ȿȺ. ɒɅəɏɌɍɇɈȼ, ɇȽ. ɅɍȾ ÑÎÑÒÎßÍÈÅ ÀÐÒÅÐÈÀËÜÍÎÃÎ ÊÐÎÂÎÒÎÊÀ ÂÅÐÕÍÅÉ ÊÎÍÅ×ÍÎÑÒÈ Â

ȿȺ. ɒɅəɏɌɍɇɈȼ, ɇȽ. ɅɍȾ
ÑÎÑÒÎßÍÈÅ ÀÐÒÅÐÈÀËÜÍÎÃÎ ÊÐÎÂÎÒÎÊÀ ÂÅÐÕÍÅÉ ÊÎÍÅ×ÍÎÑÒÈ Â
ÏÐÎÖÅÑÑÅ ÕÈÐÓÐÃÈ×ÅÑÊÎÃÎ ËÅ×ÅÍÈß ÐÀÊÀ ÌÎËÎ×ÍÎÉ ÆÅËÅÇÛ
ɍɈ «ȼɢɬɟɛɫɤɢɣ ɝɨɫɭɞɚɪɫɬɜɟɧɧɵɣ ɦɟɞɢɰɢɧɫɤɢɣ ɭɧɢɜɟɪɫɢɬɟɬ»,
Ɋɟɫɩɭɛɥɢɤɚ Ȼɟɥɚɪɭɫɶ
ɋ ɩɨɦɨɳɶɸ ɭɥɶɬɪɚɡɜɭɤɨɜɨɣ ɞɨɩɩɥɟɪɨɝɪɚɮɢɢ ɢɡɭɱɟɧɨ ɫɨɫɬɨɹɧɢɟ ɚɪɬɟɪɢɚɥɶɧɨɣ ɝɟɦɨɞɢɧɚɦɢɤɢ ɜɟɪɯɧɟɣ ɤɨɧɟɱɧɨɫɬɢ ɛɨɥɶɧɵɯ ɪɚɤɨɦ ɦɨɥɨɱɧɨɣ ɠɟɥɟɡɵ ɜ ɩɪɨɰɟɫɫɟ ɯɢɪɭɪɝɢɱɟɫɤɨɝɨ ɥɟɱɟɧɢɹ.
ɍɫɬɚɧɨɜɥɟɧɨ, ɱɬɨ ɭ 49 % ɨɩɟɪɢɪɨɜɚɧɧɵɯ ɠɟɧɳɢɧ ɢɦɟɟɬ ɦɟɫɬɨ ɭɜɟɥɢɱɟɧɢɟ ɨɛɴɟɦɧɨɣ ɫɤɨɪɨɫɬɢ
ɤɪɨɜɨɬɨɤɚ ɧɚ ɫɬɨɪɨɧɟ ɨɩɟɪɚɬɢɜɧɨɝɨ ɜɦɟɲɚɬɟɥɶɫɬɜɚ, ɫɜɹɡɚɧɧɨɟ ɫ ɢɡɦɟɧɟɧɢɹɦɢ ɫɤɨɪɨɫɬɧɵɯ ɯɚɪɚɤɬɟɪɢɫɬɢɤ ɩɨɬɨɤɚ ɢ ɢɡɦɟɧɟɧɢɣ ɫɨɫɭɞɢɫɬɨɣ ɫɬɟɧɤɢ. Ɇɚɤɫɢɦɚɥɶɧɨɟ ɡɚɪɟɝɢɫɬɪɢɪɨɜɚɧɧɨɟ ɭɜɟɥɢɱɟɧɢɟ ɨɛɴɟɦɧɨɣ ɫɤɨɪɨɫɬɢ ɤɪɨɜɨɬɨɤɚ ɩɨɫɥɟ ɨɩɟɪɚɰɢɢ ɫɨɫɬɚɜɢɥɨ 77 % ɨɬ ɢɫɯɨɞɧɨɝɨ. ɇɚɢɛɨɥɶɲɟɟ
ɭɜɟɥɢɱɟɧɢɟ ɨɛɴɟɦɧɨɣ ɫɤɨɪɨɫɬɢ ɤɪɨɜɨɬɨɤɚ ɡɚɮɢɤɫɢɪɨɜɚɧɨ ɭ ɩɚɰɢɟɧɬɨɤ ɫ I ɫɬɚɞɢɟɣ ɨɩɭɯɨɥɟɜɨɝɨ
ɩɪɨɰɟɫɫɚ. ɍɜɟɥɢɱɟɧɢɟ ɨɛɴɟɦɧɨɣ ɫɤɨɪɨɫɬɢ ɤɪɨɜɨɬɨɤɚ ɫɬɚɬɢɫɬɢɱɟɫɤɢ ɡɧɚɱɢɦɨ ɭɜɟɥɢɱɢɜɚɟɬ ɨɛɴɟɦ
ɫɭɦɦɚɪɧɨɣ ɩɨɫɥɟɨɩɟɪɚɰɢɨɧɧɨɣ ɥɢɦɮɨɪɟɢ. ɍ 11 % ɨɩɟɪɢɪɨɜɚɧɧɵɯ ɠɟɧɳɢɧ ɫɧɢɠɚɟɬɫɹ ɩɪɢɬɨɤ
ɚɪɬɟɪɢɚɥɶɧɨɣ ɤɪɨɜɢ ɤ ɪɭɤɟ ɜɫɥɟɞɫɬɜɢɟ ɪɚɡɜɢɬɢɹ ɭ ɛɨɥɶɧɵɯ ɜ ɩɨɫɥɟɨɩɟɪɚɰɢɨɧɧɨɦ ɩɟɪɢɨɞɟ ɫɤɚɥɟɧɭɫɫɢɧɞɪɨɦɚ. ɇɚɢɛɨɥɶɲɟɟ ɡɚɪɟɝɢɫɬɪɢɪɨɜɚɧɧɨɟ ɫɧɢɠɟɧɢɟ ɨɛɴɟɦɧɨɣ ɫɤɨɪɨɫɬɢ ɤɪɨɜɨɬɨɤɚ – ɧɚ 53
%. ȼ 30% ɫɥɭɱɚɟɜ ɚɪɬɟɪɢɚɥɶɧɚɹ ɝɟɦɨɞɢɧɚɦɢɤɚ ɧɟ ɢɡɦɟɧɹɟɬɫɹ. ɋɨɯɪɚɧɟɧɢɟ n. intercostabrachialis ɧɟ
ɜɥɢɹɟɬ ɧɚ ɨɛɴɟɦɧɭɸ ɫɤɨɪɨɫɬɶ ɤɪɨɜɨɬɨɤɚ. ɋɨɩɭɬɫɬɜɭɸɳɚɹ ɩɚɬɨɥɨɝɢɹ, ɬɚɤɚɹ ɤɚɤ ɚɪɬɟɪɢɚɥɶɧɚɹ ɝɢɩɟɪɬɟɧɡɢɹ, ɫɩɨɫɨɛɫɬɜɭɸɬ ɪɚɡɜɢɬɢɸ ɝɟɦɨɞɢɧɚɦɢɱɟɫɤɢɯ ɧɚɪɭɲɟɧɢɣ ɜ ɜɟɪɯɧɟɣ ɤɨɧɟɱɧɨɫɬɢ ɧɚ ɫɬɨɪɨɧɟ ɨɩɟɪɚɰɢɢ.
Ʉɥɸɱɟɜɵɟ ɫɥɨɜɚ: ɪɚɤ ɦɨɥɨɱɧɨɣ ɠɟɥɟɡɵ, ɝɟɦɨɞɢɧɚɦɢɤɚ, ɥɢɦɮɟɞɟɦɚ, ɭɥɶɬɪɚɡɜɭɤɨɜɨɟ ɢɫɫɥɟɞɨɜɚɧɢɟ, ɞɨɩɩɥɟɪɨɝɪɚɮɢɹ.
By means of ultrasound color Doppler mapping the state of the arterial hemodynamics of the upper
extremities in the patients with breast cancer in the process of surgical treatment is studied. It is established
that in 49 % of the operated women the increase in the volume of blood-groove on the side of the
operative intervention, connected with the changes of high-speed characteristics of a stream and changes
of a vascular wall takes place. The maximum registered increase in the volume speed of blood-groove
after operation has made 77 % from the initial one. The greatest increase in volume speed of blood-groove
is fixed in the patients with the 1st stage of tumor process. Rise in the volume blood-groove increases
significantly the volume of total postoperative lymph expiration. 11 % of the operated women inflow of
arterial blood to a hand decreases owing to the development of skalenus-syndrome in patients in the
postoperative period. The greatest registered decrease in the volume speed of blood-groove is on 53 %. In
30 % of cases arterial hemodynamics does not change. Preservation of intercostabrachialis does not
influence the volume speed of blood-groove. An accompanying pathology, such as arterial hypertension,
promotes the development of hemodynamic disturbances in the upper extremity on the side of the operation.
Keywords: breast cancer, hemodynamics, lymphedema, ultrasound, color Doppler mapping.
ȼɜɟɞɟɧɢɟ
ɋɪɟɞɢ ɜɫɟɯ ɡɥɨɤɚɱɟɫɬɜɟɧɧɵɯ ɧɨɜɨɨɛɪɚɡɨɜɚɧɢɣ ɭ ɠɟɧɳɢɧ ɪɚɤ ɦɨɥɨɱɧɨɣ ɠɟɥɟɡɵ
ɊɆɀ) ɡɚɧɢɦɚɟɬ ɨɫɨɛɨɟ ɦɟɫɬɨ. ȼ ɨɛɳɟɣ
ɫɬɪɭɤɬɭɪɟ ɨɧɤɨɥɨɝɢɱɟɫɤɨɣ ɡɚɛɨɥɟɜɚɟɦɨɫɬɢ
ɊɆɀ ɜ 2006 ɝɨɞɭ ɫɨɫɬɚɜɢɥ 17,6 % ɢ ɡɚɧɹɥ
ɜɬɨɪɨɟ ɪɚɧɝɨɜɨɟ ɦɟɫɬɨ ɩɨɫɥɟ ɡɥɨɤɚɱɟɫɬɜɟɧɧɵɯ ɧɨɜɨɨɛɪɚɡɨɜɚɧɢɣ ɤɨɠɢ [1].
Ɂɚ ɩɨɫɥɟɞɧɢɟ ɝɨɞɵ ɞɨɫɬɢɝɧɭɬ ɨɩɪɟɞɟ77
” ɇɨɜɨɫɬɢ ɯɢɪɭɪɝɢɢ
ɥɟɧɧɵɣ ɭɫɩɟɯ ɜ ɥɟɱɟɧɢɢ ɛɨɥɶɧɵɯ ɊɆɀ. ȼ
ɧɚɫɬɨɹɳɟɟ ɜɪɟɦɹ ɜ Ɋɟɫɩɭɛɥɢɤɟ Ȼɟɥɚɪɭɫɶ ɧɚ
ɭɱɟɬɟ ɫɨɫɬɨɢɬ ɛɨɥɟɟ 30 ɬɵɫ. ɠɟɧɳɢɧ. ɋɪɟɞɢ ɧɢɯ ɩɨɱɬɢ 60% ɫɨɫɬɚɜɥɹɸɬ ɩɚɰɢɟɧɬɤɢ
ɬɪɭɞɨɫɩɨɫɨɛɧɨɝɨ ɜɨɡɪɚɫɬɚ.
Ɉɛɲɢɪɧɵɟ ɯɢɪɭɪɝɢɱɟɫɤɢɟ ɜɦɟɲɚɬɟɥɶɫɬɜɚ, ɥɭɱɟɜɚɹ ɢ ɥɟɤɚɪɫɬɜɟɧɧɚɹ ɬɟɪɚɩɢɢ
ɩɪɢɜɨɞɹɬ ɤ ɫɟɪɶɟɡɧɵɦ ɫɨɦɚɬɢɱɟɫɤɢɦ ɢ ɩɫɢɯɨɥɨɝɢɱɟɫɤɢɦ ɧɚɪɭɲɟɧɢɹɦ, ɤɨɬɨɪɵɟ ɨɛɴɟɞɢɧɹɸɬɫɹ ɜ ɩɨɫɬɦɚɫɬɷɤɬɨɦɢɱɟɫɤɢɣ ɫɢɧɞɪɨɦ, ɜɤɥɸɱɚɸɳɢɣ ɩɨɫɬɦɚɫɬɷɤɬɨɦɢɱɟɫɤɢɣ
ɞɟɮɟɤɬ ɨɛɥɚɫɬɢ ɝɪɭɞɢ, ɛɥɨɤ ɨɫɧɨɜɧɵɯ ɩɭɬɟɣ ɨɬɬɨɤɚ ɥɢɦɮɵ ɨɬ ɜɟɪɯɧɟɣ ɤɨɧɟɱɧɨɫɬɢ,
ɭɦɟɧɶɲɟɧɢɟ ɚɦɩɥɢɬɭɞɵ ɞɜɢɠɟɧɢɣ ɜ ɩɥɟɱɟɜɨɦ ɫɭɫɬɚɜɟ, ɧɚɪɭɲɟɧɢɟ ɢɧɧɟɪɜɚɰɢɢ ɤɨɧɟɱɧɨɫɬɢ ɢ ɝɪɭɞɧɨɣ ɫɬɟɧɤɢ, ɞɟɩɪɟɫɫɢɸ.
ɉɨɫɬɦɚɫɬɷɤɬɨɦɢɱɟɫɤɢɣ ɨɬɟɤ ɜɟɪɯɧɟɣ
ɤɨɧɟɱɧɨɫɬɢ ɨɞɧɨ ɢɡ ɧɚɢɛɨɥɟɟ ɡɧɚɱɢɦɵɯ
ɩɪɨɹɜɥɟɧɢɣ ɩɨɫɬɦɚɫɬɷɤɬɨɦɢɱɟɫɤɨɝɨ ɫɢɧɞɪɨɦɚ, ɩɪɢɜɨɞɹɳɢɯ ɤ ɩɨɬɟɪɟ ɬɪɭɞɨɫɩɨɫɨɛɧɨɫɬɢ ɢ ɢɧɜɚɥɢɞɧɨɫɬɢ [2, 3].
ɋɪɚɜɧɢɬɟɥɶɧɨ ɧɟɛɨɥɶɲɨɟ ɤɨɥɢɱɟɫɬɜɨ
ɩɭɛɥɢɤɚɰɢɣ ɩɨɫɜɹɳɟɧɨ ɢɡɭɱɟɧɢɸ ɝɟɦɨɞɢɧɚɦɢɤɢ ɜɟɪɯɧɟɣ ɤɨɧɟɱɧɨɫɬɢ ɛɨɥɶɧɵɯ ɊɆɀ,
ɤɚɤ ɨɞɧɨɣ ɢɡ ɩɪɢɱɢɧ ɪɚɡɜɢɬɢɹ ɩɨɫɬɦɚɫɬɷɤɬɨɦɢɱɟɫɤɨɝɨ ɨɬɟɤɚ.
ɐɟɥɶɸ ɞɚɧɧɨɝɨ ɢɫɫɥɟɞɨɜɚɧɢɹ ɹɜɢɥɨɫɶ
ɨɩɪɟɞɟɥɟɧɢɟ ɩɚɪɚɦɟɬɪɨɜ ɚɪɬɟɪɢɚɥɶɧɨɝɨ
ɤɪɨɜɨɬɨɤɚ ɜɟɪɯɧɟɣ ɤɨɧɟɱɧɨɫɬɢ ɛɨɥɶɧɵɯ
ɪɚɤɨɦ ɦɨɥɨɱɧɨɣ ɠɟɥɟɡɵ ɧɚ ɷɬɚɩɟ ɯɢɪɭɪɝɢɱɟɫɤɨɝɨ ɥɟɱɟɧɢɹ.
Ɇɚɬɟɪɢɚɥ ɢ ɦɟɬɨɞɵ
ȼ ɦɢɧɢɦɚɥɶɧɵɣ ɩɟɪɟɱɟɧɶ ɦɟɬɨɞɨɜ ɞɢɚɝɧɨɫɬɢɤɢ, ɩɨɦɢɦɨ ɫɬɚɧɞɚɪɬɧɵɯ ɤɥɢɧɢɱɟɫɤɢɯ ɢ ɥɚɛɨɪɚɬɨɪɧɨɢɧɫɬɪɭɦɟɧɬɚɥɶɧɵɯ, ɜɯɨɞɢɥɢ ɫɥɟɞɭɸɳɢɟ ɢɫɫɥɟɞɨɜɚɧɢɹ:
- ɮɢɡɢɤɚɥɶɧɨɟ, ɜɤɥɸɱɚɸɳɟɟ ɜɵɹɜɥɟɧɢɟ
ɭɩɥɨɬɧɟɧɢɣ ɢɥɢ ɨɩɭɯɨɥɢ ɜ ɦɨɥɨɱɧɨɣ ɠɟɥɟɡɟ, ɢɡɭɱɟɧɢɟ ɫɨɫɬɨɹɧɢɹ ɤɨɠɢ, ɪɟɝɢɨɧɚɪɧɵɯ ɥɢɦɮɨɭɡɥɨɜ ɢ ɬɩ.;
- ɰɢɬɨ - ɢ ɝɢɫɬɨɥɨɝɢɱɟɫɤɨɟ ɩɨɞɬɜɟɪɠɞɟɧɢɟ ɞɢɚɝɧɨɡɚ ɪɚɤɚ ɦɨɥɨɱɧɨɣ ɠɟɥɟɡɵ;
- ɭɥɶɬɪɚɡɜɭɤɨɜɵɟ (ɍɁɂ), ɦɨɥɨɱɧɵɯ ɠɟɥɟɡ, ɡɨɧ ɥɢɦɮɨɨɬɬɨɤɚ, ɨɪɝɚɧɨɜ ɛɪɸɲɧɨɣ
ɩɨɥɨɫɬɢ, ɨɪɝɚɧɨɜ ɦɚɥɨɝɨ ɬɚɡɚ (ɩɨ ɩɨɤɚɡɚ78
ɧɢɹɦ), ɩɨɫɥɟɨɩɟɪɚɰɢɨɧɧɵɯ ɬɤɚɧɟɣ;
- ɭɥɶɬɪɚɡɜɭɤɨɜɨɟ ɞɭɩɥɟɤɫɧɨɟ ɢ ɬɪɢɩɥɟɤɫɧɨɟ ɫɤɚɧɢɪɨɜɚɧɢɟ ɫɨɫɭɞɨɜ, ɜ ɱɚɫɬɧɨɫɬɢ,
ɚɪɬɟɪɢɣ ɜɟɪɯɧɟɣ ɤɨɧɟɱɧɨɫɬɢ ɧɚ ɩɪɟɞɨɩɟɪɚɰɢɨɧɧɨɦ, ɪɚɧɧɟɦ ɩɨɫɥɟɨɩɟɪɚɰɢɨɧɧɨɦ ɢ
ɩɨɡɞɧɟɦ ɩɨɫɥɟɨɩɟɪɚɰɢɨɧɧɨɦ ɩɟɪɢɨɞɚɯ;
- ɪɟɧɬɝɟɧɨɥɨɝɢɱɟɫɤɢɟ – ɦɚɦɦɨɝɪɚɮɢɹ,
ɪɟɧɬɝɟɧɨɝɪɚɮɢɹ ɨɪɝɚɧɨɜ ɝɪɭɞɧɨɣ ɤɥɟɬɤɢ;
- ɢɡɦɟɪɟɧɢɟ ɫɭɬɨɱɧɨɝɨ ɨɛɴɟɦɚ ɥɢɦɮɨɪɟɢ ɱɟɪɟɡ ɞɪɟɧɚɠ.
ȼɵɩɨɥɧɟɧɨ 200 ɭɥɶɬɪɚɡɜɭɤɨɜɵɯ ɢɫɫɥɟɞɨɜɚɧɢɣ ɫɨɫɬɨɹɧɢɹ ɚɪɬɟɪɢɚɥɶɧɨɝɨ ɤɪɨɜɨɬɨɤɚ ɫ ɢɫɩɨɥɶɡɨɜɚɧɢɟɦ ɦɟɬɨɞɢɤ ɢɦɩɭɥɶɫɧɨɝɨ, ɰɜɟɬɧɨɝɨ ɞɨɩɩɥɟɪɨɜɫɤɨɝɨ ɤɚɪɬɢɪɨɜɚɧɢɹ ɢ ɢɡɦɟɪɟɧɢɹ ɫɤɨɪɨɫɬɟɣ ɤɪɨɜɨɬɨɤɚ ɜ
ɦɨɧɨ-, ɞɭɩɥɟɤɫɧɨɦ ɢ ɬɪɢɩɥɟɤɫɧɨɦ ɪɟɠɢɦɚɯ ɧɚ ɚɩɩɚɪɚɬɟ SA 9900 ɮɢɪɦɵ «Ɇɟdison».
Ⱦɥɹ ɢɫɫɥɟɞɨɜɚɧɢɹ ɫɨɫɭɞɨɜ ɢɫɩɨɥɶɡɨɜɚɥɢ
ɥɢɧɟɣɧɵɣ ɞɚɬɱɢɤ 7,5 ɆȽɰ. ɋ ɢɫɩɨɥɶɡɨɜɚɧɢɟɦ ȼɪɟɠɢɦɚ ɥɨɰɢɪɨɜɚɥɢ ɫɨɨɬɜɟɬɫɬɜɭɸɳɢɟ ɚɪɬɟɪɢɢ ɜ ɧɚɞɤɥɸɱɢɱɧɨɣ, ɩɨɞɤɥɸɱɢɱɧɨɣ, ɩɨɞɦɵɲɟɱɧɨɣ ɨɛɥɚɫɬɢ ɢ ɦɟɞɢɚɥɶɧɨɣ ɛɨɪɨɡɞɟ ɩɥɟɱɚ. Ɋɟɝɢɫɬɪɢɪɨɜɚɥɢɫɶ ɢ
ɨɰɟɧɢɜɚɥɢɫɶ ɩɨɤɚɡɚɬɟɥɢ ɚɪɬɟɪɢɚɥɶɧɨɝɨ
ɤɪɨɜɨɬɨɤɚ, ɬɚɤɢɟ ɤɚɤ ɩɢɤɨɜɚɹ ɫɢɫɬɨɥɢɱɟɫɤɚɹ ɫɤɨɪɨɫɬɶ (PSV), ɤɨɧɟɱɧɚɹ ɞɢɚɫɬɨɥɢɱɟɫɤɚɹ ɫɤɨɪɨɫɬɶ (EDV), ɭɫɪɟɞɧɟɧɧɚɹ ɩɨ ɜɪɟɦɟɧɢ ɫɪɟɞɧɹɹ ɫɤɨɪɨɫɬɶ ɤɪɨɜɨɬɨɤɚ (TAM),
ɢɧɞɟɤɫ ɩɟɪɢɮɟɪɢɱɟɫɤɨɝɨ ɫɨɩɪɨɬɢɜɥɟɧɢɹ
(RI), ɩɭɥɶɫɚɰɢɨɧɧɵɣ ɢɧɞɟɤɫ (PI), ɨɛɴɟɦɧɚɹ
ɫɤɨɪɨɫɬɶ ɤɪɨɜɨɬɨɤɚ (Vvol). ɂɫɫɥɟɞɨɜɚɧɢɹ
ɩɪɨɜɨɞɢɥɢɫɶ ɞɨ ɨɩɟɪɚɰɢɢ, ɧɚ 5–7 ɫɭɬɤɢ
ɩɨɫɥɟ ɨɩɟɪɚɰɢɢ. ɂɡɦɟɪɟɧɢɹ ɜɵɲɟɭɤɚɡɚɧɧɵɯ ɩɚɪɚɦɟɬɪɨɜ ɩɪɨɜɨɞɢɥɢɫɶ ɧɚ ɜɟɪɯɧɟɣ
ɤɨɧɟɱɧɨɫɬɢ ɫɩɪɚɜɚ ɢ ɫɥɟɜɚ ɞɥɹ ɜɵɹɜɥɟɧɢɹ
ɜɨɡɦɨɠɧɨɣ ɚɫɢɦɦɟɬɪɢɢ ɜ ɢɫɯɨɞɧɨɦ ɫɨɫɬɨɹɧɢɢ. Ʉɨɧɬɪɨɥɟɦ ɫɥɭɠɢɥɢ ɩɨɤɚɡɚɬɟɥɢ, ɩɨɥɭɱɟɧɧɵɟ ɧɚ ɞɨɨɩɟɪɚɰɢɨɧɧɨɦ ɩɟɪɢɨɞɟ, ɚ
ɬɚɤɠɟ ɩɨɤɚɡɚɬɟɥɢ, ɪɟɝɢɫɬɪɢɪɭɟɦɵɟ ɧɚ ɩɪɨɬɢɜɨɩɨɥɨɠɧɨɣ ɤɨɧɟɱɧɨɫɬɢ. ɋɬɚɬɢɫɬɢɱɟɫɤɚɹ ɨɛɪɚɛɨɬɤɚ ɞɚɧɧɵɯ ɩɪɨɜɨɞɢɥɚɫɶ ɫ ɢɫɩɨɥɶɡɨɜɚɧɢɟɦ ɩɚɪɚɦɟɬɪɢɱɟɫɤɢɯ ɦɟɬɨɞɨɜ,
ɪɚɡɥɢɱɢɹ ɨɰɟɧɢɜɚɥɢɫɶ ɫ ɩɨɦɨɳɶɸ ɤɪɢɬɟɪɢɹ ɋɬɶɸɞɟɧɬɚ.
ȼ ɢɫɫɥɟɞɭɟɦɭɸ ɝɪɭɩɩɭ ɜɨɲɥɢ 100 ɩɚɰɢɟɧɬɨɤ ɫ ɜɟɪɢɮɢɰɢɪɨɜɚɧɧɵɦ ɞɢɚɝɧɨɡɨɦ
ɊɆɀ. ȼɨɡɪɚɫɬ ɩɚɰɢɟɧɬɨɤ ɨɬ 34 ɥɟɬ ɞɨ 80
ʋ4x 2008 i ɬɨɦ 16
ɥɟɬ. ɋɪɟɞɧɢɣ ɜɨɡɪɚɫɬ ɫɨɫɬɚɜɢɥ 55,9 ɥɟɬ,
ɦɟɞɢɚɧɚ 55. ȼɨɜɥɟɱɟɧɢɟ ɜ ɩɚɬɨɥɨɝɢɱɟɫɤɢɣ
ɩɪɨɰɟɫɫ ɩɪɚɜɨɣ ɦɨɥɨɱɧɨɣ ɠɟɥɟɡɵ ɫɨɫɬɚɜɢɥɨ 53%, ɥɟɜɨɣ – 47%. ɍɡɥɨɜɨɣ ɪɚɤ ɞɢɚɝɧɨɫɬɢɪɨɜɚɧ ɜ 97 ɩɚɰɢɟɧɬɨɤ, ɚɤɭɥɶɬɧɚɹ ɮɨɪɦɚ
– 1, ɪɚɤ ɉɟɞɠɟɬɚ – 2 ɫɥɭɱɚɹ. ȼ 55% ɨɩɭɯɨɥɶ ɥɨɤɚɥɢɡɨɜɚɥɚɫɶ ɜ ɩɪɨɟɤɰɢɢ ɜɟɪɯɧɟɧɚɪɭɠɧɨɝɨ ɤɜɚɞɪɚɧɬɚ, 16% ɩɪɢɲɥɨɫɶ ɧɚ ɞɨɥɸ
ɧɢɠɧɟɧɚɪɭɠɧɟɝɨ ɤɜɚɞɪɚɧɬɚ, ɜ ɨɞɢɧɚɤɨɜɨɦ
ɩɪɨɰɟɧɬɟ ɫɥɭɱɚɟɜ 13% ɨɩɭɯɨɥɶ ɪɚɫɩɨɥɚɝɚɥɚɫɶ ɜ ɩɪɨɟɤɰɢɢ ɜɟɪɯɧɟɜɧɭɬɪɟɧɧɟɝɨ ɤɜɚɞɪɚɧɬɚ ɢ ɰɟɧɬɪɚɥɶɧɨɣ ɱɚɫɬɢ ɦɨɥɨɱɧɨɣ ɠɟɥɟɡɵ. ȼ 2% ɨɩɭɯɨɥɶ ɜɵɯɨɞɢɥɚ ɡɚ ɩɪɟɞɟɥɵ
ɨɞɧɨɣ ɥɨɤɚɥɢɡɚɰɢɢ ɢ ɡɚɧɢɦɚɥɚ ɛɨɥɟɟ ɨɞɧɨɣ ɚɧɚɬɨɦɢɱɟɫɤɨɣ ɨɛɥɚɫɬɢ. Ɋɚɫɩɪɟɞɟɥɟɧɢɟ ɩɚɰɢɟɧɬɨɤ ɩɨ ɫɬɚɞɢɹɦ ɨɩɭɯɨɥɟɜɨɝɨ
ɩɪɨɰɟɫɫɚ ɛɵɥɨ ɫɥɟɞɭɸɳɢɦ: I ɫɬɚɞɢɹ – 29%,
II ɫɬɚɞɢɹ – 53%, ɢɡ ɧɢɯ II A – 35%, II ȼ –
18%, III Ⱥ – 3%, III B – 4 %, III C – 11%. ȼ
ɩɥɚɧɟ ɯɢɪɭɪɝɢɱɟɫɤɨɝɨ ɥɟɱɟɧɢɹ ɛɨɥɶɧɵɦ
ɜɵɩɨɥɧɟɧɵ ɫɥɟɞɭɸɳɢɟ ɪɚɞɢɤɚɥɶɧɵɟ ɨɩɟɪɚɰɢɢ: ɪɚɞɢɤɚɥɶɧɚɹ ɦɚɫɬɷɤɬɨɦɢɹ ɩɨ Ɇɚɞɞɟɧɭ – 91, ɪɚɞɢɤɚɥɶɧɚɹ ɫɟɤɬɨɪɚɥɶɧɚɹ ɪɟɡɟɤɰɢɹ – 8, ɜ 1 ɫɥɭɱɚɟ ɜɵɩɨɥɧɟɧɚ ɪɚɞɢɤɚɥɶɧɚɹ
ɦɚɫɬɷɤɬɨɦɢɹ ɩɨ Ɇɚɞɞɟɧɭ ɫ ɨɞɧɨɦɨɦɟɧɬɧɨɣ
ɩɥɚɫɬɢɤɨɣ TRAM-ɥɨɫɤɭɬɨɦ. ɂɡ ɨɫɨɛɟɧɧɨɫɬɟɣ ɨɩɟɪɚɰɢɢ ɫɥɟɞɭɟɬ ɨɬɦɟɬɢɬɶ ɜɨɡɦɨɠɧɨɫɬɶ
ɫɨɯɪɚɧɟɧɢɹ
ɧɟɪɜɚ
n.
intercostabrachialis – 32 ɫɥɭɱɚɹ ɭ ɩɚɰɢɟɧɬɨɤ
ɫ ɨɩɭɯɨɥɟɜɵɦ ɩɪɨɰɟɫɫɨɦ c T1-2N0M0. ȼ 3
ɫɥɭɱɚɹɯ ɩɪɨɢɡɜɟɞɟɧɚ ɪɟɡɟɤɰɢɹ ɛɨɥɶɲɨɣ
ɝɪɭɞɧɨɣ ɦɵɲɰɵ, ɜɜɢɞɭ ɜɨɡɦɨɠɧɨɝɨ ɪɚɫɩɪɨɫɬɪɚɧɟɧɢɹ ɨɩɭɯɨɥɢ ɧɚ ɦɵɲɰɭ. Ⱦɪɟɧɢɪɨɜɚɧɢɟ ɩɨɫɥɟɨɩɟɪɚɰɢɨɧɧɨɣ ɪɚɧɵ ɨɫɭɳɟɫɬɜɥɹɥɨɫɶ, ɤɚɤ ɩɪɚɜɢɥɨ, ɨɞɧɨɣ ɢɥɢ ɞɜɭɦɹ ɉȼɏ
ɬɪɭɛɤɚɦɢ, ɫ ɭɤɥɚɞɤɨɣ ɥɨɫɤɭɬɨɜ ɧɚ ɨɩɟɪɚɰɢɨɧɧɨɦ ɫɬɨɥɟ ɫ ɩɨɞɫɨɟɞɢɧɟɧɢɟɦ ɜɚɤɭɭɦɟɦɤɨɫɬɢ. ȼ ɩɨɫɥɟɨɩɟɪɚɰɢɨɧɧɨɦ ɩɟɪɢɨɞɟ
ɭɱɢɬɵɜɚɥɫɹ ɫɭɦɦɚɪɧɵɣ ɨɛɴɟɦ ɩɨɫɬɦɚɫɬɷɤɬɨɦɢɱɫɟɫɤɨɣ ɥɢɦɮɨɪɟɢ ɢ ɫɪɨɤɢ ɟɟ ɩɪɟɤɪɚɳɟɧɢɹ.
Ʌɢɦɮɨɪɟɹ ɜɫɬɪɟɱɚɥɨɫɶ ɭ ɜɫɟɯ ɛɟɡ ɢɫɤɥɸɱɟɧɢɹ ɛɨɥɶɧɵɯ. ɉɨɫɥɟɨɩɟɪɚɰɢɨɧɧɵɟ
ɨɫɥɨɠɧɟɧɢɹ ɨɬɦɟɱɟɧɵ ɭ 10 ɛɨɥɶɧɵɯ: ɝɟɦɚɬɨɦɚ ɜ ɨɛɥɚɫɬɢ ɪɚɧɵ – 4, ɞɥɢɬɟɥɶɧɚɹ ɥɢɦɮɨɪɟɹ ɫ ɮɨɪɦɢɪɨɜɚɧɢɟɦ ɥɨɠɧɨɝɨ ɥɢɦɮɨɰɟɥɟ – 4, ɧɚɝɧɨɟɧɢɟ ɜ ɨɛɥɚɫɬɢ ɩɨɫɥɟɨɩɟɪɚ-
ɰɢɨɧɧɨɣ ɪɚɧɵ – 2.
Ɋɟɡɭɥɶɬɚɬɵ ɢ ɨɛɫɭɠɞɟɧɢɟ
ɉɪɢ ɨɰɟɧɤɟ ɩɨɤɚɡɚɬɟɥɟɣ ɚɪɬɟɪɢɚɥɶɧɨɝɨ ɤɪɨɜɨɬɨɤɚ ɛɨɥɶɧɵɯ ɪɚɤɨɦ ɦɨɥɨɱɧɨɣ ɠɟɥɟɡɵ ɞɨ ɢ ɩɨɫɥɟ ɨɩɟɪɚɬɢɜɧɨɝɨ ɜɦɟɲɚɬɟɥɶɫɬɜɚ ɜɫɟ ɩɚɰɢɟɧɬɤɢ ɛɵɥɢ ɪɚɡɞɟɥɟɧɵ ɧɚ 3
ɝɪɭɩɩɵ. ȼ ɩɟɪɜɭɸ ɜɨɲɥɢ 49 ɨɩɟɪɢɪɨɜɚɧɧɵɯ ɠɟɧɳɢɧ, ɢɦɟɜɲɢɯ ɫɬɚɬɢɫɬɢɱɟɫɤɢ ɡɧɚɱɢɦɨɟ (ɪ = 0,001156; n = 100) ɭɜɟɥɢɱɟɧɢɟ
ɨɛɴɟɦɧɨɣ ɫɤɨɪɨɫɬɢ ɤɪɨɜɨɬɨɤɚ (Vvol), ɪɟɝɢɫɬɪɢɪɭɟɦɨɟ ɧɚ ɩɥɟɱɟɜɨɣ ɚɪɬɟɪɢɢ ɜɟɪɯɧɟɣ ɤɨɧɟɱɧɨɫɬɢ ɧɚ ɫɬɨɪɨɧɟ ɨɩɟɪɚɰɢɢ. ȼɨ
ɜɬɨɪɭɸ – 40 ɩɚɰɢɟɧɬɨɤ ɛɟɡ ɡɧɚɱɢɦɵɯ ɢɡɦɟɧɟɧɢɣ Vvol. Ɍɪɟɬɶɸ ɝɪɭɩɩɭ ɫɨɫɬɚɜɢɥɢ 11
ɠɟɧɳɢɧ, ɢɦɟɜɲɢɯ ɭɦɟɧɶɲɟɧɢɟ ɩɨɤɚɡɚɬɟɥɹ
ɨɛɴɟɦɧɨɣ ɫɤɨɪɨɫɬɢ ɤɪɨɜɨɬɨɤɚ.
Ɇɚɤɫɢɦɚɥɶɧɨɟ ɡɚɪɟɝɢɫɬɪɢɪɨɜɚɧɧɨɟ
ɭɜɟɥɢɱɟɧɢɟ Vvol ɩɨɫɥɟ ɨɩɟɪɚɰɢɢ ɫɨɫɬɚɜɢɥɨ 77% ɨɬ ɢɫɯɨɞɧɨɝɨ. ɇɚɢɛɨɥɶɲɟɟ ɫɧɢɠɟɧɢɟ – ɧɚ 53% ɨɬ ɩɟɪɜɨɧɚɱɚɥɶɧɵɯ ɰɢɮɪ.
ɂɡɦɟɧɟɧɢɹ ɨɛɴɟɦɧɨɣ ɫɤɨɪɨɫɬɢ ɤɪɨɜɨɬɨɤɚ ɫɜɹɡɚɧɵ, ɝɥɚɜɧɵɦ ɨɛɪɚɡɨɦ, ɫ ɢɡɦɟɧɟɧɢɹɦɢ ɫɤɨɪɨɫɬɧɵɯ ɩɚɪɚɦɟɬɪɨɜ ɚɪɬɟɪɢɚɥɶɧɨɝɨ ɤɪɨɜɨɬɨɤɚ, ɚ ɢɦɟɧɧɨ ɫ ɢɡɦɟɧɟɧɢɹɦɢ
ɩɢɤɨɜɨɣ ɫɢɫɬɨɥɢɱɟɫɤɨɣ ɫɤɨɪɨɫɬɢ (PSV) ɢ
ɤɨɧɟɱɧɨɣ ɞɢɚɫɬɨɥɢɱɟɫɤɨɣ ɫɤɨɪɨɫɬɢ (EDV).
Ⱦɚɧɧɵɟ ɜɟɥɢɱɢɧɵ ɨɬɪɚɠɚɸɬ ɡɧɚɱɟɧɢɹ ɫɤɨɪɨɫɬɟɣ ɤɪɨɜɨɬɨɤɚ ɜ ɤɨɧɤɪɟɬɧɨɦ ɩɟɪɢɨɞɟ
ɫɟɪɞɟɱɧɨɝɨ ɰɢɤɥɚ, ɧɟ ɞɚɜɚɹ ɢɧɮɨɪɦɚɰɢɢ ɨɛ
ɢɫɬɢɧɧɨɣ ɫɤɨɪɨɫɬɢ ɤɪɨɜɢ ɜ ɫɨɫɭɞɟ ɡɚ ɜɟɫɶ
ɫɟɪɞɟɱɧɵɣ ɰɢɤɥ. ȼɟɥɢɱɢɧɚ ɭɫɪɟɞɧɟɧɧɨɣ ɩɨ
ɜɪɟɦɟɧɢ ɫɪɟɞɧɟɣ ɫɤɨɪɨɫɬɢ (TAV) ɞɚɟɬ ɩɪɟɞɫɬɚɜɥɟɧɢɟ ɨɛ ɢɫɬɢɧɧɨɣ ɫɤɨɪɨɫɬɢ ɞɜɢɠɟɧɢɹ
ɱɚɫɬɢɰ ɜ ɫɨɫɭɞɟ. ȼ 70% ɫɥɭɱɚɟɜ ɨɬɦɟɱɚɥɨɫɶ
ɭɦɟɧɶɲɟɧɢɟ TAV, ɜ 24% – ɭɜɟɥɢɱɟɧɢɟ, ɢ ɜ
6% ɫɥɭɱɚɟɜ ɞɚɧɧɵɣ ɩɚɪɚɦɟɬɪ ɧɟ ɢɡɦɟɧɹɥɫɹ. ɇɚ ɜɟɥɢɱɢɧɭ ɨɛɴɟɦɧɨɝɨ ɤɪɨɜɨɬɨɤɚ ɜɥɢɹɸɬ ɬɚɤɠɟ ɜɟɥɢɱɢɧɵ, ɤɨɫɜɟɧɧɨ ɨɬɪɚɠɚɸɳɢɟ ɫɨɫɬɨɹɧɢɟ ɫɨɫɭɞɢɫɬɨɣ ɫɬɟɧɤɢ: ɢɧɞɟɤɫ
ɪɟɡɢɫɬɢɜɧɨɫɬɢ (RI) ɢ ɢɧɞɟɤɫ ɩɭɥɶɫɚɰɢɢ
(PI). ɇɚɢɛɨɥɶɲɟɣ ɜɚɪɢɚɛɟɥɶɧɨɫɬɶɸ ɯɚɪɚɤɬɟɪɢɡɨɜɚɥɫɹ PI. ȼ 54% ɫɥɭɱɚɟɜ ɨɧ ɭɜɟɥɢɱɢɥɫɹ, ɜ 40% – ɭɦɟɧɶɲɢɥɫɹ ɢ ɧɟɢɡɦɟɧɧɵɦ
ɨɫɬɚɜɚɥɫɹ ɜ 6%. RI ɨɫɬɚɜɚɥɫɹ ɫɬɚɛɢɥɶɧɵɦ
ɜ 74% ɢɡɦɟɪɟɧɢɣ. ɍɜɟɥɢɱɟɧɢɟ ɩɨɫɥɟɞɧɟɝɨ
79
” ɇɨɜɨɫɬɢ ɯɢɪɭɪɝɢɢ
Ɍɚɛɥɢɰɚ 1
ȼɚɪɢɚɧɬɵ ɢɡɦɟɧɟɧɢɹ ɩɚɪɚɦɟɬɪɨɜ ɚɪɬɟɪɢɚɥɶɧɨɝɨ ɤɪɨɜɨɬɨɤɚ, ɪɟɝɢɫɬɪɢɪɭɟɦɵɯ
ɧɚ ɩɥɟɱɟɜɨɣ ɚɪɬɟɪɢɢ ɭ ɛɨɥɶɧɵɯ ɪɚɤɨɦ ɦɨɥɨɱɧɨɣ ɠɟɥɟɡɵ ɩɨɫɥɟ ɯɢɪɭɪɝɢɱɟɫɤɨɝɨ
ɥɟɱɟɧɢɹ ɨɬɧɨɫɢɬɟɥɶɧɨ ɢɫɯɨɞɧɨɝɨ ɭɪɨɜɧɹ (ɤɨɥɢɱɟɫɬɜɨ ɫɥɭɱɚɟɜ ɜ %)
PSV
EDV
TAM
PI
RI
Vvol
ɍɜɟɥɢɱɟɧɢɟ
41
29
24
54
24
49
ɋɨɯɪɚɧɢɥɨɫɶ ɧɚ ɢɫɯɨɞɧɨɦ
ɭɪɨɜɧɟ
45
27
6
6
74
40
ɍɦɟɧɶɲɟɧɢɟ
14
44
70
40
2
11
ɛɵɥɨ ɡɚɮɢɤɫɢɪɨɜɚɧɨ ɜ 24% ɫɥɭɱɚɟɜ, ɚ
ɭɦɟɧɶɲɟɧɢɟ – 2%. ɋɜɨɞɧɵɟ ɞɚɧɧɵɟ ɨɛ ɢɡɦɟɧɟɧɢɹɯ ɚɪɬɟɪɢɚɥɶɧɨɝɨ ɤɪɨɜɨɬɨɤɚ ɩɪɢɜɟɞɟɧɵ ɜ ɬɚɛɥɢɰɟ 1.
ɉɨɫɤɨɥɶɤɭ ɧɚ ɜɟɥɢɱɢɧɭ ɢ ɢɡɦɟɧɟɧɢɹ
ɞɚɧɧɵɯ ɩɨɤɚɡɚɬɟɥɟɣ ɨɤɚɡɵɜɚɟɬ ɜɥɢɹɧɢɟ
ɦɧɨɠɟɫɬɜɨ ɮɚɤɬɨɪɨɜ ɩɪɨɜɟɞɟɧ ɚɧɚɥɢɡ ɡɚɜɢɫɢɦɨɫɬɢ ɢɡɦɟɧɟɧɢɹ ɞɚɧɧɵɯ ɩɨɤɚɡɚɬɟɥɟɣ
ɨɬ ɫɬɚɞɢɢ ɨɩɭɯɨɥɟɜɨɝɨ ɩɪɨɰɟɫɫɚ, ɜɢɞɚ ɢ
ɨɫɨɛɟɧɧɨɫɬɟɣ ɨɩɟɪɚɬɢɜɧɨɝɨ ɜɦɟɲɚɬɟɥɶɫɬɜɚ, ɩɨɫɥɟɨɩɟɪɚɰɢɨɧɧɵɯ ɨɫɥɨɠɧɟɧɢɣ, ɚ
ɬɚɤɠɟ ɧɚɥɢɱɢɹ ɢ ɜɵɪɚɠɟɧɧɨɫɬɢ ɫɨɩɭɬɫɬɜɭɸɳɟɣ ɩɚɬɨɥɨɝɢɢ.
ɉɪɢ ɞɟɬɚɥɶɧɨɦ ɚɧɚɥɢɡɟ ɢɡɦɟɧɟɧɢɣ ɚɪɬɟɪɢɚɥɶɧɨɝɨ ɤɪɨɜɨɬɨɤɚ ɜ ɡɚɜɢɫɢɦɨɫɬɢ ɨɬ
ɫɬɚɞɢɢ ɨɩɭɯɨɥɟɜɨɝɨ ɩɪɨɰɟɫɫɚ ɨɬɦɟɱɟɧɵ
ɫɥɟɞɭɸɳɢɟ ɨɫɨɛɟɧɧɨɫɬɢ (ɪɢɫ. 1–3). ɇɚɢɛɨɥɶɲɟɟ ɭɜɟɥɢɱɟɧɢɟ ɨɛɴɟɦɧɨɣ ɫɤɨɪɨɫɬɢ
ɤɪɨɜɨɬɨɤɚ ɡɚɮɢɤɫɢɪɨɜɚɧɨ ɭ ɩɚɰɢɟɧɬɨɤ ɫ I
ɫɬɚɞɢɟɣ ɨɩɭɯɨɥɟɜɨɝɨ ɩɪɨɰɟɫɫɚ (62 %), ɞɥɹ
ɩɚɰɢɟɧɬɨɤ ɫ II ɢ III ɫɬɚɞɢɟɣ ɛɨɥɟɡɧɢ ɨɬɦɟɱɟɧɨ ɬɚɤ ɠɟ ɭɜɟɥɢɱɟɧɢɟ ɷɬɨɝɨ ɩɨɤɚɡɚɬɟɥɹ,
ɧɨ ɫɪɚɜɧɢɬɟɥɶɧɨ ɦɟɧɶɲɟ 43% ɢ 44% ɫɨɨɬɜɟɬɫɬɜɟɧɧɨ. Ʉɪɨɦɟ ɬɨɝɨ, ɭ ɛɨɥɶɧɵɯ ɫ ɧɚɥɢɱɢɟɦ ɦɟɬɚɫɬɚɡɨɜ ɜ ɪɟɝɢɨɧɚɪɧɵɯ ɩɨɞɦɵɲɟɱɧɵɯ ɢ ɩɨɞɤɥɸɱɢɱɧɵɯ ɥɢɦɮɨɭɡɥɚɯ, ɤ ɤɨɬɨɪɵɦ ɢ ɨɬɧɨɫɹɬɫɹ ɩɚɰɢɟɧɬɤɢ ɫ II ɢ III ɫɬɚɞɢɟɣ ɨɩɭɯɨɥɟɜɨɝɨ ɩɪɨɰɟɫɫɚ ɩɪɨɫɥɟɠɢɜɚɟɬɫɹ
ɬɟɧɞɟɧɰɢɹ ɤ ɧɟɤɨɬɨɪɨɦɭ ɫɧɢɠɟɧɢɸ Vvol.
Ⱥɧɚɥɨɝɢɱɧɚɹ ɤɚɪɬɢɧɚ ɯɚɪɚɤɬɟɪɧɚ ɞɥɹ ɫɤɨɪɨɫɬɧɵɯ ɩɨɤɚɡɚɬɟɥɟɣ ɤɪɨɜɨɬɨɤɚ ɤɚɤ PSV ɢ
EDV. ɉɨ ɦɟɪɟ ɪɨɫɬɚ ɫɬɚɞɢɢ ɨɩɭɯɨɥɟɜɨɝɨ
80
ɩɪɨɰɟɫɫɚ ɱɚɫɬɨɬɚ ɭɜɟɥɢɱɟɧɢɹ PSV ɢ EDV
ɫɧɢɠɚɟɬɫɹ, ɚ ɱɚɫɬɨɬɚ ɫɧɢɠɟɧɢɹ PSV ɢ EDV
ɜɨɡɪɚɫɬɚɟɬ. ɗɬɨ ɧɚɯɨɞɢɬ ɫɜɨɟ ɨɬɪɚɠɟɧɢɟ,
ɝɥɚɜɧɵɦ ɨɛɪɚɡɨɦ, ɜ ɢɡɦɟɧɟɧɢɢ TAV. ȼɧɟ ɡɚɜɢɫɢɦɨɫɬɢ ɨɬ ɫɬɚɞɢɢ ɡɚɛɨɥɟɜɚɧɢɹ ɞɚɧɧɚɹ
ɜɟɥɢɱɢɧɚ ɢɦɟɟɬ ɡɧɚɱɢɬɟɥɶɧɨɟ ɫɧɢɠɟɧɢɟ
ɩɨɫɥɟ ɨɩɟɪɚɰɢɢ.
ɂɧɞɟɤɫ ɪɟɡɢɫɬɢɜɧɨɫɬɢ (RI) ɡɧɚɱɢɬɟɥɶɧɨ ɩɨɜɵɲɚɟɬɫɹ ɭ ɩɚɰɢɟɧɬɨɤ ɫ III ɫɬɚɞɢɟɣ
ɊɆɀ. ɂɧɞɟɤɫ ɩɭɥɶɫɚɰɢɢ (PI) ɤɚɤ ɫɧɢɠɚɟɬɫɹ, ɬɚɤ ɢ ɭɜɟɥɢɱɢɜɚɟɬɫɹ ɜɧɟ ɡɚɜɢɫɢɦɨɫɬɢ
ɨɬ ɫɬɚɞɢɢ.
ɋɬɚɬɢɫɬɢɱɟɫɤɢ ɡɧɚɱɢɦɵɯ (ɪ>0,05) ɪɚɡɥɢɱɢɣ ɜ ɢɡɦɟɧɟɧɢɢ ɩɨɤɚɡɚɬɟɥɟɣ ɨɛɴɟɦɧɨɝɨ
ɤɪɨ ɜɨɬɨ ɤɚ
ɩɪɢ
ɫɨɯɪɚɧɟɧɢɢ
n.intercostabrachialis ɭ ɛɨɥɶɧɵɯ ɫ ɪT12N0M0 ɢ ɩɪɢ ɧɟɜɨɡɦɨɠɧɨɫɬɢ ɫɨɯɪɚɧɟɧɢɹ
ɩɨɫɥɟɞɧɟɝɨ ɩɪɢ ɪT1-3N1-3M0 ɧɟ ɩɨɥɭɱɟɧɨ. ȼ ɨɛɟɢɯ ɝɪɭɩɩɚɯ ɨɬɦɟɱɚɥɚɫɶ ɨɞɢɧɚɤɨɜɚɹ ɱɚɫɬɨɬɚ ɭɜɟɥɢɱɟɧɢɹ Vvol.
Ɉɫɨɛɵɣ ɢɧɬɟɪɟɫ ɩɪɟɞɫɬɚɜɥɹɟɬ ɬɨɬ ɮɚɤɬ,
ɱɬɨ ɭ 86 % ɠɟɧɳɢɧ, ɢɦɟɸɳɢɯ ɢɡɦɟɧɟɧɢɹ
ɨɛɴɟɦɧɨɣ ɫɤɨɪɨɫɬɢ ɤɪɨɜɨɬɨɤɚ ɜ ɫɬɨɪɨɧɭ
ɭɜɟɥɢɱɟɧɢɹ (1-ɚɹ ɝɪɭɩɩɚ), ɨɬɦɟɱɚɟɬɫɹ ɫɬɚɬɢɫɬɢɱɟɫɤɢ ɡɧɚɱɢɦɨɟ (ɪ < 0,05) ɭɜɟɥɢɱɟɧɢɟ ɨɛɴɟɦɚ ɥɢɦɮɨɪɟɢ, ɩɨ ɫɪɚɜɧɟɧɢɸ ɫ
ɠɟɧɳɢɧɚɦɢ 2-ɨɣ ɢ 3-ɟɣ ɝɪɭɩɩɵ. ɋɪɟɞɧɢɣ
ɨɛɴɟɦ ɥɢɦɮɵ ɜ 1-ɨɣ ɝɪɭɩɩɟ ɫɨɫɬɚɜɢɥ
1100±310 ɦɥ (Ɇ±m). ȼɨ 2-ɨɣ ɢ 3-ɟɣ –
850±105 (Ɇ±m). Ɉɞɧɚɤɨ ɱɚɫɬɨɬɚ ɬɚɤɨɝɨ
ɩɨɫɥɟɨɩɟɪɚɰɢɨɧɧɨɝɨ ɨɫɥɨɠɧɟɧɢɹ ɥɟɱɟɧɢɹ
ɊɆɀ ɤɚɤ ɞɥɢɬɟɥɶɧɚɹ ɥɢɦɮɨɪɟɹ, ɫɪɨɤɢ ɟɟ
ʋ4x 2008 i ɬɨɦ 16
ɭɜɟɥɢɱɟɧɢɟ
0,8
ɧɟɢɡɦɟɧɧɵɣ
0,7
ɭɦɟɧɶɲɟɧɢɟ
0,6
0,5
0,4
0,3
0,2
0,1
0
PSV
EDV
TAM
RI
PI
Vvol
Ɋɢɫ. 1. ȼɚɪɢɚɧɬɵ ɢɡɦɟɧɟɧɢɹ ɩɚɪɚɦɟɬɪɨɜ ɚɪɬɟɪɢɚɥɶɧɨɝɨ ɤɪɨɜɨɬɨɤɚ ɩɨɫɥɟ ɯɢɪɭɪɝɢɱɟɫɤɨɝɨ
ɥɟɱɟɧɢɹ ɛɨɥɶɧɵɯ ɊɆɀ I ɫɬɚɞɢɢ (ɨɬɧɨɫɢɬɟɥɶɧɨ ɢɫɯɨɞɧɨɝɨ ɭɪɨɜɧɹ)
ɪɚɡɪɟɲɟɧɢɹ ɧɟ ɡɚɜɢɫɹɬ ɨɬ Vvol. Ɉɞɢɧɚɤɨɜɨ
ɱɚɫɬɨ ɨɧɨ ɜɨɡɧɢɤɚɥɨ ɤɚɤ ɭ ɛɨɥɶɧɵɯ ɫ ɭɜɟɥɢɱɟɧɧɵɦ, ɬɚɤ ɢ ɫɧɢɠɟɧɧɵɦ ɨɛɴɟɦɧɵɦ
ɤɪɨɜɨɬɨɤɨɦ 50% ɢ 50% ɫɨɨɬɜɟɬɫɬɜɟɧɧɨ.
ɋɨɩɭɬɫɬɜɭɸɳɚɹ ɩɚɬɨɥɨɝɢɹ, ɟɟ ɜɵɪɚɠɟɧɧɨɫɬɶ ɢ ɤɨɦɩɟɧɫɚɰɢɹ, ɧɟɫɨɦɧɟɧɧɨ, ɜɥɢɹɟɬ ɧɚ ɚɪɬɟɪɢɚɥɶɧɭɸ ɝɟɦɨɞɢɧɚɦɢɤɭ. ɍ 78
ɠɟɧɳɢɧ ɩɪɢ ɨɫɦɨɬɪɟ ɬɟɪɚɩɟɜɬɚ ɞɢɚɝɧɨɫɬɢɪɨɜɚɧɵ ɪɚɡɥɢɱɧɵɟ ɜɢɞɵ ɬɟɪɚɩɟɜɬɢɱɟɫɤɨɣ
ɩɚɬɨɥɨɝɢɢ. ȼɟɞɭɳɟɟ ɦɟɫɬɨ ɡɚɧɢɦɚɸɬ ɛɨɥɟɡɧɢ ɫɟɪɞɟɱɧɨɫɨɫɭɞɢɫɬɨɣ ɫɢɫɬɟɦɵ, ɫɪɟɞɢ
ɤɨɬɨɪɵɯ ɥɢɞɢɪɭɟɬ ɚɪɬɟɪɢɚɥɶɧɚɹ ɝɢɩɟɪɬɟɧɡɢɹ ɤɚɤ ɫɚɦɨɫɬɨɹɬɟɥɶɧɨ, ɬɚɤ ɢ ɜ ɫɨɱɟɬɚɧɢɢ
ɫ ɂȻɋ, ɨɠɢɪɟɧɢɟɦ, ɚɬɟɪɨɫɤɥɟɪɨɡɨɦ. Ɋɟɠɟ
ɜɫɬɪɟɱɚɥɚɫɶ ɩɚɬɨɥɨɝɢɹ ɨɪɝɚɧɨɜ ɞɵɯɚɧɢɹ ɜ
ɜɢɞɟ ɯɪɨɧɢɱɟɫɤɨɝɨ ɛɪɨɧɯɢɬɚ (ɬɚɛɥɢɰɚ 2).
ɍ 36 ɢɡ 49 ɠɟɧɳɢɧ, ɢɦɟɜɲɢɯ ɭɜɟɥɢɱɟɧɢɟ ɨɛɴɟɦɧɨɣ ɫɤɨɪɨɫɬɢ ɤɪɨɜɨɬɨɤɚ, ɨɬɦɟɱɚɥɚɫɶ ɞɨɫɬɚɬɨɱɧɨ ɜɵɪɚɠɟɧɧɚɹ ɫɨɩɭɬɫɬɜɭɸɳɚɹ ɬɟɪɚɩɟɜɬɢɱɟɫɤɚɹ ɩɚɬɨɥɨɝɢɹ, ɬɪɟɛɭɸɳɚɹ ɧɟɨɛɯɨɞɢɦɨɣ ɤɨɪɪɟɤɰɢɢ.
Ɉɛɫɭɠɞɟɧɢɟ
ɉɚɪɚɦɟɬɪɵ ɩɢɤɨɜɨɣ ɫɢɫɬɨɥɢɱɟɫɤɨɣ ɢ
ɤɨɧɟɱɧɨɣ ɞɢɚɫɬɨɥɢɱɟɫɤɨɣ ɫɤɨɪɨɫɬɟɣ ɤɪɨɜɨɬɨɤɚ ɨɬɪɚɠɚɸɬ ɡɧɚɱɟɧɢɹ ɫɤɨɪɨɫɬɢ ɤɪɨɜɨɬɨɤɚ ɜ ɤɨɧɤɪɟɬɧɵɟ ɩɟɪɢɨɞɵ ɫɟɪɞɟɱɧɨɝɨ
Ɋɢɫ. 2. ȼɚɪɢɚɧɬɵ ɢɡɦɟɧɟɧɢɹ ɩɚɪɚɦɟɬɪɨɜ ɚɪɬɟɪɢɚɥɶɧɨɝɨ ɤɪɨɜɨɬɨɤɚ ɩɨɫɥɟ ɯɢɪɭɪɝɢɱɟɫɤɨɝɨ
ɥɟɱɟɧɢɹ ɛɨɥɶɧɵɯ ɊɆɀ II ɫɬɚɞɢɢ (ɨɬɧɨɫɢɬɟɥɶɧɨ ɢɫɯɨɞɧɨɝɨ ɭɪɨɜɧɹ)
ɭɜɟɥɢɱɟɧɢɟ
0,8
ɧɟɢɡɦɟɧɧɵɣ
0,7
ɭɦɟɧɶɲɟɧɢɟ
0,6
0,5
0,4
0,3
0,2
0,1
0
PSV
EDV
TAM
RI
PI
Vvol
81
” ɇɨɜɨɫɬɢ ɯɢɪɭɪɝɢɢ
0,9
ɭɜɟɥɢɱɟɧɢɟ
0,8
ɧɟɢɡɦɟɧɧɵɣ
0,7
ɭɦɟɧɶɲɟɧɢɟ
0,6
0,5
0,4
0,3
0,2
0,1
0
PSV
EDV
TAM
RI
PI
Vvol
Ɋɢɫ. 3. ȼɚɪɢɚɧɬɵ ɢɡɦɟɧɟɧɢɹ ɩɚɪɚɦɟɬɪɨɜ ɚɪɬɟɪɢɚɥɶɧɨɝɨ ɤɪɨɜɨɬɨɤɚ ɩɨɫɥɟ ɯɢɪɭɪɝɢɱɟɫɤɨɝɨ
ɥɟɱɟɧɢɹ ɛɨɥɶɧɵɯ ɊɆɀ III ɫɬɚɞɢɢ (ɨɬɧɨɫɢɬɟɥɶɧɨ ɢɫɯɨɞɧɨɝɨ ɭɪɨɜɧɹ)
ɰɢɤɥɚ. Ɉɫɧɨɜɧɵɦ ɮɚɤɬɨɪɨɦ, ɜɥɢɹɸɳɢɦ ɧɚ
ɜɟɥɢɱɢɧɭ ɩɢɤɨɜɨɣ ɫɢɫɬɨɥɢɱɟɫɤɨɣ ɫɤɨɪɨɫɬɢ ɤɪɨɜɨɬɨɤɚ, ɹɜɥɹɟɬɫɹ ɭɞɚɪɧɵɣ ɨɛɴɟɦ (ɢɥɢ
ɫɟɪɞɟɱɧɵɣ ɜɵɛɪɨɫ ɩɪɢ ɭɫɬɚɧɨɜɢɜɲɟɣɫɹ
ɱɚɫɬɨɬɟ ɫɟɪɞɟɱɧɵɯ ɫɨɤɪɚɳɟɧɢɣ). ȼ ɦɟɧɶɲɟɣ ɫɬɟɩɟɧɢ ɧɚ ɧɟɟ ɨɤɚɡɵɜɚɸɬ ɜɥɢɹɧɢɹ
ɫɜɨɣɫɬɜɚ ɫɨɫɭɞɢɫɬɨɣ ɫɬɟɧɤɢ ɢ ɪɟɨɥɨɝɢɱɟɫɤɢɟ ɯɚɪɚɤɬɟɪɢɫɬɢɤɢ ɤɪɨɜɢ.
ɍɫɪɟɞɧɟɧɧɚɹ ɩɨ ɜɪɟɦɟɧɢ ɫɪɟɞɧɹɹ ɫɤɨɪɨɫɬɶ ɤɪɨɜɨɬɨɤɚ ɞɚɟɬ ɧɚɢɛɨɥɟɟ ɩɨɥɧɨɟ
ɩɪɟɞɫɬɚɜɥɟɧɢɟ ɨɛ ɢɫɬɢɧɧɨɣ ɫɤɨɪɨɫɬɢ ɤɪɨɜɢ ɜ ɫɨɫɭɞɚɯ. Ⱦɚɧɧɚɹ ɜɟɥɢɱɢɧɚ ɹɜɥɹɟɬɫɹ
ɧɚɢɛɨɥɟɟ ɱɭɜɫɬɜɢɬɟɥɶɧɵɦ ɩɚɪɚɦɟɬɪɨɦ ɢ
ɢɡɦɟɧɹɟɬɫɹ ɭɠɟ ɩɪɢ ɫɥɚɛɨ ɜɵɪɚɠɟɧɧɨɣ ɚɪɬɟɪɢɚɥɶɧɨɣ ɩɚɬɨɥɨɝɢɢ, ɬɨɝɞɚ ɤɚɤ ɩɚɪɚɦɟɬɪɵ ɩɢɤɨɜɵɯ ɫɤɨɪɨɫɬɟɣ ɦɟɧɹɸɬɫɹ ɩɪɢ ɛɨ-
ɥɟɟ ɩɨɡɞɧɟɣ ɫɬɚɞɢɢ ɩɚɬɨɥɨɝɢɱɟɫɤɨɝɨ ɩɪɨɰɟɫɫɚ. ɂɡɦɟɧɟɧɢɹ ɫɤɨɪɨɫɬɧɵɯ ɯɚɪɚɤɬɟɪɢɫɬɢɤ ɩɨɬɨɤɚ ɦɨɝɭɬ ɛɵɬɶ ɫɜɹɡɚɧɵ ɫ ɮɭɧɤɰɢɟɣ ɫɟɪɞɰɚ, ɫɨɫɬɨɹɧɢɟɦ ɫɨɫɭɞɢɫɬɨɣ ɫɬɟɧɤɢ,
ɪɟɨɥɨɝɢɱɟɫɤɢɦɢ ɫɜɨɣɫɬɜɚɦɢ ɤɪɨɜɢ, ɭɞɚɥɟɧɧɨɫɬɶɸ ɢɫɫɥɟɞɭɟɦɨɣ ɫɨɫɭɞɢɫɬɨɣ ɨɛɥɚɫɬɢ
ɨɬ ɫɟɪɞɰɚ [1, 4]. Ɋɚɡɥɢɱɧɵɟ ɜɢɞɵ ɚɪɬɟɪɢɚɥɶɧɨɣ ɩɚɬɨɥɨɝɢɢ ɩɪɢɜɨɞɹɬ ɤ ɢɡɦɟɧɟɧɢɸ
ɫɤɨɪɨɫɬɧɵɯ ɩɚɪɚɦɟɬɪɨɜ ɤɪɨɜɨɬɨɤɚ, ɫɬɟɩɟɧɶ
ɢɡɦɟɧɟɧɢɹ ɤɨɬɨɪɵɯ ɩɪɹɦɨ ɩɪɨɩɨɪɰɢɨɧɚɥɶɧɚ ɜɵɪɚɠɟɧɧɨɫɬɢ ɩɚɬɨɥɨɝɢɱɟɫɤɨɝɨ ɩɪɨɰɟɫɫɚ.
ɂɧɞɟɤɫ ɫɨɩɪɨɬɢɜɥɟɧɢɹ (RI) ɢ ɢɧɞɟɤɫ
ɩɭɥɶɫɚɰɢɢ (PI) ɩɨɡɜɨɥɹɸɬ ɤɨɫɜɟɧɧɨ ɫɭɞɢɬɶ
ɨ ɜɟɥɢɱɢɧɟ ɩɟɪɢɮɟɪɢɱɟɫɤɨɝɨ ɫɨɩɪɨɬɢɜɥɟɧɢɹ. ɂɧɞɟɤɫ ɩɭɥɶɫɚɰɢɢ ɛɨɥɟɟ ɬɨɱɧɨ ɨɬɪɚ-
Ɍɚɛɥɢɰɚ 2
ɑɚɫɬɨɬɚ ɫɨɩɭɬɫɬɜɭɸɳɟɣ ɩɚɬɨɥɨɝɢɢ ɭ ɨɩɟɪɢɪɨɜɚɧɧɵɯ ɛɨɥɶɧɵɯ ɩɨ ɩɨɜɨɞɭ ɪɚɤɚ
ɦɨɥɨɱɧɨɣ ɠɟɥɟɡɵ
82
ȺȽ
57
35%
ɂȻɋ
32
20%
Ⱥɬɟɪɨɫɤɥɟɪɨɡ
24
15%
Ɉɠɢɪɟɧɢɟ
17
11%
ɋɚɯɚɪɧɵɣ ɞɢɚɛɟɬ ɬɢɩ 2
4
2%
ɏɪɨɧɢɱɟɫɤɢɣ ɛɪɨɧɯɢɬ
23
14%
ɉɪɨɱɢɟ
4
2%
ʋ4x 2008 i ɬɨɦ 16
ɠɚɟɬ ɟɝɨ ɫɨɫɬɨɹɧɢɟ, ɬɚɤ ɤɚɤ ɞɥɹ ɟɝɨ ɜɵɱɢɫɥɟɧɢɹ ɢɫɩɨɥɶɡɭɟɬɫɹ ɭɫɪɟɞɧɟɧɧɚɹ ɫɤɨɪɨɫɬɶ.
ɉɨɜɵɲɟɧɢɟ ɜɵɲɟɧɚɡɜɚɧɧɵɯ ɢɧɞɟɤɫɨɜ ɧɚɛɥɸɞɚɟɬɫɹ ɩɪɢ ɪɚɡɥɢɱɧɵɯ ɮɨɪɦɚɯ ɫɬɟɧɨɨɤɥɸɡɢɪɭɸɳɟɣ ɩɚɬɨɥɨɝɢɢ, ɚ ɬɚɤɠɟ ɩɪɢ ɜɚɡɨɫɩɚɫɬɢɱɟɫɤɨɣ ɪɟɚɤɰɢɢ. ɂɯ ɫɧɢɠɟɧɢɟ ɦɨɠɟɬ ɛɵɬɶ ɜɵɡɜɚɧɨ ɨɬɤɪɵɬɢɟɦ ɚɪɬɟɪɢɨɜɟɧɨɡɧɵɯ ɲɭɧɬɨɜ ɢ ɩɟɪɢɮɟɪɢɱɟɫɤɨɣ ɜɚɡɨɞɢɥɹɬɚɰɢɟɣ.
Ɂɧɚɱɟɧɢɟ ɜɟɥɢɱɢɧɵ ɨɛɴɟɦɧɨɣ ɫɤɨɪɨɫɬɢ ɤɪɨɜɨɬɨɤɚ (Vvol) ɩɨɡɜɨɥɹɟɬ ɫɭɞɢɬɶ ɨɛ
ɢɫɬɢɧɧɨɦ ɤɪɨɜɨɫɧɚɛɠɟɧɢɢ ɨɪɝɚɧɚ [5]. Ⱦɚɧɧɵɣ ɩɨɤɚɡɚɬɟɥɶ ɡɚɜɢɫɢɬ ɨɬ ɞɢɚɦɟɬɪɚ ɫɨɫɭɞɚ, ɚ ɢɦɟɧɧɨ ɨɬ ɩɥɨɳɚɞɢ ɩɨɩɟɪɟɱɧɨɝɨ ɫɟɱɟɧɢɹ, ɫɪɟɞɧɟɣ ɫɤɨɪɨɫɬɢ ɢ ɢɧɞɟɤɫɚ ɩɭɥɶɫɚɰɢɢ, ɤɨɬɨɪɵɣ ɫɥɭɠɢɬ ɞɥɹ ɨɰɟɧɤɢ ɢɡɦɟɧɟɧɢɹ ɞɢɚɦɟɬɪɚ ɫɨɫɭɞɚ ɦɟɠɞɭ ɮɚɡɨɣ ɫɢɫɬɨɥɵ ɢ ɞɢɚɫɬɨɥɵ.
ɂɡɦɟɧɟɧɢɹ ɨɛɴɟɦɧɨɝɨ ɤɪɨɜɨɬɨɤɚ
(Vvol) ɜɟɪɯɧɟɣ ɤɨɧɟɱɧɨɫɬɢ, ɚ ɢɦɟɧɧɨ ɭɜɟɥɢɱɟɧɢɟ ɩɪɢɬɨɤɚ ɚɪɬɟɪɢɚɥɶɧɨɣ ɤɪɨɜɢ ɭ
ɛɨɥɶɧɵɯ ɩɟɪɟɧɟɫɲɢɯ ɪɚɞɢɤɚɥɶɧɭɸ ɨɩɟɪɚɰɢɸ ɩɨ ɩɨɜɨɞɭ ɊɆɀ ɫɥɟɞɭɟɬ ɫɜɹɡɚɬɶ ɧɟɩɨɫɪɟɞɫɬɜɟɧɧɨ ɫ ɨɩɟɪɚɰɢɨɧɧɨɣ ɬɪɚɜɦɨɣ, ɜ
ɪɟɡɭɥɶɬɚɬɟ ɤɨɬɨɪɨɣ ɩɪɨɢɫɯɨɞɢɬ ɩɟɪɟɫɟɱɟɧɢɟ ɦɧɨɠɟɫɬɜɚ ɦɟɥɤɢɯ ɧɟɪɜɧɵɯ ɜɨɥɨɤɨɧ,
ɩɪɢɜɨɞɹɳɟɟ ɤ ɩɨɬɟɪɟ ɫɢɦɩɚɬɢɱɟɫɤɨɝɨ ɜɚɡɨɤɨɧɫɬɪɢɤɬɨɪɧɨɝɨ ɤɨɧɬɪɨɥɹ, ɹɜɥɹɸɳɟɝɨɫɹ ɪɟɡɭɥɶɬɚɬɨɦ ɧɟɜɪɨɥɨɝɢɱɟɫɤɨɝɨ ɞɟɮɢɰɢɬɚ [6]. ɗɬɨ ɩɪɢɜɨɞɢɬ ɤ ɢɡɦɟɧɟɧɢɸ ɫɨɫɬɨɹɧɢɹ ɫɨɫɭɞɢɫɬɨɝɨ ɤɨɦɩɨɧɟɧɬɚ, ɜ ɱɚɫɬɧɨɫɬɢ,
ɫ ɢɡɦɟɧɟɧɢɹɦɢ ɫɨɫɭɞɢɫɬɨɣ ɫɬɟɧɤɢ ɚɪɬɟɪɢɣ, ɫɧɢɠɟɧɢɟ ɟɟ ɜɚɡɨɤɨɧɫɬɪɢɤɬɨɪɧɵɯ ɢ
ɷɥɚɫɬɢɱɧɵɯ ɫɜɨɣɫɬɜ, ɱɬɨ ɨɬɪɚɠɚɸɬ RI ɢ PI.
ɂɡɦɟɧɟɧɢɹ ɧɟɩɨɫɪɟɞɫɬɜɟɧɧɨ ɫɤɨɪɨɫɬɧɵɯ
ɯɚɪɚɤɬɟɪɢɫɬɢɤ ɩɨɬɨɤɚ ɫɥɟɞɭɟɬ ɫɜɹɡɵɜɚɬɶ ɧɟ
ɬɨɥɶɤɨ ɫ ɨɩɟɪɚɬɢɜɧɵɦ ɜɦɟɲɚɬɟɥɶɫɬɜɨɦ, ɧɨ
ɢ ɫ ɧɚɥɢɱɢɟɦ ɭ ɩɚɰɢɟɧɬɨɤ ɜɵɪɚɠɟɧɧɨɣ ɫɨɩɭɬɫɬɜɭɸɳɟɣ ɩɚɬɨɥɨɝɢɢ, ɚ ɢɦɟɧɧɨ ɫ ɧɚɥɢɱɢɟɦ ɭ ɧɢɯ ɛɨɥɟɡɧɟɣ ɫɟɪɞɟɱɧɨɫɨɫɭɞɢɫɬɨɣ
ɫɢɫɬɟɦɵ, ɝɥɚɜɧɵɦ ɨɛɪɚɡɨɦ, ɚɪɬɟɪɢɚɥɶɧɨɣ
ɝɢɩɟɪɬɟɧɡɢɢ. Ʉɚɤ ɢɡɜɟɫɬɧɨ, ɭ ɝɢɩɟɪɬɨɧɢɤɨɜ ɢɦɟɟɬɫɹ ɥɢɛɨ ɝɢɩɟɪɤɢɧɟɬɢɱɟɫɤɢɣ ɥɢɛɨ
ɝɢɩɟɪɜɨɥɟɦɢɱɟɫɤɢɣ ɬɢɩ ɝɟɦɨɞɢɧɚɦɢɤɢ [7].
ɉɨɥɭɱɟɧɧɵɟ ɞɚɧɧɵɟ ɫɜɢɞɟɬɟɥɶɫɬɜɭɸɬ ɨ
ɬɨɦ, ɱɬɨ ɚɪɬɟɪɢɚɥɶɧɚɹ ɝɢɩɟɪɬɟɧɡɢɹ ɹɜɥɹɟɬɫɹ ɩɪɟɞɪɚɫɩɨɥɚɝɚɸɳɢɦ ɮɚɤɬɨɪɨɦ ɤ ɪɚɡ-
ɜɢɬɢɸ ɝɟɦɨɞɢɧɚɦɢɱɟɫɤɢɯ ɧɚɪɭɲɟɧɢɣ ɜ ɜɟɪɯɧɟɣ ɤɨɧɟɱɧɨɫɬɢ ɭ ɛɨɥɶɧɵɯ ɊɆɀ ɢ ɬɪɟɛɭɟɬ ɨɛɹɡɚɬɟɥɶɧɨɣ ɤɨɪɪɟɤɰɢɢ.
ɋɧɢɠɟɧɢɟ Vvol ɦɨɠɟɬ ɛɵɬɶ ɜɵɡɜɚɧɨ,
ɤɚɤ ɩɪɚɜɢɥɨ, ɥɢɛɨ ɜɵɪɚɠɟɧɧɵɦ ɫɩɚɡɦɨɦ
ɚɪɬɟɪɢɚɥɶɧɨɝɨ ɫɨɫɭɞɚ, ɥɢɛɨ ɦɟɯɚɧɢɱɟɫɤɢɦ
ɩɪɟɩɹɬɫɬɜɢɟɦ ɤɚɤ ɜɧɭɬɪɢ ɫɨɫɭɞɚ (ɷɦɛɨɥ,
ɚɬɟɪɨɫɤɥɟɪɨɬɢɱɟɫɤɚɹ ɛɥɹɲɤɚ), ɬɚɤ ɢ ɫɧɚɪɭɠɢ (ɪɭɛɰɨɜɚɹ ɞɟɮɨɪɦɚɰɢɹ ɦɹɝɤɢɯ ɬɤɚɧɟɣ
ɨɤɪɭɠɚɸɳɢɯ ɫɨɫɭɞ, ɦɵɲɟɱɧɵɣ ɫɩɚɡɦ ɜ ɦɟɫɬɚɯ ɩɪɨɯɨɠɞɟɧɢɹ ɦɚɝɢɫɬɪɚɥɶɧɵɯ ɚɪɬɟɪɢɣ).
ȼ ɪɟɞɤɢɯ ɫɥɭɱɚɹɯ ɩɚɞɟɧɢɟ Vvol ɫɜɹɡɚɧɨ ɫ
ɧɟɚɞɟɤɜɚɬɧɨɣ ɪɚɛɨɬɨɣ ɫɟɪɞɰɚ. ɍɱɢɬɵɜɚɹ
ɬɨɬ ɮɚɤɬ, ɱɬɨ ɧɚ ɩɪɟɞɨɩɟɪɚɰɢɨɧɧɨɦ ɷɬɚɩɟ
ɹɜɥɟɧɢɣ ɚɬɟɪɨɫɤɥɟɪɨɡɚ ɢ ɷɦɛɨɥɢɡɚɰɢɢ ɩɥɟɱɟɜɨɣ ɚɪɬɟɪɢɢ ɧɟ ɜɵɹɜɥɟɧɨ, ɨɫɥɨɠɧɟɧɢɣ ɫɨ
ɫɬɨɪɨɧɵ ɫɟɪɞɟɱɧɨɫɨɫɭɞɢɫɬɨɣ ɫɢɫɬɟɦɵ ɜ
ɜɢɞɟ ɫɟɪɞɟɱɧɨɣ ɧɟɞɨɫɬɚɬɨɱɧɨɫɬɢ ɧɟ ɛɵɥɨ,
ɚ ɞɥɹ ɮɨɪɦɢɪɨɜɚɧɢɹ ɪɭɛɰɨɜɨɣ ɞɟɮɨɪɦɚɰɢɢ
ɧɟɨɛɯɨɞɢɦ ɞɨɫɬɚɬɨɱɧɵɣ ɩɪɨɦɟɠɭɬɨɤ ɜɪɟɦɟɧɢ, ɨɫɧɨɜɧɵɦ ɮɚɤɬɨɪɨɦ, ɩɪɢɜɟɞɲɢɦ ɤ
ɫɧɢɠɟɧɢɸ ɚɪɬɟɪɢɚɥɶɧɨɝɨ ɩɪɢɬɨɤɚ, ɦɨɠɧɨ
ɫɱɢɬɚɬɶ ɫɩɚɡɦ ɦɵɲɰ, ɱɟɪɟɡ ɤɨɬɨɪɵɟ ɩɪɨɯɨɞɹɬ ɦɚɝɢɫɬɪɚɥɶɧɚɹ ɚɪɬɟɪɢɹ, ɤɪɨɜɨɫɧɚɛɠɚɸɳɚɹ ɪɭɤɭ, ɚ ɢɦɟɧɧɨ ɩɟɪɟɞɧɹɹ ɥɟɫɬɧɢɱɧɚɹ ɦɵɲɰɚ. ɋɢɧɞɪɨɦ ɩɟɪɟɞɧɟɣ ɥɟɫɬɧɢɱɧɨɣ
ɦɵɲɰɵ ɜɩɟɪɜɵɟ ɨɩɢɫɚɧ ɜ 1938 ɝ. H.C.
Naffziger ɢ W.T. Grant [8]. ɋɩɚɡɦ ɦɵɲɰɵ
ɮɨɪɦɢɪɭɟɬɫɹ ɜ ɪɟɡɭɥɶɬɚɬɟ ɪɟɮɥɟɤɬɨɪɧɨɣ
ɪɟɚɤɰɢɢ ɧɚ ɩɚɬɨɥɨɝɢɱɟɫɤɭɸ ɢɦɩɭɥɶɫɚɰɢɸ
ɢɡ ɩɨɪɚɠɟɧɧɵɯ ɫɟɝɦɟɧɬɨɜ ɩɨɡɜɨɧɨɱɧɢɤɚ,
ɩɟɪɢɚɪɬɢɤɭɥɹɪɧɵɯ ɬɤɚɧɟɣ ɩɥɟɱɟɜɨɝɨ ɫɭɫɬɚɜɚ, ɚ ɬɚɤɠɟ ɪɟɰɟɩɬɨɪɨɜ ɩɨɡɜɨɧɨɱɧɨɣ ɚɪɬɟɪɢɢ. ɉɪɢ ɷɬɨɦ ɩɟɪɟɞɧɹɹ ɥɟɫɬɧɢɱɧɚɹ
ɦɵɲɰɚ ɹɜɥɹɟɬɫɹ ɢɫɬɨɱɧɢɤɨɦ ɩɚɬɨɥɨɝɢɱɟɫɤɨɣ ɩɪɨɩɪɢɨɰɟɩɬɢɜɧɨɣ ɢɦɩɭɥɶɫɚɰɢɢ, ɨɛɭɫɥɨɜɥɢɜɚɸɳɢɯ ɩɨɹɜɥɟɧɢɟ ɮɭɧɤɰɢɨɧɚɥɶɧɵɯ
ɢɡɦɟɧɟɧɢɣ ɫɟɪɞɟɱɧɨɫɨɫɭɞɢɫɬɨɣ ɫɢɫɬɟɦɵ
[9]. Ɉɱɟɜɢɞɧɨ, ɱɬɨ ɜ ɨɫɧɨɜɟ ɮɨɪɦɢɪɨɜɚɧɢɹ
ɫɤɚɥɟɧɭɫɫɢɧɞɪɨɦɚ ɭ ɛɨɥɶɧɵɯ, ɩɟɪɟɧɟɫɲɢɯ
ɪɚɞɢɤɚɥɶɧɨɟ ɥɟɱɟɧɢɟ ɩɨ ɩɨɜɨɞɭ ɊɆɀ, ɥɟɠɚɬ ɫɩɟɰɢɮɢɱɟɫɤɢɟ ɪɟɚɤɰɢɢ, ɩɪɨɢɫɯɨɞɹɳɢɟ ɜ ɨɪɝɚɧɢɡɦɟ ɜ ɨɬɜɟɬ ɧɚ ɚɝɪɟɫɫɢɜɧɨɟ ɯɢɪɭɪɝɢɱɟɫɤɨɟ ɜɦɟɲɚɬɟɥɶɫɬɜɨ [10]. Ʉɥɢɧɢɱɟɫɤɨɟ ɡɧɚɱɟɧɢɟ ɞɚɧɧɨɝɨ ɩɚɬɨɥɨɝɢɱɟɫɤɨɝɨ
ɫɨɫɬɨɹɧɢɹ ɡɚɤɥɸɱɚɟɬɫɹ ɜ ɬɨɦ, ɱɬɨ, ɩɨɦɢɦɨ
ɫɞɚɜɥɟɧɢɹ ɚɪɬɟɪɢɢ, ɩɪɨɢɫɯɨɞɢɬ ɡɧɚɱɢɬɟɥɶ83
” ɇɨɜɨɫɬɢ ɯɢɪɭɪɝɢɢ
ɧɚɹ ɤɨɦɩɪɟɫɫɢɹ ɩɨɞɤɥɸɱɢɱɧɨɣ ɜɟɧɵ ɢ ɡɚɦɟɞɥɟɧɢɟ ɨɬɬɨɤɚ ɤɪɨɜɢ ɨɬ ɜɟɪɯɧɟɣ ɤɨɧɟɱɧɨɫɬɢ. ɋɥɟɞɭɟɬ ɨɬɦɟɬɢɬɶ, ɱɬɨ ɩɨ ɦɟɪɟ ɪɨɫɬɚ ɫɬɚɞɢɢ ɨɩɭɯɨɥɟɜɨɝɨ ɩɪɨɰɟɫɫɚ ɩɪɨɹɜɥɟɧɢɹ ɞɚɧɧɨɝɨ ɫɢɧɞɪɨɦɚ ɛɨɥɟɟ ɜɵɪɚɠɟɧɧɨ,
ɜɟɪɨɹɬɧɟɟ ɜɜɢɞɭ ɭɫɥɨɠɧɟɧɢɹ ɨɩɟɪɚɰɢɢ ɩɪɢ
ɦɟɬɚɫɬɚɬɢɱɟɫɤɨɦ ɩɨɪɚɠɟɧɢɢ ɩɨɞɦɵɲɟɱɧɵɯ ɢ ɩɨɞɤɥɸɱɢɱɧɵɯ ɥɢɦɮɨɭɡɥɨɜ.
ɇɟɫɦɨɬɪɹ ɧɚ ɬɨ ɱɬɨ ɧɚɪɭɲɟɧɢɹ ɝɟɦɨɞɢɧɚɦɢɤɢ ɨɞɢɧɚɤɨɜɨ ɱɚɫɬɨ ɜɨɡɧɢɤɚɸɬ ɭ
ɠɟɧɳɢɧ, ɤɨɬɨɪɵɦ ɫɨɯɪɚɧɢɥɢ n.
intercostabrachialis ɢ ɤɨɬɨɪɵɦ ɧɟɜɨɡɦɨɠɧɨ
ɛɵɥɨ ɷɬɨ ɫɞɟɥɚɬɶ, ɫɨɯɪɚɧɟɧɢɟ ɩɨɫɥɟɞɧɟɝɨ
ɰɟɥɟɫɨɨɛɪɚɡɧɨ ɜɜɢɞɭ ɥɭɱɲɢɯ ɩɨɤɚɡɚɬɟɥɟɣ
ɮɭɧɤɰɢɢ ɜɟɪɯɧɟɣ ɤɨɧɟɱɧɨɫɬɢ [10, 12].
ɇɚɤɨɧɟɰ ɩɪɨɛɥɟɦɚ ɩɨɫɥɟɨɩɟɪɚɰɢɨɧɧɨɣ
ɥɢɦɮɨɪɟɢ ɤɚɤ ɡɚɤɨɧɨɦɟɪɧɨɝɨ ɢ ɧɟɢɡɛɟɠɧɨɝɨ ɨɫɥɨɠɧɟɧɢɹ ɨɩɟɪɚɰɢɢ, ɧɟɫɦɨɬɪɹ ɧɚ
ɩɪɚɤɬɢɱɟɫɤɢɣ ɢɧɬɟɪɟɫ, ɞɨ ɤɨɧɰɚ ɧɟ ɪɟɲɟɧɚ. ȼ ɧɚɫɬɨɹɳɟɟ ɜɪɟɦɹ ɫɥɨɠɧɨ ɩɪɟɞɫɤɚɡɚɬɶ
ɫ ɩɨɥɧɨɣ ɭɜɟɪɟɧɧɨɫɬɶɸ ɨɛɴɟɦ ɢ ɫɪɨɤɢ
ɥɢɦɮɨɪɟɢ ɩɨɫɥɟ ɪɚɞɢɤɚɥɶɧɨɣ ɦɚɫɬɷɤɬɨɦɢɢ. ɍɜɟɥɢɱɟɧɢɟ ɩɪɢɬɨɤɚ ɤɪɨɜɢ ɤ ɜɟɪɯɧɟɣ
ɤɨɧɟɱɧɨɫɬɢ ɩɪɢɜɨɞɢɬ ɤ ɭɜɟɥɢɱɟɧɢɸ ɮɨɪɦɢɪɨɜɚɧɢɹ ɦɟɠɬɤɚɧɟɜɨɣ ɠɢɞɤɨɫɬɢ, ɚ ɩɪɢ
ɧɚɪɭɲɟɧɧɨɦ ɜ ɪɟɡɭɥɶɬɚɬɟ ɨɩɟɪɚɰɢɢ ɥɢɦɮɚɬɢɱɟɫɤɨɦ ɨɬɬɨɤɟ ɩɨɥɧɨɣ ɷɜɚɤɭɚɰɢɢ ɥɢɦɮɵ
ɧɟ ɩɪɨɢɫɯɨɞɢɬ, ɱɬɨ ɩɪɢɜɨɞɢɬ ɤ ɭɜɟɥɢɱɟɧɢɸ
ɫɭɦɦɚɪɧɨɝɨ ɨɛɴɟɦɚ ɥɢɦɮɨɪɟɢ, ɭɞɚɥɹɟɦɨɝɨ ɩɨ ɞɪɟɧɚɠɚɦ. ɗɬɨ ɩɨɞɬɜɟɪɠɞɚɟɬ ɬɨɬ
ɮɚɤɬ, ɱɬɨ ɞɥɹ ɩɪɟɞɨɬɜɪɚɳɟɧɢɹ ɢ ɭɦɟɧɶɲɟɧɢɹ ɥɢɦɮɨɪɟɢ ɜ ɩɨɫɥɟɨɩɟɪɚɰɢɨɧɧɨɦ ɩɟɪɢɨɞɟ ɧɟɨɛɯɨɞɢɦɚ ɤɨɪɪɟɤɰɢɹ ɝɟɦɨɞɢɧɚɦɢɱɟɫɤɢɯ ɜɨɥɟɦɢɱɟɫɤɢɯ ɧɚɪɭɲɟɧɢɣ ɪɚɡɜɢɜɚɸɳɢɯɫɹ ɜ ɩɨɫɥɟɨɩɟɪɚɰɢɨɧɧɨɦ ɩɟɪɢɨɞɟ [11,
12].
Ɂɚɤɥɸɱɟɧɢɟ
ɍ 49 % ɨɩɟɪɢɪɨɜɚɧɧɵɯ ɠɟɧɳɢɧ ɢɦɟɟɬ
ɦɟɫɬɨ ɫɬɚɬɢɫɬɢɱɟɫɤɢ ɡɧɚɱɢɦɨɟ ɭɜɟɥɢɱɟɧɢɟ
ɩɪɢɬɨɤɚ ɚɪɬɟɪɢɚɥɶɧɨɣ ɤɪɨɜɢ ɤ ɜɟɪɯɧɟɣ ɤɨɧɟɱɧɨɫɬɢ ɧɚ ɫɬɨɪɨɧɟ ɨɩɟɪɚɰɢɢ, ɫɜɹɡɚɧɧɨɟ,
ɝɥɚɜɧɵɦ ɨɛɪɚɡɨɦ, ɫ ɢɦɟɧɢɹɦɢ ɫɤɨɪɨɫɬɧɵɯ
ɯɚɪɚɤɬɟɪɢɫɬɢɤ ɩɨɬɨɤɚ ɢ ɫɨɫɬɨɹɧɢɹ ɫɨɫɭɞɢɫɬɨɣ ɫɬɟɧɤɢ. ɉɪɢ ɫɨɯɪɚɧɟɧɢɢ ɩɨɞɨɛɧɨɝɨ
ɫɨɫɬɨɹɧɢɹ ɩɪɢ ɩɪɨɝɪɟɫɫɢɜɧɨ ɭɯɭɞɲɚɸɳɟɦ84
ɫɹ ɥɢɦɮɨɜɟɧɨɡɧɨɦ ɨɬɬɨɤɟ ɜɫɥɟɞɫɬɜɢɟ ɩɪɨɜɟɞɟɧɢɹ ɜ ɩɨɫɥɟɞɭɸɳɟɦ ɥɭɱɟɜɨɣ ɬɟɪɚɩɢɢ
ɢ ɨɬɫɭɬɫɬɜɢɹ ɩɪɨɮɢɥɚɤɬɢɱɟɫɤɢɯ ɦɟɪɨɩɪɢɹɬɢɣ ɞɚɧɧɚɹ ɤɚɬɟɝɨɪɢɢ ɛɨɥɶɧɵɯ ɹɜɥɹɟɬɫɹ
ɝɪɭɩɩɨɣ ɪɢɫɤɚ ɩɨ ɪɚɡɜɢɬɢɸ ɥɢɦɮɟɞɟɦɵ
ɜɟɪɯɧɟɣ ɤɨɧɟɱɧɨɫɬɢ.
ɇɚɥɢɱɢɟ ɫɨɩɭɬɫɬɜɭɸɳɟɣ ɬɟɪɚɩɟɜɬɢɱɟɫɤɨɣ ɩɚɬɨɥɨɝɢɢ ɢ, ɝɥɚɜɧɵɦ ɨɛɪɚɡɨɦ, ɡɚɛɨɥɟɜɚɧɢɣ ɫɟɪɞɟɱɧɨɫɨɫɭɞɢɫɬɨɣ ɫɢɫɬɟɦɵ ɹɜɥɹɟɬɫɹ ɩɪɟɞɪɚɫɩɨɥɚɝɚɸɳɢɦ ɮɚɤɬɨɪɨɦ ɞɥɹ
ɪɚɡɜɢɬɢɹ ɝɟɦɨɞɢɧɚɦɢɱɟɫɤɢɯ ɧɚɪɭɲɟɧɢɣ ɢ
ɩɨɞɥɟɠɢɬ ɨɛɹɡɚɬɟɥɶɧɨɣ ɚɞɟɤɜɚɬɧɨɣ ɤɨɪɪɟɤɰɢɢ.
ɍɜɟɥɢɱɟɧɢɹ ɩɨɤɚɡɚɬɟɥɹ ɨɛɴɟɦɧɨɣ ɫɤɨɪɨɫɬɢ ɤɪɨɜɨɬɨɤɚ ɩɪɢɜɨɞɢɬ ɤ ɫɬɚɬɢɫɬɢɱɟɫɤɢ ɡɧɚɱɢɦɨɦɭ ɭɜɟɥɢɱɟɧɢɸ ɫɭɦɦɚɪɧɨɝɨ
ɨɛɴɟɦɚ ɥɢɦɮɨɪɟɢ, ɱɬɨ ɹɜɥɹɟɬɫɹ ɩɪɨɜɨɰɢɪɭɸɳɢɦ ɮɚɤɬɨɪɨɦ ɞɥɹ ɪɚɡɜɢɬɢɹ ɩɨɫɥɟɨɩɟɪɚɰɢɨɧɧɵɯ ɨɫɥɨɠɧɟɧɢɣ, ɬɚɤɢɯ, ɤɚɤ ɞɥɢɬɟɥɶɧɚɹ ɥɢɦɮɨɪɟɹ, ɫɟɪɨɦɚ ɢ ɧɚɝɧɨɟɧɢɟ
ɩɨɫɥɟɨɩɟɪɚɰɢɨɧɧɨɣ ɪɚɧɵ, ɫɥɭɠɚɳɢɯ, ɜ
ɫɜɨɸ ɨɱɟɪɟɞɶ, ɮɚɤɬɨɪɚɦɢ, ɫɩɨɫɨɛɫɬɜɭɸɳɢɦɢ ɜɨɡɧɢɤɧɨɜɟɧɢɸ ɜɬɨɪɢɱɧɨɣ ɥɢɦɮɟɞɟɦɵ
ɜɟɪɯɧɟɣ ɤɨɧɟɱɧɨɫɬɢ.
Ɉ ɩɪɨɹɜɥɟɧɢɢ ɫɤɚɥɟɧɭɫɫɢɧɞɪɨɦɚ ɦɨɠɧɨ ɝɨɜɨɪɢɬɶ ɭ 11% ɛɨɥɶɧɵɯ, ɢɦɟɜɲɢɯ ɫɧɢɠɟɧɢɟ ɨɛɴɟɦɧɨɣ ɫɤɨɪɨɫɬɢ ɤɪɨɜɨɬɨɤɚ ɜ ɩɨɫɥɟɨɩɟɪɚɰɢɨɧɧɨɦ ɩɟɪɢɨɞɟ, ɩɪɨɮɢɥɚɤɬɢɤɚ ɢ
ɤɨɪɪɟɤɰɢɹ ɤɨɬɨɪɨɝɨ ɞɨɥɠɧɚ ɧɚɱɢɧɚɬɶɫɹ ɜ
ɪɚɧɧɟɦ ɩɨɫɥɟɨɩɟɪɚɰɢɨɧɧɨɦ ɩɟɪɢɨɞɟ.
ɅɂɌȿɊȺɌɍɊȺ
1. ɗɩɢɞɟɦɢɨɥɨɝɢɹ ɡɥɨɤɚɱɟɫɬɜɟɧɧɵɯ ɧɨɜɨɨɛɪɚɡɨɜɚɧɢɣ ɜ Ȼɟɥɚɪɭɫɢ / ɂ. ȼ. Ɂɚɥɭɰɤɢɣ [ɢ ɞɪ.]. – Ɇɢɧɫɤ:
Ɂɨɪɧɵ ɜɟɪɚɫɟɧɶ, 2006. – ɋ. 96-105.
2. ȼɬɨɪɢɱɧɚɹ ɥɢɦɮɟɞɟɦɚ ɜɟɪɯɧɟɣ ɤɨɧɟɱɧɨɫɬɢ ɭ ɨɧɤɨɥɨɝɢɱɟɫɤɢɯ ɛɨɥɶɧɵɯ (ɷɬɢɨɥɨɝɢɹ, ɤɥɢɧɢɤɚ, ɥɟɱɟɧɢɟ): ɩɪɚɤɬɢɱɟɫɤɨɟ ɩɨɫɨɛɢɟ ɞɥɹ ɜɪɚɱɟɣ / ɂ. ȼ. Ɂɚɥɭɰɤɢɣ [ɢ ɞɪ.]. – Ɇɢɧɫɤ: Ȼɟɥɚɪɭɫɶ, 2004. – ɋ. 11-20.
3. ɉɪɨɧɢɧ, ȼ. ɂ. Ɇɚɫɬɷɤɬɨɦɢɹ ɢ ɟɟ ɩɨɫɥɟɞɫɬɜɢɹ /
ȼɂ. ɉɪɨɧɢɧ, ɘ. Ʌ. Ɋɨɡɚɧɨɜ, Ʌ. Ɂ. ȼɟɥɶɲɟɪ. – Ɇ.:
Ɇɟɞɢɰɢɧɚ, 1985. – ɋ. 95-96.
4. Ɇɹɫɧɢɤɨɜɚ, Ɇ. Ɉ. Ɉɛɨɫɧɨɜɚɧɢɟ ɢ ɨɰɟɧɤɚ ɷɮɮɟɤɬɢɜɧɨɫɬɢ ɦɟɬɨɞɨɜ ɞɢɚɝɧɨɫɬɢɤɢ ɢ ɥɟɱɟɧɢɹ ɛɨɥɶɧɵɯ
ɩɨɫɬɦɚɫɬɷɤɬɨɦɢɱɟɫɤɢɦ ɨɬɟɤɨɦ ɜɟɪɯɧɟɣ ɤɨɧɟɱɧɨɫɬɢ: ɚɜɬɨɪɟɮ. ɞɢɫ. … ɞɪɚ ɦɟɞ. ɧɚɭɤ: 14.00.14 / Ɇ. Ɉ.
Ɇɹɫɧɢɤɨɜɚ; ɋ.-ɉɟɬɟɪɛ. ɝɨɫ. ɦɟɞ. ɭɧɬ ɢɦ. ɚɤɚɞ. ɂ. ɉ.
ɉɚɜɥɨɜɚ. – ɋɉɛ., 2002. – 39 ɫ.
ʋ4x 2008 i ɬɨɦ 16
5. ɏɨɮɟɪ, Ɇ. ɐɜɟɬɨɜɚɹ ɞɭɩɥɟɤɫɧɚɹ ɫɨɧɨɝɪɚɮɢɹ:
ɩɪɚɤɬɢɱɟɫɤɨɟ ɪɭɤɨɜɨɞɫɬɜɨ / Ɇ. ɏɨɮɟɪ. – Ɇɨɫɤɜɚ.:
Ɇɟɞɥɢɬ., 2007. – ɋ. 7-14, 73-88.
6. Svensson, W. Colour Doppler demonstrates venous
flow abnormalities in breast cancer patients with
chronic arm swelling / W. Svensson, P. Mortimer,
E. Yohno // Eur. J. Cancer. – 1994. – ʋ 5. – P. 657660.
7. Ʌɭɠɧɢɤɨɜ, ȿ. Ⱥ. Ɇɟɬɨɞɢɤɚ ɨɰɟɧɤɢ ɮɭɧɤɰɢɨɧɚɥɶɧɨɝɨ ɫɨɫɬɨɹɧɢɹ ɝɟɦɨɞɢɧɚɦɢɤɢ ɢ ɯɚɪɚɤɬɟɪɚ ɩɟɪɟɪɚɫɩɪɟɞɟɥɟɧɢɹ ɤɪɨɜɢ ɭ ɱɟɥɨɜɟɤɚ ɜ ɪɟɚɧɢɦɚɰɢɨɧɧɨɦ ɢ
ɪɟɚɛɢɥɢɬɚɰɢɨɧɧɨɦ ɩɟɪɢɨɞɟ: ɦɟɬɨɞ. ɪɟɤɨɦɟɧɞɚɰɢɢ
/ ȿ. Ⱥ. Ʌɭɠɧɢɤɨɜ, Ʌ. Ƚ. Ʉɨɫɬɨɦɚɪɨɜɚ, Ⱥ. Ⱥ. ɐɜɟɬɤɨɜ.
– Ɇ., 1981. – ɋ. 12-17.
8. Naffziger, H. C. // Surg. Gynecol. Obstet. /
H. C. Naffziger, W. T. Grant. – 1938. – Vol. 67. – P.
722-748.
9. Ʉɢɩɟɪɜɚɫ, ɂ. ɉ. ɉɟɪɢɮɟɪɢɱɟɫɤɢɟ ɬɭɧɧɟɥɶɧɵɟ ɫɢɧɞɪɨɦɵ / ɂ. ɉ. Ʉɢɩɟɪɜɚɫ, Ɇ. ȼ. Ʌɭɤɶɹɧɨɜ. – Ɇ.,
1991. – ɋ. 43-47.
10. ɋɬɚɯɚɧɨɜ, Ɇ. Ʌ. ɉɨɫɬɦɚɫɬɷɤɬɨɦɢɱɟɫɤɢɣ ɫɢɧɞɪɨɦ: ɩɚɬɨɝɟɧɟɡ, ɤɥɚɫɫɢɮɢɤɚɰɢɹ / Ɇ. Ʌ. ɋɬɚɯɚɧɨɜ,
Ʌ. Ɂ. ȼɟɥɶɲɟɪ, Ⱥ. Ⱥ. ɋɚɜɢɧ // Ɋɨɫ. ɨɧɤɨɥɨɝɢɱ. ɠɭɪɧ.
– 2006. – ʋ 1. – ɋ. 24-31.
11. Petrek, J. A. Incidence of breast carcinoma-related
lymphedema / J. A. Petrek, M. C. Heelan // Cancer. –
1998. – Vol. 83. – P. 2776-2781.
12. Ƚɪɭɲɢɧɚ, Ɍ. ɂ. Ɋɟɚɛɢɥɢɬɚɰɢɹ ɜ ɨɧɤɨɥɨɝɢɢ: ɮɢɡɢɨɬɟɪɚɩɢɹ / Ɍ. ɂ. Ƚɪɭɲɢɧɚ. – Ɇ.: ȽɗɈɌȺɊɆɟɞɢɚ,
2006. – ɋ. 83-85.
ɉɨɫɬɭɩɢɥɚ 30.09.2008 ɝ.
ɑɂɌȺɃɌȿ ȼ ɋɅȿȾɍɘɓȿɆ ɇɈɆȿɊȿ:
Ɉɩɵɬ ɥɟɱɟɧɢɹ ɛɨɥɶɧɵɯ ɫ ɩɨɫɬɬɪɚɜɦɚɬɢɱɟɫɤɢɦ ɨɫɫɢɮɢɰɢɪɭɸɳɢɦ
ɦɢɨɡɢɬɨɦ.
ɂɦɦɭɧɨɯɢɦɢɱɟɫɤɢɣ ɬɟɫɬ ɜ ɧɟɢɧɜɚɡɢɜɧɨɣ ɞɢɚɝɧɨɫɬɢɤɟ ɩɨɥɢɩɨɜ
ɬɨɥɫɬɨɣ ɤɢɲɤɢ.
85