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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 : -. , ..., , \r\f \n \t \b. . \n .  : ...,  . .      . ;  . 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 Sent for press Format Circulation 1000 copy he price contractual  e certi­cate on registration of mass media  \n77-32248 from June, 09, 2008 Subscription index 88210 in the incorporated catalogue «Press of Russia» Address of edition: 123060, Moskow, 1 Volokolamsky pr-d., case 15/16; tel/fax (495) 168-18-49, e-mail: [email protected] ; http://www.mossj.ru Printed in «Center of printing services» Rainbow, Russia, 123182, Moscow, Russia. Schukinskaya, 8-74. •e reprint of the materials published in magazine is supposed only with the permission of edition. At use of materials the reference to magazine is obliga tory. •e sent materials do not come back. •e point of view of authors can not coincide with opinion of edition. Edition does not bear responsibility for reliability of the advertising information. •e magazine is included in the list of the leading reviewed scienti–c magazines and editions in which should be the basic scienti–c results are published \n Ž  .\r. \f   , . .   \n  , .\f.   , ..  , .\t. \b  ,.\t.  \r \b\b ™  ™š™  ™ ƒ „‰\b › ƒƒ ........................................................................... ..     , . . \r  , ..   \b”\b… „\bƒ\b„ š™ ƒ\b › ˜‘  ƒ š™ ƒ › ‘ š  ..   , ..   . . \t  , ..   , ..   , ..     ‰ ƒ …‡  ™ ” ‡\b\b \b € ™ \b ..  \f , .. \t , ..  „‘˜\b Ÿ …\bƒ\b › , ƒƒ „ š   ‡   ™ € ™  \b… ™ .   , ..   , ..  ƒ„ ‰ \b ™ ƒ‘‰ ¡ ˜ ƒ ™ \b „ ‘”\b   ™ … Ÿ \b €\b ™ …\b ™ ..   , ..  \b  , \t.\t.  \t , .. \b \f , ..   \b \b ™ €… ™  ™  Ÿ ‰\b \b „\b…\b… ™ \b \b ‘…\b‰ \n Ž  I L B .Z., KAL INICHENKO A .YU., A M R.H. , C HINIKO M . A . , P NTE L EE A I. S ., KU R BA NO F. S . MBI N ED TREATME N T OF RECTAL CA N ........................................................................................ BAS SH ., BITEE N.Y., T T E A D.K. AROSCOPIC SURGERY CAPABILITIES CLI N ICAL CASE ž ZKO . L ., K NE LL ER L .O. SE M ENO A .Y., R NO D. A ., L ZKO M .F., ZAG ORODNY V DICATIO S TO STABILI Z TIO OF TIBIOFIBULAR SY N DESMOSIS HOD A . A ., Z N EN S A . A ., N IKONO A . A A TUMOR OF THE SMALL I N TESTI N E AS A CAUSE OF I N TUSSUSCEPTIO I N MIDDLE AGE SHKRE O ZO M . R., DU KHIN A . O. PRESSIO OF MOLECULAR MAR K ERS I N E X N GE N ITAL E N DOMETRIOSIS 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 ODER RESE N TATIO F TRA N SUYULAR PORTHOSYSTEM SHU N TI N \n Ž  €‚: 616.345–006.66–072.1–089 Комбинированное лечение ра а прямой .\r. \f   , . .   \n  , .\f.   .. \n     , .\t. \b  ,.\t.  \r О Рпттйктлйк Уойгжстйужу Цжоусбмьобя впмьойчб д. Бблу, Аижсвбкезботлбя сжтрувмйлб : „\n  ‚“, †Œ“ \nŒ\r ‚\nŽ ­ ‚ˆŽ 67   ­\r\f  ‚\f ,  ‚\f Š \n\f ˆ­ Œ­ ­ Š  ‹\n  †\n . €­ \n\f\n ‚ ‹\n ‚\nŽ ­ ‚ˆ\f†  ­ Š Š† \nŒ\f† Ž.  :  ­ Š, †\n­ ­, ˆ­ Œ­ ­ Š. COMBINED TREATMENT OF RE TAL I L B , KAL INICHENKO A .YU. , M R.H. HINIKO M . A , NTE L EE A I. S , KU BA F. S 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. „ ­­ Œ\n\f \f   Œ‚\n  ­ Š, \f Ž ­ \n\fŠ  \n  \n ™ \n     Œ\n\f† † [1, 2].  ‹ \n­Œ ­\f  †Ž\n  Ž\n  Œ“ ‹ \f \n  [1, 3, 4]. \b Œ \n\f† \n \nŠ \n\n­ ‚\n ­ ‚ˆ\f†  ­ Š ­\n­­ \n­ Œ‚  \n \n ¤ “\nŽ †\nŽ ­ ‚ˆ\f†  ­ Š. \b‚Œ,  \n \nŠˆ\n ­\n ­­ \n\f  \n  ‚ˆ\f†  ­ Š. …  ,  \f ™ .. …“­\n [5]   \n ŽŒ   10-15% ‚ˆ\f† Œ“ ­ ‚ˆ\f Œ-Œ ˆ  ­ † \n \r“ Ž\f. ƒ Ž,  ˆ \f†  ‚“­ \n\f­  ŽŽ Œ\n­,  ­­­ \n\f\r\nˆ  \n\f Š 45-50%. Š ‚¤ \nŠˆ\n, \n    Œ  Œˆ ‹Œ, Šˆ  10% \r  \f† \n\n,   \n  ‚† \n­ \n ŽŽ ­  ­ Š. \b Œ ‹\n\f† \n ‚\nŽ ­ ‚ˆ\f†  ­ Š ­\n­­  ­ †\n­ ­ (˜…). „ \f . Rodel [6],  \n, \nŠ† “ ˜…,   \n\f­\n­ -Žˆ\f† Œ\n Œˆ \n \n Œ,  N . Janian [7] Œ,   - \f† †­† \n  ˜…  \n \n\fŒ\f\n ˆŠ ‚¤ †,  \n 15-28% \n ¥  \f Ž.  \f ‚\f \n\r \f Œˆ Ž† \n\n, \n     \n\f† † , [8, 9]. \r\f ­\n­­ \r   ‚­ˆ\n,   \n  ˜…  ‚ˆ\f† Š† \nŒ\f† Ž   \n ­ \f \r [10]. \n Ž  „\n  ‚“, ““ \nŒ \r ‹\nŽ ‚\nŽ ­ ‚ˆŽ  ­ Š Š \nŒ Ž. ˆ ., 67 ,  \n ‡ƒ  (Ž. \n)  - ŽŒ:  \r­Ž  ­ Š N 0M0. ­  ˜…   Œ\n ‹ \n. †\f ‚ 2 ,  ­ \r, ‚\f , \n  ‚. €‚ ­ ˆ­  ­. €‚­   ­ \n \f, †­ Œ. ˜­  Š\n \n† \n \f I-II . Wagner. „\f ­ , Ž\n , †­ ‚ Š . €\n¦Œ Ž\n Š. „\n†\f . ”‚\f   ­    ˆ“  \n, \r , ‚ˆ. Œ Œ‚\n­: \f \r‚\f ­\nˆ Œ Ž  ­Ž ­. „ ‚\n   Ž   \rˆ\n ‚\f \n\f­\n ‚Œ\n Œ  ­ Š \n \r­ . „ ŽŽ \n - \n\f \n­ . „ \f … Ž\n  Ž Œ - ‚¤ ‚Œ\n \n \r­  ­ Š Œ 1,2 † 0,9 , 2 \n\f†  Œ \n \nŒŠ Ž\f \n Œ 1,5 † 1,3   1,1 † 0,7 . ˆ ‚\f \n    \n  (23 )    ƒ ‚ (ƒ® 1000 Ž). „ ˆ … ¥ Œ ˆ ˆŠ ‚Œ\n­ \r­Ž  (\n  \nŒŒ­), Œ\f ‚Œ Œ . „ Œ\nŠ †\n  \n ‡ƒ  ‚ˆ ‚\f \n\f ­ Œ\n­ ‹ ­ \n, \f  ‚Œ \r . „ \n  \n †Ž  ‡ƒ  ­ \nŽ ‹ \nŽ \nŽ \nŠˆ\n. Œ  \f†  \n“† Œ‚\n  ˆ †\f ‚ 2  \n  30 , \n   10  . Status localis:   †, Žˆ \f Œ\f  ˆ“­.  ­ 1    ( 6 †) ­ ‚“‚Œ  \n\r ‚Œ \n  1,5  \n . €\f ‚\f† \n   : \b‚ Œ \n: ŽŽ‚ ¥ 119 Ž/; ‹\f ¥ 3,9 ·10 /; Ž ¥ 34,8%;  ‚¤ ‹ ¥ 88,8 ³;  \r ŽŽ‚ \n ‹ ¥ 30,4 Ž; ­­ ­ ŽŽ‚ \n ‹† ¥  \f ¥ 7,1 ·10 /,  ¥ 3,  ¥ 70,  ¥ 19,  ¥ 6, ‹ ¥ 1, ‚ ¥ 1, ‚\f ¥ 215 Ž/, \b ¥ 40 /. † Œ \n: ‚ ‚ ¥ 74 Ž/, ‚ ‚‚ ¥ 7,7 ˆ/, Ž“Œ ¥ 7,8 ˆ/, … ¥ 18 ™ /, … ¥ 9 ™ /, ­ Œ ¥ 224 ™ ƒŽŽ: … - 31,5 ; ‚  ƒ\n ¥ 95,0 %; \b -1,1. „  Ž\n ‚ˆ ‚\f \n\f  ˆ­ Œ­ Œ  ­ Š  ­ 2   ­ † \n † \n† \n   †   ˆ“  «Ligasure». „ˆ Œ\f Œ \n†   Š  ‚Œ\n Ž‚\r \fŠŽ ­ ­ \n Ž Œ\n­. \bˆ\f Œ\n\f Š\n ˆ  Š \n\n  Œ\n­ \n†Ž ­. Œ \r Ž \f ˆ  \n \n \n\f \r. \bˆ\f Š\n\f  \r . Œˆ ŽŽŽ \n­ Ž  : \n \n Ž  Š \n\f­\n ˆ“  -\n  \f ŠŽ   \n\f\r ‚   \f,  \n\f\r Œ   Ž\n Ž­ \nˆ ˆ , Ž\f Ž Œ ( \n \n, Œ \nŽ Œ)  \nŒ  \n­ 1/3 \fŠ ‚. „  ‚Œ \r .  \n \nˆ ­ ‚ˆ \n\f  ‚“ †Ž  Ž   \rˆ\n.  \f 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   . . † . ., 2011; 22, 3 (85).  .†., \r „.‡. \nŠ\n\n † Ž   \r   Š \n Ž ˆ .  \n-Ž Ž\n Ž Ž \n . .. \n. 2014; 1. (6): 59¥65.   ….. ˜\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. \n­ ‚ \n† Š\t\t ‹Œ †Ž ¥ . . , Œ\n“ † Ž  ‡ˆ ‚ˆ\f Ž. , E-mail: [email protected] ‚\t \t ‡ –  \f Ž ˆ †Ž    †Ž \t „\b‘ \b -  Ž ‘\n €\r‚\f \n, E-mail: [email protected]  Œ Š ¥ . . , Œ\n“ † Ž  ‡ˆ ƒ ˆ\f    , E-mail: [email protected] ‘ „ \t ¥ . . ,   \f Žˆ †Ž    †Ž \t „\b‘ \b  Ž ‘\n €\r‚\f \n. \t. 8-926-152-00-04, E-mail:[email protected] \t \t \n\f ¥ . . ,   \f Žˆ †Ž    †Ž \t „\b‘ \b  Ž ‘\n €\r‚\f \n/ E-mail: [email protected] ‚Œ \t \n ¥ . . ,   \f Žˆ †Ž    †Ž \t „\b‘ \b  Ž ‘\n €\r‚\f \n? E-mail [email protected] 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] 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, . †- ­, .6,  Žˆ †Ž ‘€ Post address: 117198, Russia, Moscow, Miklukho-Maklay str., •e Department of hospital surgery with the course of pediatric surgery of the RUD University \n Ž  €‚ 617-089: 617-5 жности лапарос ой хирургии ий случай) ..     , . . \r  , ..   :  \nŠˆ\n   \n\f\f† \f\f†   Ž† ‚“Š  \n Š \n­  ˆ. \b, ­ †‹­   \r  \n\f Š \f  \n \n ‚ˆ \n­  . …    \r  \n \n\f­­  ‚Œ \n Š,  \n\fŒ\f\n \n\f ‚\n-\f  \n ‚ Žˆ \n­Œ  \n \n  \n.   ˆ    ŠŽ ­ \nŒ\r   , Š “ \r   \n\f  \n  ‚Œ    Žˆ\f† \n.  : ­, ­ †‹­, ‚Œ \r  \n\f, ­ \r  \n\f, ­ ‚ Œˆ ‚“Š . 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. ˆ ˜Š Œ\n,  \n\f \nŠˆ\n   Ž† ‚“Š  \f\f  \n Œ ‚ ­ \n ,  \n   ,   \n .    ˆ    Œ\n Ž  ‚“Š  \n  ,  \n ˆ Š Œ­ \n\f .  Š  “ Ž‚­  ,  ­  ‚\f \n\f \f  \n \n ‚ˆ,  ‚Œ \n Š.  \n\fŠŒ \f \f \n­  \n ‚\n-   \n  \n,  \n\fŠ   \f† \r \n \n­  †‹. \b, ­  \f \n  \n  \n ‚ˆŠ\n \n, Š   “.  \tŒ „\n­ \nŠ \n“ \f    , 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, ™ /; ­ Œ 122 ™ /; … 30,5 ™ /; Œ 74 ™ /; ‚ 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 \ Œ 12 \n  , Œ Œ 12  \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 ™ /; ­  Œ 83 ™ /; … 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   Œ [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  Œ 51% [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  Œ \n \f\r, Œ \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 uest TK. 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Posterior mal leolar ankle fractures: an in vitro biomechanical analysis of stability in the loaded and unloaded states. J Orthop Trauma 6:96¥101, 1992. artford JM, Gorczyca JT, McNamara JL, Mayor MB. Tibiotalar contact area: contribution of posterior malleolus and deltoid ligament. Clin Orthop Relat Res 320:182¥187, 1995. Heim UF. Trimalleolar fractures: late results a¢er –xation of the posterior fragment. Orthopedics 12:1053¥1059, 1989. askulka RA, Ittner G, Schedl R. Fractures of the posterior tibial margin: their role in the prognosis of malleolar fractures. J Trauma acko VW, Matthews LS, Zwirkoski P, Goldstein SA. •e joint contact area of the ankle: the contribution of the posterior malleolus. J Bone Joint Surg 73:347¥351, 1991. cDaniel WJ, Wilson FC. Trimalleolar fractures of the ankle: an end result study. Clin Orthop Relat Res 122:37¥45, 1977. 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]    \r\r\r\f  \f \n  \t\b\r\r \r \r\r  ( . – -.  .. - \b\r) \r   67 (\b   .) 1.  ƒ . .. ­\n € Ž. \n\f 2.  ƒ § 67  .. †‚\n \n Ž  ‚€ ˆ‚: 14.01.17 пухоль тон агинации в среднем возрасте ..  \f , .. \t , ..  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 Œ†  \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 Œ (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 Œ (p 0.05); \r \n­ ˆ ‹ - ƒ-425 \n Ž  ‹Œ \n \n    \n 1,5 Œ (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 ..   , ..  \b  , \t.\t.  \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 Œ , \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. , Liu-DeRyke X. Medical management of variceal hemor rhage // Crit Care N s Clin N rth Am. 2010. ¥ Vol. 22. ¥ N . 3. ¥ . 381- Cholongitas E., Papatheodoridis G.V., Vangeli M., Terreni N., Patch D., Burroughs A.K. Systematic review: the model for end-stage liver disease ¥ should it replace Child-Pugh¨s classi–cation for assessing prog nosis in cirrhosis? // Aliment Pharmacol •er. ¥ 2005. ¥ Vol.22, no.11¥12. ¥ P.1079-1089. Christensen E. Prognostic models including the Child¥Pugh, MELD and Mayo risk scores ¥ where are we and where should we go? // Journal of Hepatology. ¥ 2004. ¥ V.41. ¥ P.344¥350. Frye J.W., Perri R.E. Perioperative risk assessment for patients with cirrhosis and liver disease // Expert Rev Gastroenterol Hepatol. ¥ 2009. ¥ Vol.3, no.1. ¥ P.65-75. Garcia-Tsao G., Sanyal A.J., Grace N.D., Carey W.D. Prevention and Management of Gastroesophageal Varices and Variceal Hemorrhage in Cirrhosis // Am J Gastroenterol. 2007. ¥ N .102. ¥ P.2086¥2102. Wang M.T., Liu T., Ma X.Q., He J. Prognostic factors associated with rebleeding in cirrhotic inpatients complicated with esophageal variceal bleeding / /Chin Med J (Engl). 2011. ¥ Vol. 124. ¥ N .10. ¥ . 1493-1497. \n­ ‚ \n† ‚\t \t ˆ\t ¥ Œ\n“  Ž‹\n­ Ž  ­ ‚  ‚ˆ\f . Š\n , ail: [email protected] ‚  ™\f šŒ ¥ ...,  \f ‚ †Ž . . ..  ˆ \t \b‘ \b ƒ ‘ . . .\t.  -‰Ž Œ\n , ail: [email protected] €Œ \n\t \n\f ¥ ...,  \f ‚ †Ž . . ..  ˆ \t \b‘ \b ƒ ‘ . . .\t.  -‰Ž Œ\n , ail: [email protected] Ž \f \t ¥ ...,  \f ‚ †Ž . . ..  ˆ \t \b‘ \b ƒ ‘ . . .\t.  -‰Ž Œ\n , ail: [email protected] 660118, ­, Ž. ƒ­, . - \n, 24-20. ‚ ˜\t ˆ ¥ ...,  \f ‚  †Ž . . ..  ˆ \t \b‘ \b ƒ ‘ . . .\t.  -‰Ž Œ\n , -ray dovascular diagnostics and treatment of the Republican Clinical Hos pital. Remishevskaya, ail: [email protected] Karapetyan George Eduardovich ¥ MD, Professor of the Depart ment of General Surgery. prof. M.I. Gulman FGBOU at the State Peda ail: [email protected] Dunaevskaya Svetlana Sergeevna ¥ MD, Professor of the Depart ment of General Surgery. prof. M.I. Gulman FGBOU at the State Peda ail: [email protected] Pakhomova Regina Aleksandrovna ¥ Candidate of Medical Sci ence, Assistant Professor of the Department of General Surgery. prof. M.I. Gulman FGBOU at the State Pedagogical University. prof. V.F. ail: [email protected] 660118 Russia, K snoyarsk, Alekseeva 24-20. Kochetova Lyudmila Victorovna ¥ Ph.D., Associate Professor of the Department of General Surgery. prof. M.I. Gulman FGBOU at the

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