
„ \nˆ Œ ˆŽ \n­ ‹
 ƒ-625* \r Ž ‚ˆ\f† ‹
Œ  ˆ Ž ,  ‚\f \n\f­\n Œ .
 † ­Ž \n­ \n:

\r \n­ ˆ ‹ 
ƒ-155 \n Ž  ‹Œ \n \n  
 \n 1,16 Π(p 0.05);

 ‚\f \n\f­\n Œ \n ‹ ƒ-625*
\r Œ\f Ž (p 0.05);

\r \n­ ˆ ‹ 
ƒ-574* \n Ž  ‹Œ, ˆ
ˆ Ž\f \n 1,37 Œ (p 0.05);

\n\fŠ \n­ ‹ ƒ-133 \n Ž 
‹Œ ˆ ˆ Ž\f \n 1,17
Π(p 0.05);

\r \n­ ˆ ‹ -
ƒ-425 \n Ž  ‹Œ \n \n  
 \n 1,5 Π(p 0.05).
 ˆ,  \f \f  \nŒ\r
 ˆŒ\n­ ƒ \n \n Ž†
\n,  \r ­  ‹Œ  
 ­\r,   \n\n\f[9].
š
 \n Œ\f†
‚† Œˆ\f \n\f \n Œ\f† † Œ
­,  \n Œ­ \n 
\n\f† \f†  ˆŽ \n­ ‹
ƒ[8,9].  Ž‚­­ Œˆ\f 
­ \n \n ‹ \r \n­\f Ž
‚Œ\n. … ‚Œ, \n\f ‚ Š­
‚\f ­\n­­ Œ­ ‚ \nˆ\f†
\n ­ Œ­ Ž , ‚\n
“ \n Œ \n\nˆ  
. \f­\n\f  ˆ\f \f ‚“
 \nˆ Œˆ  , †­
 \n \n † ŠŽ \n­ 
 \n\f Œ­  \n Ž. …
‚Œ, ‹ ƒ Ž ‚\fˆ \n\f ˆ
 \f Ž .
„ Œˆ \nŽ \n­, \r 
ˆ \n\f\n,  Œ\n \nŒ\nŽ ŽŽ
\n­  ˆŒ\n ƒ,  ‚ˆŠ
\n
Ž

. €ˆ Š \n­ \n ‚ 
  Œ ‹ “† ƒ,
 ˆ\f† \n ­ Ž ‹Œ
  Ž ­\r,  ˆŒ\n Š \n\f
‚ \n,  \r   \n Š† \n\f
\f†  \n\f\n\nˆ\f† ­-Ž†
\n (\n\fŒ\nˆ \n\n  
\n­-ˆ­ „‡), \n  Œ‚ \r 
Ž .
ˆƒ
… ‚Œ,  \n \n  
\r­ “† ƒ, \r 
\nˆ ƒ-30, ƒ-155, ƒ-574*,
ƒ-425, ƒ-133 ­ \n“­ \n \n 
Ž  ‹Œ.
 \f
ercellini P.
Long-term adjuvant therapy for the prevention of post

erformance of CA-125 measurement in the detection of en
dometriosis: a meta-analysis.
/ B. W. Mol,
N

 „..
ƒ \n  \f† Ž† †
 Œ\n ‚, ‚\n Œ /
„.. 
// 
Š\n, ŽŽ­  ­ ¥ 2013. ¥ …. 7. ¥ § 4. ¥ . 6¥10.

inetic signatures of microRNA modes of action.
N
. Morozova,
Z
ovyev,
N
.
N
N
ol. 18. ¥ § 9. ¥ P. 1635¥

croRNAs and angiogenesis in endometriosis /
J. Marí-Alexan-

croRNA-regulated pathways associated with endometriosis.
E. M. C. Ohlsson Teague,
K

 ˆ.„.
 \n \nˆ Œ\f
­ \n\f‚   ‹Œ / .. €\n, .. „
, .. ‰­ // †\n Š\n  ŽŽ . .\t.
Ž\n ¥ 2015. ¥ …. 2 ¥ § 4. ¥ . 41.

unctional microRNA involved in endometriosis.
/ S. M. Hawkins,

ail:
[email protected]
 „ Žƒ
¥ ...,  \f
Š\n  ŽŽ   Ž  Ž
\n \r‚\f \n; ˆ Œ ¥ Š
\n  ŽŽ­; 117198, ­, \n, . †-­, .6,
ail: [email protected]
€ŒŽ  \t\f
¥ ...,  \f Š
\n  ŽŽ   Ž  Ž \n
 \r‚\f \n; ˆ Œ ¥ Š\n 
ŽŽ­; 117198, ­, \n, . †-­, .6,
ail: [email protected]
Information about the authors
Shkreli Ivirt –
ail: [email protected]
Orazov Mekan Rakhimberdievich
¥ MD, Professor in the Depart
ail: [email protected]
Dukhin Armen Olegovich-
MD, Professor in the Department of
ail: [email protected]
\n
Ž

€‚ 616.36-004.7-021.3
современное
представление
трансь
гулярного
тосистемного
шунтирования
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\t
, .. \b
\f
, .. 

:
ˆ­ \n­ ‚ \f ‚Œ   ¤“Ž­Ž \nŽ Ž Š\n­
(TIPS)  ‚ˆ\f† Œ . € ­ \n  \n    ‚\n Ž ­. \f 
Œ­  \nŒ­  \n“ TIPS, Œ\n\f ‚ \f \r­  Ž \n.
 :
¤“Ž­ \n  Š\n, TIPS, Œ .
REPRESENTATION

SHUNTING
AL
E

A
.
V
KA
R
TY
N
G
.E., DU
N
E
S

S
.
S
.,
P
KHO
A R.
A
., K
CHETO
A
L
.
V
Krasnoyarsk state medical University im. professor V. F. Voyno-Yasenetsky ministry of health of Russia
Abstract:
•e article is a literature review of the use of transjugular intrahepatic portosystemic shunting (TIPS) in patients with cirrhosis of the liver. A historical reference
N
IS \n\f­\n,  Œ 9-
  \n Œ  \n\n­ \r
Ž  3,7%. ­­ \rˆˆ \rŒ ‚ˆ
\f†  Œ  \n­ 9 .  \f
ˆ Œ  ‚ˆ Œ 6-8 .
„ ˆ \n 8% \n ­\n­­ , 18%
¥ ­ ‹­, 10% ¥ \n­ Œ \n
Œ-Š\f† \n \n  \n 45% \n Œ\n
ŽˆŽ  [2, 4, 10, 15].
Œ\n,  Œ  ­\n­­ Œ“ˆ
 ‚ˆŠŽ  †† Œ‚\n 
.  26% \n Œ  ­\n­­ † †
Ž Ž , \n\fŒ\f\nŽ hepatitis C virus.  \n
  Žˆ, \n\fŒ\f\n­ Œ\n ŽˆŽ 
Œ \n 20% \n. Žˆ\f Œ  Œ
 \n     Œ‚\n Ž\n
\n­. …ˆ \n   1 . “ 
Žˆ\f Œ , \n  Œ‚\n Œ
\n\n­ Œ 10-20  Œ‚­ Ž.  15%
Œ\n Œ ‚\n  HCV- 
Žˆ ‚Œ .  “ Ž\f† 
Œ\n  †­ 18%,  ­ \n\n , 
­ Ž \n Žˆ \r\n ‚Œ
ˆ“ .  Ž  (HBV) \n  Œ\n“
Œ Šˆ \n 15% \n [1, 9, 11, 20].
Ž \f

\n Ž ‚\n  Œ“
Œ‚\n  Œ  Œ ““
Œ“   ­  ,  
\n­ 59%.
 ŽŒ Œ\n­ Œ‚\n­ “\n\f 
­\n­­ \n\r Ž, \n­  ‚Œ
 .
  Œ\n­ Œ‚\n­  \n\f  \n\f†
­ “ \r­: , ­ ­ 
ˆ, ­ ‹­, \f
‚ˆ\f , ˆ­ ŽŒ­, \n 
\n
Ž

 \n Œ \nŒ-Š\f† \n 
\n, Žˆ\f .  ­\n­­ ‚
\f \r Π, \n 50% 
\n Œ\n\n­  \n \n  \n\f† 10  Œ\n
­ Œ‚\n­. ”ŒŽ\r\f \r 
­ \n­ Œ \nŒ-Š\f† \n \n,
\n­†  \n  ˆ \n 80% \n.
‘ 90% \n  ˆ ŽŒ  Œ
 Œ\n\n“­ \n­ Œ \n-\r
\f† \n\n [6, 7, 18].
„Ž\n , Œ\n \r ,  -
\r ‹\nˆ Œ  ­\n­­ 
Œ  \n“ ¤“Ž­Ž 
Ž Š\n­ (…„), ŽŒ  
. „\n \f\f† \f†  ,
­\f†  ­\r ˆ† ­ , Œ
“ Ž‚­ ­ .  \n 
\n­ \n  †ŽŽ ­ ˆ Ž
Œ \nŒ\n\f† ‹\n­\f† \nŠˆ\n,
Œ \n“ ‹\nˆ [3, 8, 12, 17].
\b\n\f Œ­  \n“ …„ ­\n­“
­: \f , ŽŒ Œ\n­ \n Œ
\nŒ-Š\f† \n \n  \n \n
Œ,  \r Žˆ\f . Œ 
Œ\n \r \n \n   ­
Œ\n­ \n\fˆ “ ˆ \f 
\n\nˆ \f ˆ ŽŒ. €Œ
,   ŠŽ \n\f­ …„ \n 
\r­ \n \n \n \n [3, 5, 12, 16].
 \n\r­ \f \r
­ \n 13,0% \n: \n 4,3% ¥ \n\r Ž\f†
\r\f† \n, \n\r Œ\n Ž‚;
\n 5% ¥ Œ\n \n Ž\f  \n 4% ¥ \n
‚“Š \n.  † ­†  
 ˆ \n\f,  Œ\n \n
  \n  ,  \n
\n\f \nˆ .   
\r, \n­Œ  \f  \n
 \n\f  ‹  , ­  \n\f
­­, \r Ž Œ, \n
Š  ˆ †.
 17% \n  ­ ‹­,  ­\n
­­ ‚ \f \r, \n ‚ˆŠ\n \n
­ \n\n\f ­­.  2% \n
Œ\n\n­ ­\r­ ‹­, \n\r­ Š
 Œ­, \nˆ  \f. ­  ,  Ž
\n ‹ ­\n­­ \r\f \r,
‚† \nˆ ­ † ­ .
Ž ‚“ \f, ““ Œ\f, \n“
\n “ “† \n: Œ, L--L-
  ‚‚\f \n Š ‚ (
ˆ Œ Ž\f ) [1, 9, 14, 19].
  Œ\n­ \r \n  
 \n­“ “ \f: ˆˆ 
 (\n ­†), ‹Œ\f \n \n Œ
(\n), \n ‚‚ (ˆ/), ­ Œ\f
(ˆ/), ŽŽ‚ (Ž/)   (ˆ/). Ž
­\f  “­ \f ‹Œ\f 
\n  ‚\f  Ž .
Œ\n ˆ  
\nŽ Š ‚“­ \n 13% \n. \b\f 
‚Œ\f Š ­\n­“­ †\f \r …„.
 2% \n Œ\n\n“­  ‚Œ\f \n   30
 Ž . „‚­
“Œ­ Š † \n   9 ­\n  10% 
\n [3, 13, 17].
„ -  \f† \r
 ­\n­“­ Ž ­­, \n\f
\n  : ˆŒ\n\n 
\n \f \n \n\f  ˆ“­ 
Ž­, Œ\n­“ Œˆ ‚ Ž
† ˆ \f  .
… ‚Œ, ‹\n  …„ \n 
\n  ˆ ŽŒ  Ž
\n Œ  Œ\n­ Œˆ \n 
\n\n \n \n­ ‚\f\n­ ‚ˆŽ \n « \r­»
 “ .
 \f
Blachier M., Leleu H., Peck-Radosavljevic M. et al.
•e burden of
liver disease in Europe: a review of available epidemiological data // J. Hepa
tol. 2013. Vol. 58. § 3. P. 593¥608.
Henry J.A., Moloney C., Rivas C., Goldin R.D.
Increase in alcohol
related deaths: is hepatitis C a factor? // J. Clin. Pathol. 2002. Vol. 55. § 9.
P. 704¥707.
Kowdley K.V., Wang C.C., Welch S. et al.
Prevalence of chronic
hepatitis B among foreign-born persons living in the United States by coun
try of origin // Hepatology. 2012. Vol. 56. § 2. P. 422¥433.
Vierling J.M., Zeuzem S., Poordad F. et al.
N
S3
N
. Engl. J. Med. 2008. Vol.
359. § 14. P. 1486¥1500.
Lok A.S., McMahon B.J.
Chronic hepatitis B: update 2009 // Hepa
tology. 2009. Vol. 50. § 3. P. 661¥662.
Marcellin P.
Gane E., Buti M. et al.
Regression of cirrhosis du-
ring treatment with tenofovir disoproxil fumarate for chronic hepatitis B:
\n
Ž

š
\r .., \nŠ .…. [ .]. 
\n Œ \nŒ Š\f† \n \n  \r //
\f †Ž ŽŽ. ¥ 2013. ¥ ….18, no. 3. ¥ .110-129.
Cat T.
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