x i ȼɅ. ȾȿɇɂɋȿɇɄɈ ÎÏÒÈÌÈÇÀÖÈß ËÅ×ÅÍÈß ÝÏÈÒÅËÈÀËÜÍÎÃÎ ÊÎÏ×ÈÊÎÂÎÃÎ ÕÎÄÀ,

ʋ1x2008 iɬɨɦ 16
ȼɅ. ȾȿɇɂɋȿɇɄɈ
ÎÏÒÈÌÈÇÀÖÈß ËÅ×ÅÍÈß ÝÏÈÒÅËÈÀËÜÍÎÃÎ ÊÎÏ×ÈÊÎÂÎÃÎ ÕÎÄÀ,
ÎÑËÎÆÍÅÍÍÎÃÎ ÀÁÑÖÅÑÑÎÌ
Ʌɉɍ «Ɉɬɞɟɥɟɧɱɟɫɤɚɹɤɥɢɧɢɱɟɫɤɚɹɛɨɥɶɧɢɰɚɧɚɫɬ. ȼɢɬɟɛɫɤ»
ɉɪɨɜɟɞɟɧɚɧɚɥɢɡɥɟɱɟɧɢɹɷɩɢɬɟɥɢɚɥɶɧɨɝɨɤɨɩɱɢɤɨɜɨɝɨɯɨɞɚ, ɨɫɥɨɠɧɟɧɧɨɝɨɚɛɫɰɟɫɫɨɦɭ 185
ɛɨɥɶɧɵɯ. ȼɵɞɟɥɟɧɨɞɜɟɝɪɭɩɩɵɛɨɥɶɧɵɯ. ȼɩɟɪɜɨɣ – ɥɟɱɟɧɢɟɩɪɨɜɨɞɢɥɨɫɶɩɨɨɛɳɟɩɪɢɧɹɬɵɦ
ɦɟɬɨɞɢɤɚɦ. ȼɨɜɬɨɪɨɣ – ɧɚɩɟɪɜɨɦɷɬɚɩɟɩɭɧɤɬɢɪɨɜɚɥɢɩɨɥɨɫɬɶɚɛɫɰɟɫɫɚɞɥɹɨɩɪɟɞɟɥɟɧɢɹɜɢɞɚ
ɦɢɤɪɨɨɪɝɚɧɢɡɦɚɢɜɫɤɪɵɜɚɥɢɚɛɫɰɟɫɫɬɢɩɢɱɧɵɦɫɩɨɫɨɛɨɦ. ɍ 90 ɛɨɥɶɧɵɯɜɬɨɪɨɣɝɪɭɩɩɵɧɚɜɬɨɪɨɦɷɬɚɩɟɢɫɫɟɱɟɧɢɟɪɚɧɟɜɨɣɩɨɥɨɫɬɢɫɨɫɜɢɳɚɦɢɩɪɨɢɡɜɨɞɢɥɢɞɜɭɦɹɲɢɪɨɤɢɦɢɨɤɚɣɦɥɹɸɳɢɦɢ
ɪɚɡɪɟɡɚɦɢɜɞɨɥɶɦɟɠɴɹɝɨɞɢɱɧɨɣɫɤɥɚɞɤɢ. ɍ 20 ɛɨɥɶɧɵɯɷɬɨɣɝɪɭɩɩɵɩɪɢɦɟɧɟɧɚɤɨɠɧɚɹɩɥɚɫɬɢɤɚɩɨɅɢɦɛɟɪɝɭ.
ɍɫɬɚɧɨɜɥɟɧɨ, ɱɬɨɞɜɭɯɷɬɚɩɧɨɟɯɢɪɭɪɝɢɱɟɫɤɨɟɥɟɱɟɧɢɟɜɨɛɟɢɯɝɪɭɩɩɚɯɛɨɥɶɧɵɯɨɛɟɫɩɟɱɢɜɚɟɬ ɷɮɮɟɤɬɢɜɧɨɫɬɶɥɟɱɟɧɢɹɜɬɟɱɟɧɢɟɨɞɧɨɣ ɝɨɫɩɢɬɚɥɢɡɚɰɢɢ, ɩɪɢɜɨɞɢɬ ɤɫɧɢɠɟɧɢɸɱɚɫɬɨɬɵ
ɩɨɫɥɟɨɩɟɪɚɰɢɨɧɧɵɯɝɧɨɣɧɨɜɨɫɩɚɥɢɬɟɥɶɧɵɯɨɫɥɨɠɧɟɧɢɣ, ɫɪɨɤɨɜɜɪɟɦɟɧɧɨɣɧɟɬɪɭɞɨɫɩɨɫɨɛɧɨɫɬɢ
ɢɤɨɥɢɱɟɫɬɜɚɪɟɰɢɞɢɜɨɜ. ɉɥɚɫɬɢɤɚɩɟɪɟɦɟɳɟɧɧɵɦɹɝɨɞɢɱɧɵɦɤɨɠɧɨɩɨɞɤɨɠɧɵɦɥɨɫɤɭɬɨɦɨɤɚɡɚɥɚɫɶɛɨɥɟɟɷɮɮɟɤɬɢɜɧɨɣɩɨɫɪɚɜɧɟɧɢɸɫɩɪɢɦɟɧɟɧɢɟɦɝɥɭɯɨɝɨɦɚɬɪɚɰɧɨɝɨɲɜɚɢɩɨɞɲɢɜɚɧɢɟɦ
ɤɪɚɟɜɪɚɧɵɤɟɟɞɧɭ.
Ʉɥɸɱɟɜɵɟ ɫɥɨɜɚ: ɷɩɢɬɟɥɢɚɥɶɧɵɣ ɤɨɩɱɢɤɨɜɵɣ ɯɨɞ, ɨɩɟɪɚɬɢɜɧɨɟ ɥɟɱɟɧɢɟ, ɤɨɠɧɚɹ ɩɥɚɫɬɢɤɚ.
The analysis of treatment of epithelial coccygeal passage, complicated by abscess was performed
in 185 patients. 2 groups of patients were singled out. In the 1 st group the treatment was carried out
according to generally accepted techniques. In the 2nd group, at the 1st stage, the abscess cavity was
subjected to puncturing to determine the types of microorganisms; abscess was opened using the typical
technique. In 90 patients of the 2nd group, at the 2nd stage, the cavity of the wound with fistulas was
dissected with two wide edging incisions along the intergluteal folds. In 20 patients of this group, Limberg’s
graft was applied. Double-stage surgical therapy in both groups of patients was found out to provide
efficiency of treatment during one hospitalization only; it leads to decrease of post-operative, pyoinflammatory complications incidence and reduces the terms of time disability and the number of relapses.
Plastics with shifted gluteal cutaneous-subcutaneous graft appeared to be more effective in comparison
with mattress suture and sewing of the edge of the wound to its fundus.
Keywords: epithelial coccygeal passage, surgical treatment, skin plastics.
ɗɩɢɬɟɥɢɚɥɶɧɵɣɤɨɩɱɢɤɨɜɵɣɯɨɞ (ɗɄɏ)
ɩɪɟɞɫɬɚɜɥɹɟɬɫɨɛɨɣɜɪɨɠɞɟɧɧɭɸɚɧɨɦɚɥɢɸ
ɤɨɠɢ, ɫɜɹɡɚɧɧɭɸ ɫ ɧɟɩɨɥɧɨɣ ɪɟɞɭɤɰɢɟɣ
ɦɵɲɟɱɧɵɯɢɫɨɟɞɢɧɢɬɟɥɶɧɨɬɤɚɧɧɵɯɫɬɪɭɤɬɭɪɤɚɭɞɚɥɶɧɨɝɨɨɬɞɟɥɚɩɨɡɜɨɧɨɱɧɢɤɚɷɦɛɪɢɨɧɚ [1, 2, 3]. ɇɚ ɞɨɥɸɛɨɥɶɧɵɯɫɗɄɏ,
ɨɫɥɨɠɧɟɧɧɵɦɢ ɚɛɫɰɟɫɫɚɦɢ ɢ ɩɨɫɬɨɹɧɧɨ
ɪɟɰɢɞɢɜɢɪɭɸɳɢɦɢ ɫɜɢɳɚɦɢ ɤɪɟɫɬɰɨɜɨɤɨɩɱɢɤɨɜɨɣ ɨɛɥɚɫɬɢ, ɩɪɢɯɨɞɢɬɫɹɞɨ 12,5%
ɩɚɰɢɟɧɬɨɜ ɩɪɨɤɬɨɥɨɝɢɱɟɫɤɢɯ ɨɬɞɟɥɟɧɢɣ.
ɑɚɳɟɜɫɟɝɨɗɄɏɜɫɬɪɟɱɚɟɬɫɹɭɥɢɰɦɨɥɨɞɨɝɨɬɪɭɞɨɫɩɨɫɨɛɧɨɝɨɜɨɡɪɚɫɬɚ [4]. ȼɛɨɥɶɲɢɧɫɬɜɟɫɥɭɱɚɟɜɨɧɢɫɤɥɨɧɧɵɤɯɪɨɧɢɱɟɫɤɨɦɭɬɟɱɟɧɢɸ, ɱɚɫɬɨɨɫɥɨɠɧɹɸɬɫɹɚɛɫɰɟɫ55
”ɇɨɜɨɫɬɢɯɢɪɭɪɝɢɢ
ɫɚɦɢ ɢ ɜɵɧɭɠɞɚɸɬ ɧɟɨɞɧɨɤɪɚɬɧɨ ɜɵɩɨɥɧɹɬɶ ɨɩɟɪɚɬɢɜɧɵɟ ɜɦɟɲɚɬɟɥɶɫɬɜɚ, ɛɟɡɭɫɩɟɲɧɨɫɬɶɤɨɬɨɪɵɯɩɪɢɜɨɞɢɬɤɱɚɫɬɨɣɢɞɥɢɬɟɥɶɧɨɣɩɨɬɟɪɟɬɪɭɞɨɫɩɨɫɨɛɧɨɫɬɢ [5].
ɇɟɫɦɨɬɪɹɧɚɬɨɱɬɨɩɨɫɥɟɩɟɪɜɨɝɨɫɨɨɛɳɟɧɢɹɆɚɭɨɜ 1833 ɝ. ɨɤɥɢɧɢɱɟɫɤɨɣɤɚɪɬɢɧɟɗɄɏɩɪɨɲɥɨɛɨɥɟɟ 170 ɥɟɬ [6], ɜɨɩɪɨɫ ɜɵɛɨɪɚ ɦɟɬɨɞɚ ɨɩɟɪɚɬɢɜɧɨɝɨ ɜɦɟɲɚɬɟɥɶɫɬɜɚɩɪɢɚɛɫɰɟɞɢɪɭɸɳɟɦɗɄɏɞɨɫɢɯ
ɩɨɪɧɟɪɟɲɟɧ.
ɋɭɳɟɫɬɜɭɟɬɬɪɢɨɫɧɨɜɧɵɯɦɟɬɨɞɚɨɩɟɪɚɬɢɜɧɨɝɨɥɟɱɟɧɢɹ ɚɛɫɰɟɞɢɪɭɸɳɟɝɨɗɄɏ:
ɡɚɤɪɵɬɵɣ (ɢɫɫɟɱɟɧɢɟɝɧɨɣɧɨɝɨɨɱɚɝɚɜɩɪɟɞɟɥɚɯɡɞɨɪɨɜɵɯɬɤɚɧɟɣɫɭɲɢɜɚɧɢɟɦɤɪɚɟɜ
ɪɚɧɵɧɚɝɥɭɯɨ), ɨɬɤɪɵɬɵɣ (ɢɫɫɟɱɟɧɢɟɚɛɫɰɟɫɫɚɜɩɪɟɞɟɥɚɯɡɞɨɪɨɜɵɯɬɤɚɧɟɣɢɜɟɞɟɧɢɟɪɚɧɵɨɬɤɪɵɬɵɦɫɩɨɫɨɛɨɦ), ɩɨɥɭɨɬɤɪɵɬɵɣ (ɧɚɩɟɪɜɨɦɷɬɚɩɟɜɫɤɪɵɜɚɸɬɚɛɫɰɟɫɫ
ɗɄɏ, ɧɚɜɬɨɪɨɦɷɬɚɩɟɩɨɫɥɟɤɭɩɢɪɨɜɚɧɢɹ
ɜɨɫɩɚɥɟɧɢɹɢɫɫɟɤɚɸɬɫɜɢɳɟɜɵɟɯɨɞɵɢɡɚɬɟɤɢɜɩɪɟɞɟɥɚɯɡɞɨɪɨɜɵɯɬɤɚɧɟɣɫɩɨɞɲɢɜɚɧɢɟɦɤɨɠɧɵɯɤɪɚɟɜɤɨɞɧɭɪɚɧɵ). Ɉɞɧɚɤɨɩɪɢɜɫɟɯɦɟɬɨɞɚɯɫɬɨɣɢɥɢɢɧɨɣɱɚɫɬɨɬɨɣ ɨɬɦɟɱɚɸɬɫɹ ɪɟɰɢɞɢɜɵ [7, 8, 9]. Ɍɚɤ,
ɩɪɢɞɜɭɯɷɬɚɩɧɵɯɦɟɬɨɞɚɯɥɟɱɟɧɢɹɱɚɫɬɨɬɚɪɚɡɜɢɬɢɹɝɧɨɣɧɨɫɟɩɬɢɱɟɫɤɢɯɨɫɥɨɠɧɟɧɢɣ ɜ ɪɚɧɧɟɦ ɩɨɫɥɟɨɩɟɪɚɰɢɨɧɧɨɦ ɩɟɪɢɨɞɟɞɨɫɬɢɝɚɟɬ 16%, ɪɟɰɢɞɢɜɨɜ – 20% [3, 10,
11]. ɉɪɢɨɬɤɪɵɬɨɦɫɩɨɫɨɛɟɨɩɟɪɚɬɢɜɧɨɝɨ
ɥɟɱɟɧɢɹɱɢɫɥɨɪɟɰɢɞɢɜɨɜɦɟɧɶɲɟ, ɨɞɧɚɤɨ
ɫɪɨɤɢɜɪɟɦɟɧɧɨɣɧɟɬɪɭɞɨɫɩɨɫɨɛɧɨɫɬɢɛɨɥɟɟ
ɩɪɨɞɨɥɠɢɬɟɥɶɧɵ ɢ ɞɨɫɬɢɝɚɸɬ 45 ɫɭɬɨɤ, ɜ
ɫɜɹɡɢɫɱɟɦɜɵɫɨɤɢɡɚɬɪɚɬɵɧɚɥɟɱɟɧɢɟ [12].
ɗɮɮɟɤɬɢɜɧɨɫɬɶɨɩɟɪɚɬɢɜɧɨɝɨɥɟɱɟɧɢɹ
ɗɄɏ ɜɨ ɦɧɨɝɨɦ ɩɪɟɞɨɩɪɟɞɟɥɹɟɬɫɹ ɪɚɞɢɤɚɥɶɧɨɫɬɶɸ ɟɝɨ ɢɫɫɟɱɟɧɢɹ. Ɉɞɧɚɤɨ ɩɪɢ
ɷɬɨɦɜɨɡɧɢɤɚɟɬɩɪɨɛɥɟɦɚɡɚɤɪɵɬɢɹɪɚɧɟɜɨɝɨɞɟɮɟɤɬɚ. Ⱦɚɧɧɨɟɨɛɫɬɨɹɬɟɥɶɫɬɜɨɩɨɛɭɞɢɥɨɪɹɞɢɫɫɥɟɞɨɜɚɬɟɥɟɣɩɵɬɚɬɶɫɹɩɪɢɦɟɧɹɬɶ
ɞɥɹɷɬɨɝɨɪɚɡɥɢɱɧɵɟɜɢɞɵɩɥɚɫɬɢɤɢ. ȼ 1997
ɝɨɞɭ ȻɯɢɦɚɧɢɂɫɦɚɬɄɚɫɫɚɦɩɪɟɞɥɨɠɢɥɚ
ɤɨɠɧɭɸɩɥɚɫɬɢɤɭɩɪɢ ɥɟɱɟɧɢɢɗɄɏ, ɫɭɬɶ
ɤɨɬɨɪɨɣ ɡɚɤɥɸɱɚɟɬɫɹ ɜ ɟɝɨ ɢɫɫɟɱɟɧɢɢ ɢ
ɩɟɪɜɢɱɧɨɣɩɥɚɫɬɢɤɟɪɚɧɟɜɨɝɨɞɟɮɟɤɬɚɫɜɨɛɨɞɧɵɦɞɟɪɦɚɬɨɦɧɵɦɩɟɪɮɨɪɢɪɨɜɚɧɧɵɦ
56
ɥɨɫɤɭɬɨɦɢɥɢɨɬɤɪɵɬɨɣɨɫɬɪɨɜɤɨɜɨɣɩɥɚɫɬɢɤɨɣ. ɇɟɞɨɫɬɚɬɤɨɦɞɚɧɧɨɝɨɫɩɨɫɨɛɚɥɟɱɟɧɢɹɹɜɥɹɟɬɫɹɞɥɢɬɟɥɶɧɵɣɩɟɪɢɨɞɪɟɚɛɢɥɢɬɚɰɢɢ.
S. Davidson (1997) ɩɪɢɦɟɧɢɥɜɥɟɱɟɧɢɢ
ɗɄɏɲɢɪɨɤɨɟɢɫɫɟɱɟɧɢɟɯɨɞɚɫɡɚɤɪɵɬɢɟɦ
ɪɚɧɵɦɵɲɟɱɧɵɦɥɨɫɤɭɬɨɦ, ɜɡɹɬɵɦɢɡɛɨɥɶɲɨɣɹɝɨɞɢɱɧɨɣɦɵɲɰɵ. J. Bascom [9] ɩɪɟɞɥɨɠɢɥɩɪɢɩɥɚɧɨɜɨɦɢɫɫɟɱɟɧɢɢɗɄɏɩɥɚɫɬɢɤɭ ɩɟɪɟɦɟɳɟɧɧɵɦ ɤɨɠɧɵɦ ɥɨɫɤɭɬɨɦ.
ɑɚɫɬɨɬɚɝɧɨɣɧɨɫɟɩɬɢɱɟɫɤɢɯɨɫɥɨɠɧɟɧɢɣɜ
ɪɚɧɧɟɦ ɩɨɫɥɟɨɩɟɪɚɰɢɨɧɧɨɦ ɩɟɪɢɨɞɟ ɩɪɢ
ɷɬɨɦɫɨɫɬɚɜɥɹɥɚ 4,5%.
ɉɪɢɦɟɧɟɧɢɟɪɚɡɥɢɱɧɵɯɜɚɪɢɚɧɬɨɜɩɥɚɫɬɢɤ ɩɪɢ ɥɟɱɟɧɢɢ ɗɄɏ ɩɪɟɞɫɬɚɜɥɹɟɬɫɹ
ɩɟɪɫɩɟɤɬɢɜɧɵɦ, ɨɞɧɚɤɨɞɨɧɚɫɬɨɹɳɟɝɨɜɪɟɦɟɧɢɞɚɧɧɵɣɜɨɩɪɨɫɟɳɺɞɟɬɚɥɶɧɨɧɟɪɚɡɪɚɛɨɬɚɧ.
ȼ ɫɜɹɡɢ ɫ ɜɵɲɟɢɡɥɨɠɟɧɧɵɦ, ɦɨɠɧɨ
ɤɨɧɫɬɚɬɢɪɨɜɚɬɶ, ɱɬɨɜɨɩɪɨɫɵɨɩɬɢɦɚɥɶɧɨɝɨɜɵɛɨɪɚɢɬɚɤɬɢɤɢɥɟɱɟɧɢɹɗɄɏɧɭɠɞɚɸɬɫɹɜɞɚɥɶɧɟɣɲɟɣɪɚɡɪɚɛɨɬɤɟ, ɱɬɨɢ ɩɨɫɥɭɠɢɥɨɨɫɧɨɜɚɧɢɟɦɞɥɹɜɵɩɨɥɧɟɧɢɹɞɚɧɧɨɝɨɢɫɫɥɟɞɨɜɚɧɢɹ.
Ɇɚɬɟɪɢɚɥɵɢɦɟɬɨɞɵ
ɉɪɨɜɟɞɟɧ ɚɧɚɥɢɡɪɟɡɭɥɶɬɚɬɨɜ ɥɟɱɟɧɢɹ
185 ɛɨɥɶɧɵɯɫɚɛɫɰɟɞɢɪɭɸɳɢɦɗɄɏ, ɧɚɯɨɞɢɜɲɢɯɫɹɧɚɥɟɱɟɧɢɢɜɩɪɨɤɬɨɥɨɝɢɱɟɫɤɨɦ
ɨɬɞɟɥɟɧɢɢɛɨɥɶɧɢɰɵɧɚɫɬɚɧɰɢɢȼɢɬɟɛɫɤ
ɫ 1994 ɩɨ 2004 ɝɝ. ȼɵɞɟɥɟɧɨ ɞɜɟ ɝɪɭɩɩɵ
ɛɨɥɶɧɵɯ.
ȼɩɟɪɜɭɸ (ɤɨɧɬɪɨɥɶɧɭɸ) ɝɪɭɩɩɭɜɨɲɥɢ
75 ɩɚɰɢɟɧɬɨɜ (60 ɦɭɠɱɢɧ ɢ 15 ɠɟɧɳɢɧ),
ɥɟɱɟɧɢɟɤɨɬɨɪɵɯɩɪɨɜɨɞɢɥɨɫɶɩɨɨɛɳɟɩɪɢɧɹɬɵɦɦɟɬɨɞɢɤɚɦ. ɇɚɩɟɪɜɨɦɷɬɚɩɟɭɷɬɢɯ
ɛɨɥɶɧɵɯɚɛɫɰɟɫɫɜɫɤɪɵɜɚɥɢɬɢɩɢɱɧɵɦɫɩɨɫɨɛɨɦɩɨɞɦɟɫɬɧɨɣɚɧɟɫɬɟɡɢɟɣ Sol. Lidokaini
2% – 6 ɦɥ. Ɋɚɡɦɟɪɪɚɡɪɟɡɚɡɚɜɢɫɟɥɨɬɩɥɨɳɚɞɢɝɢɩɟɪɟɦɢɢɤɨɠɢ. ɉɨɫɥɟɜɡɹɬɢɹɦɚɬɟɪɢɚɥɚɞɥɹɦɢɤɪɨɛɢɨɥɨɝɢɱɟɫɤɨɝɨɢɫɫɥɟɞɨɜɚɧɢɹɝɧɨɣɧɭɸɩɨɥɨɫɬɶɨɛɢɥɶɧɨɩɪɨɦɵɜɚɥɢ
3% ɪɚɫɬɜɨɪɨɦɩɟɪɟɤɢɫɢɜɨɞɨɪɨɞɚɢ 0,05%
ɪɚɫɬɜɨɪɨɦ ɯɥɨɪɝɟɤɫɢɞɢɧɚ, ɞɪɟɧɢɪɨɜɚɥɢ
ʋ1x2008 iɬɨɦ 16
ɪɟɡɢɧɨɜɨɣɩɨɥɨɫɤɨɣ, ɧɚɤɥɚɞɵɜɚɥɢɚɫɟɩɬɢɱɟɫɤɭɸɩɨɜɹɡɤɭ. ȼɩɨɫɥɟɞɭɸɳɟɦɟɠɟɞɧɟɜɧɨɜɬɟɱɟɧɢɟ 7 – 8 ɫɭɬɨɤɩɪɨɜɨɞɢɥɢɫɚɧɚɰɢɸ ɢ ɩɪɨɦɵɜɚɧɢɟ ɝɧɨɣɧɨɣ ɩɨɥɨɫɬɢ 3%
ɪɚɫɬɜɨɪɨɦɩɟɪɟɤɢɫɢɜɨɞɨɪɨɞɚɢ 0,05% ɪɚɫɬɜɨɪɨɦ ɯɥɨɪɝɟɤɫɢɞɢɧɚ, ɧɚɡɧɚɱɚɥɢ ɷɦɩɢɪɢɱɟɫɤɭɸɚɧɬɢɛɢɨɬɢɤɨɬɟɪɚɩɢɸ.
ɇɚɜɬɨɪɨɦɷɬɚɩɟɩɨɞɫɚɤɪɚɥɶɧɨɣɚɧɟɫɬɟɡɢɟɣ ɩɪɨɢɡɜɨɞɢɥɢ ɢɫɫɟɱɟɧɢɟ ɫɜɢɳɚ ɢ
ɪɚɧɟɜɨɣ ɩɨɥɨɫɬɢ ɞɜɭɦɹ ɫɩɨɫɨɛɚɦɢ. ɉɪɢ
ɩɟɪɜɨɦ 32 ɩɚɰɢɟɧɬɚɦɞɜɭɦɹɨɤɚɣɦɥɹɸɳɢɦɢɪɚɡɪɟɡɚɦɢɢɫɫɟɤɚɥɢɝɧɨɣɧɭɸɩɨɥɨɫɬɶɫ
ɡɚɬɟɤɚɦɢɧɚɪɚɫɫɬɨɹɧɢɢ 0,5 ɫɦɫɨɛɟɢɯɫɬɨɪɨɧɨɬɧɚɪɭɠɧɨɝɨɨɬɜɟɪɫɬɢɹɯɨɞɚ. Ɉɤɚɣɦɥɹɸɳɢɣɪɚɡɪɟɡɤɨɠɢɩɪɨɞɨɥɠɚɥɢɧɚ 1,5–
2 ɫɦɜɜɟɪɯɢɜɧɢɡɨɬɧɚɱɚɥɚɢɤɨɧɰɚɯɨɞɚ.
Ƚɥɭɛɢɧɭɢɫɫɟɱɟɧɢɹɨɤɪɭɠɚɸɳɟɣɤɥɟɬɱɚɬɤɢ
ɯɨɞɚɭɜɟɥɢɱɢɜɚɥɢɜɫɪɟɞɧɟɣɱɚɫɬɢɢɭɦɟɧɶɲɚɥɢɩɨɧɚɩɪɚɜɥɟɧɢɸɤɜɟɪɯɧɟɦɭɢɧɢɠɧɟɦɭɤɪɚɹɦɪɚɡɪɟɡɚ. ɉɪɨɢɡɜɨɞɢɥɢɝɟɦɨɫɬɚɡ
ɤɨɚɝɭɥɹɰɢɟɣ. Ⱦɥɹ ɧɚɢɥɭɱɲɟɣ ɚɞɚɩɬɚɰɢɢ
ɤɪɚɟɜ ɪɚɧɵ ɢɫɩɨɥɶɡɨɜɚɥɢ ɜɟɪɬɢɤɚɥɶɧɵɟ
ɦɚɬɪɚɰɧɵɟ ɲɜɵ Ⱦɨɧɚɬɢ ɫ ɨɛɹɡɚɬɟɥɶɧɵɦ
ɡɚɯɜɚɬɨɦ ɞɧɚ, ɨɬɫɬɭɩɹ 0,8 – 1 ɫɦ ɨɬ ɤɪɚɹ
ɪɚɧɵ. Ʉɨɠɭ ɩɪɨɤɚɥɵɜɚɥɢ ɛɨɥɶɲɨɣ ɪɟɠɭɳɟɣɢɝɥɨɣ, ɥɢɝɚɬɭɪɵɩɪɨɜɨɞɢɥɢɩɨɞɞɧɨɦ
ɪɚɧɵɢɜɵɤɚɥɵɜɚɥɢɧɚɩɪɨɬɢɜɨɩɨɥɨɠɧɨɣ
ɫɬɨɪɨɧɟɧɚɬɨɦɠɟɪɚɫɫɬɨɹɧɢɢɨɬɟɟɤɪɚɹ.
ɇɚɟɺɫɜɨɛɨɞɧɵɣɤɨɧɟɰɧɚɞɟɜɚɥɢɪɟɠɭɳɭɸ
ɢɝɥɭɦɟɧɶɲɢɯɪɚɡɦɟɪɨɜ, ɤɨɬɨɪɨɣɩɪɨɤɚɥɵ-
ɜɚɥɢɤɨɠɭɜ 2 – 3 ɦɦɨɬɤɪɚɹɪɚɧɵ ɫɧɚɱɚɥɚ
ɫɨɞɧɨɣɫɬɨɪɨɧɵ, ɚɡɚɬɟɦɫɞɪɭɝɨɣ. ɋɥɟɞɭɸɳɢɣɲɨɜɧɚɤɥɚɞɵɜɚɥɢɧɚɪɚɫɫɬɨɹɧɢɢ 2 ɫɦ
ɨɬɩɪɟɞɵɞɭɳɟɝɨ (ɪɢɫ. 1). Ɋɚɧɭɞɪɟɧɢɪɨɜɚɥɢɪɟɡɢɧɨɜɨɣɩɨɥɨɫɤɨɣ. Ɉɩɟɪɚɰɢɸɡɚɤɚɧɱɢɜɚɥɢɧɚɥɨɠɟɧɢɟɦɚɫɟɩɬɢɱɟɫɤɨɣɩɨɜɹɡɤɢ.
ɉɨɫɬɟɥɶɧɵɣɪɟɠɢɦɧɚɡɧɚɱɚɥɢɧɚɫɭɬɤɢ. ɇɚ
ɜɬɨɪɵɟɫɭɬɤɢɞɪɟɧɚɠɭɞɚɥɹɥɢ. ɉɪɢɧɟɨɫɥɨɠɧɟɧɧɨɦɬɟɱɟɧɢɢɲɜɵɫɧɢɦɚɥɢɧɚ 10-ɵɣ –
12-ɵɣɞɟɧɶ.
ɉɪɢɜɬɨɪɨɦɫɩɨɫɨɛɟ 43 ɩɚɰɢɟɧɬɚɦɩɨɫɥɟɩɪɨɤɪɚɲɢɜɚɧɢɹɫɜɢɳɚɪɚɫɬɜɨɪɨɦɦɟɬɢɥɟɧɨɜɨɝɨɫɢɧɟɝɨɫ 3% ɪɚɫɬɜɨɪɨɦɩɟɪɟɤɢɫɢ
ɜɨɞɨɪɨɞɚɞɜɭɦɹɨɤɚɣɦɥɹɸɳɢɦɢɪɚɡɪɟɡɚɦɢ
ɢɫɫɟɤɚɥɢɟɞɢɧɵɦɛɥɨɤɨɦɝɧɨɣɧɭɸɩɨɥɨɫɬɶ,
ɷɩɢɬɟɥɢɚɥɶɧɵɣɤɨɩɱɢɤɨɜɵɣɯɨɞ, ɢɧɮɢɥɶɬɪɚɬ, ɩɟɪɜɢɱɧɵɟɢɜɬɨɪɢɱɧɵɟɫɜɢɳɟɜɵɟɨɬɜɟɪɫɬɢɹ. ɉɪɢ ɷɬɨɦ ɳɚɞɢɥɢ ɧɚɞɤɨɫɬɧɢɰɭ
ɤɪɟɫɬɰɚɢɤɨɩɱɢɤɚ, ɢɧɚɱɟɩɨɫɥɟɨɩɟɪɚɰɢɢ
ɜɨɡɧɢɤɚɥɢɭɩɨɪɧɵɟɛɨɥɢ. Ɋɚɞɢɤɚɥɶɧɨɟɭɞɚɥɟɧɢɟ ɜɫɟɝɨ ɩɨɪɚɠɟɧɧɨɝɨ ɭɱɚɫɬɤɚ ɤɨɠɢ ɢ
ɩɨɞɤɨɠɧɨɣɠɢɪɨɜɨɣɤɥɟɬɱɚɬɤɢɩɪɢɜɨɞɢɥɨ
ɤɨɛɪɚɡɨɜɚɧɢɸɛɨɥɶɲɨɝɨɪɚɧɟɜɨɝɨɞɟɮɟɤɬɚ. ɍɲɢɜɚɧɢɸɪɚɧɵɩɭɬɟɦɧɚɥɨɠɟɧɢɹɜɟɪɬɢɤɚɥɶɧɵɯɦɚɬɪɚɰɧɵɯɲɜɨɜɜɷɬɨɦɫɥɭɱɚɟ
ɩɪɟɩɹɬɫɬɜɭɸɬɡɧɚɱɢɬɟɥɶɧɨɟɧɚɬɹɠɟɧɢɟɬɤɚɧɟɣɢɜɨɡɦɨɠɧɨɫɬɶɨɛɪɚɡɨɜɚɧɢɹɧɟɛɨɥɶɲɢɯ
ɩɨɥɨɫɬɟɣɜ ɝɥɭɛɢɧɟɟɟ. ɇɚɬɹɠɟɧɢɟɬɤɚɧɟɣ
ɩɪɨɢɫɯɨɞɢɬɜɫɥɟɞɫɬɜɢɟɦɚɥɨɣɩɨɞɜɢɠɧɨɫɬɢɤɪɚɟɜɪɚɧɵ, ɮɢɤɫɚɰɢɢ ɤɨɠɢɢɩɨɞɤɨɠ-
Ɋɢɫ. 1. ɋɯɟɦɚɭɲɢɜɚɧɢɹɪɚɧɵɦɚɬɪɚɰɧɵɦɢɲɜɚɦɢ
ɜɤɨɧɬɪɨɥɶɧɨɣɝɪɭɩɩɟɛɨɥɶɧɵɯ (1-ɵɣɫɩɨɫɨɛ). 1 –
ɤɪɚɣɪɚɧɵ; 2 – ɦɚɬɪɚɰɧɵɣɲɨɜ.
Ɋɢɫ. 2. ɋɯɟɦɚɩɨɞɲɢɜɚɧɢɹɤɪɚɟɜɪɚɧɵɤɨɞɧɭɜ
ɤɨɧɬɪɨɥɶɧɨɣɝɪɭɩɩɟɛɨɥɶɧɵɯ (2-ɨɣɫɩɨɫɨɛ). 1 –
ɤɪɚɣɪɚɧɵ; 2 – ɲɨɜɪɚɧɵ.
57
”ɇɨɜɨɫɬɢɯɢɪɭɪɝɢɢ
ɧɨɣɠɢɪɨɜɨɣɤɥɟɬɱɚɬɤɢɩɭɱɤɚɦɢɫɨɟɞɢɧɢɬɟɥɶɧɨɣɬɤɚɧɢɤɧɚɞɤɨɫɬɧɢɰɟɤɪɟɫɬɰɚɢɤɨɩɱɢɤɚ. ɉɨɷɬɨɦɭɧɚɤɥɚɞɵɜɚɥɢɲɜɵ, ɩɨɞɲɢɜɚɹɤɪɚɹɪɚɧɵɤɟɟɞɧɭ (ɪɢɫ. 2). Ȼɨɥɶɲɨɣ
ɪɟɠɭɳɟɣ ɢɝɥɨɣ ɫ ɤɚɩɪɨɧɨɜɨɣ ɧɢɬɶɸ ʋ5
ɩɪɨɤɚɥɵɜɚɥɢɤɨɠɭɧɚɪɚɫɫɬɨɹɧɢɢ 1,5 – 2 ɫɦ
ɨɬɤɪɚɹɪɚɧɵ. Ɂɚɬɟɦɢɝɥɭɜɦɟɫɬɟɫɥɢɝɚɬɭɪɨɣɩɪɨɜɨɞɢɥɢɱɟɪɟɡɫɥɨɣɩɨɞɤɨɠɧɨɣɠɢɪɨɜɨɣɤɥɟɬɱɚɬɤɢɩɨɞɞɧɨɪɚɧɵɢɜɵɜɨɞɢɥɢ
ɥɢɝɚɬɭɪɭ, ɜɛɥɢɡɢɫɪɟɞɧɟɣɥɢɧɢɢ, ɧɟɩɪɨɤɚɥɵɜɚɹɤɨɠɭɧɚɩɪɨɬɢɜɨɩɨɥɨɠɧɨɣɫɬɨɪɨɧɟ.
Ɍɚɤɢɟɲɜɵɧɚɤɥɚɞɵɜɚɥɢɜɲɚɯɦɚɬɧɨɦɩɨɪɹɞɤɟɫɨɛɟɢɯɫɬɨɪɨɧɪɚɧɵɧɚɪɚɫɫɬɨɹɧɢɢ
ɧɟɦɟɧɟɟ 2 ɫɦɞɪɭɝɨɬɞɪɭɝɚ. ɉɨɫɥɟɡɚɬɹɝɢɜɚɧɢɹɲɜɨɜ ɧɚɞɧɟɪɚɧɵɨɫɬɚɜɚɥɚɫɶ ɧɟɡɚɲɢɬɚɹɭɡɤɚɹɢɡɜɢɥɢɫɬɚɹɩɨɥɨɫɤɚ, ɨɛɟɫɩɟɱɢɜɚɸɳɚɹɨɬɬɨɤɪɚɧɟɜɨɝɨɫɨɞɟɪɠɢɦɨɝɨ. ɇɚ
ɪɚɧɭɧɚɤɥɚɞɵɜɚɥɢɫɚɥɮɟɬɤɭɫ 0,05% ɪɚɫɬɜɨɪɨɦɯɥɨɪɝɟɤɫɢɞɢɧɚ.
ȼɨɜɬɨɪɭɸ (ɨɫɧɨɜɧɭɸ) ɝɪɭɩɩɭɜɨɲɥɨ 110
ɱɟɥɨɜɟɤ (86 ɦɭɠɱɢɧɢ 24 ɠɟɧɳɢɧɵ). Ʌɟɱɟɧɢɟɬɚɤɠɟɛɵɥɨɪɚɡɞɟɥɟɧɨɧɚɞɜɚɷɬɚɩɚ.
ɇɚ ɩɟɪɜɨɦ ɷɬɚɩɟ ɜɫɤɪɵɜɚɥɢ ɚɛɫɰɟɫɫ
ɬɢɩɢɱɧɵɦɫɩɨɫɨɛɨɦɩɨɞɦɟɫɬɧɨɣ ɚɧɟɫɬɟɡɢɟɣ Sol. Lidokaini 2% – 6 ɦɥ. Ɋɚɡɪɟɡɤɨɠɢɢ
ɩɨɞɤɨɠɧɨɣɤɥɟɬɱɚɬɤɢɩɪɨɢɡɜɨɞɢɥɢɫɜɟɪɯɭ
ɜɧɢɡɧɚɜɫɸɞɥɢɧɭɝɢɩɟɪɟɦɢɢɤɨɠɢ. ȿɠɟɞɧɟɜɧɨɜɬɟɱɟɧɢɟ 5–6 ɫɭɬɨɤɝɧɨɣɧɭɸɩɨɥɨɫɬɶ
ɩɪɨɦɵɜɚɥɢ 3% ɪɚɫɬɜɨɪɨɦɩɟɪɟɤɢɫɢɜɨɞɨɪɨɞɚɢ 0,05% ɯɥɨɪɝɟɤɫɢɞɢɧɚ. Ɋɚɧɭɞɪɟɧɢɪɨɜɚɥɢɲɢɪɨɤɨɣɪɟɡɢɧɨɜɨɣɩɨɥɨɫɤɨɣ, ɧɚɤɥɚɞɵɜɚɥɢ ɚɫɟɩɬɢɱɟɫɤɭɸ ɩɨɜɹɡɤɭ. ȼɫɟɦ
ɛɨɥɶɧɵɦ ɧɚɡɧɚɱɚɥɢ ɚɬɢɛɢɨɬɢɤɨɬɟɪɚɩɢɸ,
ɤɨɬɨɪɚɹɤɨɪɪɢɝɢɪɨɜɚɥɚɫɶɧɚ 3 – 4-ɵɟɫɭɬɤɢ
ɫɭɱɟɬɨɦɪɟɡɭɥɶɬɚɬɨɜɛɚɤɬɟɪɢɨɥɨɝɢɱɟɫɤɢɯ
ɢɫɫɥɟɞɨɜɚɧɢɣ.
ɍ 90 ɛɨɥɶɧɵɯɨɫɧɨɜɧɨɣɝɪɭɩɩɵɫɝɧɨɣɧɨɣɩɨɥɨɫɬɶɸɦɟɧɶɲɟ 1,5 – 2 ɫɦɜɞɢɚɦɟɬɪɟɜɬɨɪɨɣɷɬɚɩɨɩɟɪɚɬɢɜɧɨɝɨɥɟɱɟɧɢɹɩɪɨɜɨɞɢɥɢɧɚ 6-ɵɟɫɭɬɤɢ. ɂɫɫɟɱɟɧɢɟɪɚɧɟɜɨɣ
ɩɨɥɨɫɬɢɫɨɫɜɢɳɚɦɢɩɪɨɢɡɜɨɞɢɥɢɩɨɞɫɚɤɪɚɥɶɧɨɣɚɧɟɫɬɟɡɢɟɣ ɞɜɭɦɹɲɢɪɨɤɢɦɢɨɤɚɣɦɥɹɸɳɢɦɢɪɚɡɪɟɡɚɦɢɜɞɨɥɶɦɟɠɴɹɝɨɞɢɱɧɨɣɫɤɥɚɞɤɢɧɚɪɚɫɫɬɨɹɧɢɢ 0,5 ɫɦɫɨɛɟɢɯ
ɫɬɨɪɨɧɨɬɧɚɪɭɠɧɨɝɨɤɪɚɹɪɚɧɟɜɨɣɩɨɥɨɫ58
ɬɢ. Ɋɚɡɪɟɡɤɨɠɢɩɪɨɞɨɥɠɚɥɢɧɚ 1,5 – 2 ɫɦ
ɜɜɟɪɯ ɢ ɜɧɢɡ ɨɬ ɧɚɱɚɥɚ ɢ ɤɨɧɰɚ ɪɚɧɟɜɨɣ
ɩɨɥɨɫɬɢ. Ƚɥɭɛɢɧɭɢɫɫɟɱɟɧɢɹɨɤɪɭɠɚɸɳɟɣ
ɪɚɧɟɜɭɸɩɨɥɨɫɬɶɤɥɟɬɱɚɬɤɢ ɭɜɟɥɢɱɢɜɚɥɢɜ
ɫɪɟɞɧɟɣɱɚɫɬɢɢɭɦɟɧɶɲɚɥɢɜɧɚɩɪɚɜɥɟɧɢɢ
ɤɜɟɪɯɧɟɦɭɢɧɢɠɧɟɦɭɤɪɚɹɦɪɚɡɪɟɡɚ. Ƚɟɦɨɫɬɚɡ ɩɪɨɢɡɜɨɞɢɥɢ ɤɨɚɝɭɥɹɰɢɟɣ. Ɋɚɧɭ
ɨɛɢɥɶɧɨɩɪɨɦɵɜɚɥɢ 0,05% ɪɚɫɬɜɨɪɨɦɯɥɨɪɝɟɤɫɢɞɢɧɚɢ 3% ɪɚɫɬɜɨɪɨɦɩɟɪɟɤɢɫɢɜɨɞɨɪɨɞɚ. ɇɚɤɥɚɞɵɜɚɥɢɦɚɬɪɚɰɧɵɟɲɜɵ, ɤɨɠɭ
ɩɪɨɤɚɥɵɜɚɥɢɛɨɥɶɲɨɣɪɟɠɭɳɟɣɢɝɥɨɣ, ɥɢɝɚɬɭɪɭ ɜɵɤɚɥɵɜɚɥɢ ɧɚ ɩɪɨɬɢɜɨɩɨɥɨɠɧɨɣ
ɫɬɨɪɨɧɟɧɚɬɨɦɠɟɪɚɫɫɬɨɹɧɢɢɨɬɤɪɚɹɪɚɧɵ.
ɇɚɫɜɨɛɨɞɧɵɣɤɨɧɟɰɧɢɬɢ ɧɚɞɟɜɚɥɢɪɟɠɭɳɭɸɢɝɥɭɦɟɧɶɲɢɯɪɚɡɦɟɪɨɜ, ɤɨɬɨɪɨɣɩɪɨɤɚɥɵɜɚɥɢɤɨɠɭɜ 2 – 3 ɦɦɨɬɤɪɚɹɪɚɧɵɫɧɚɱɚɥɚɫɨɞɧɨɣ, ɚɡɚɬɟɦɫɞɪɭɝɨɣɫɬɨɪɨɧɵ, ɭɥɨɠɢɜɧɚɞɧɨɪɚɧɵ ɧɚɞɲɜɚɦɢɫɢɥɢɤɨɧɨɜɭɸ
ɩɟɪɮɨɪɢɪɨɜɚɧɧɭɸɬɪɭɛɤɭɞɢɚɦɟɬɪɨɦ 0,3 ɫɦ.
ɋɥɟɞɭɸɳɢɣɲɨɜɧɚɤɥɚɞɵɜɚɥɢɧɚɪɚɫɫɬɨɹɧɢɢ
2 ɫɦɨɬɩɪɟɞɵɞɭɳɟɝɨ (ɪɢɫ. 3).
ɉɨɫɬɟɥɶɧɵɣɪɟɠɢɦɧɚɡɧɚɱɚɥɢɧɚɫɭɬɤɢ. ɉɪɢɧɟɨɫɥɨɠɧɟɧɧɨɦɬɟɱɟɧɢɢɲɜɵɫɧɢɦɚɥɢɧɚ 10-ɵɟɫɭɬɤɢ. ȼɬɟɱɟɧɢɟɩɟɪɜɵɯɫɭɬɨɤɪɚɧɭɩɪɨɦɵɜɚɥɢ 0,05% ɪɚɫɬɜɨɪɨɦɯɥɨɪɝɟɤɫɢɞɢɧɚ (ɜɫɟɝɨ 800 ɦɥ) ɱɟɪɟɡɩɪɢɜɨɞɹɳɢɣ
ɨɬɞɟɥɩɟɪɮɨɪɢɪɨɜɚɧɧɨɣɬɪɭɛɤɢ, ɡɚɬɟɦɩɨɞɫɨɟɞɢɧɹɥɢɨɬɜɨɞɹɳɢɣɤɨɧɟɰɞɪɟɧɚɠɚɤɜɚɤɭɭɦɚɫɩɢɪɚɬɨɪɭ. ɇɚɜɬɨɪɵɟɫɭɬɤɢɞɪɟɧɚɠ
ɭɞɚɥɹɥɢ.
ɍ 20 ɛɨɥɶɧɵɯ ɨɫɧɨɜɧɨɣ ɝɪɭɩɩɵ ɩɪɢ
ɪɚɡɦɟɪɚɯ ɝɧɨɣɧɨɣ ɩɨɥɨɫɬɢ ɛɨɥɟɟ 2,0 ɫɦ.
ɩɪɢɦɟɧɟɧɚɤɨɠɧɚɹɩɥɚɫɬɢɤɚ ɩɨɅɢɦɛɟɪɝɭ
ɪɢɫ. 4).
ɉɨɞ ɫɚɤɪɚɥɶɧɨɣ ɚɧɟɫɬɟɡɢɟɣ ɫɨɨɬɜɟɬɫɬɜɭɸɳɢɦɪɨɦɛɨɜɢɞɧɵɦɪɚɡɪɟɡɨɦɢɫɫɟɤɚɥɢɝɧɨɣɧɭɸɩɨɥɨɫɬɶɫɡɚɬɟɤɚɦɢ. Ɋɚɧɭɩɪɨɦɵɜɚɥɢ 0,05% ɪɚɫɬɜɨɪɨɦɯɥɨɪɝɟɤɫɟɞɢɧɚɢ
3% ɪɚɫɬɜɨɪɨɦɩɟɪɟɤɢɫɢɜɨɞɨɪɨɞɚ. ɂɡɹɝɨɞɢɱɧɨɣ ɨɛɥɚɫɬɢ ɜɵɤɪɚɢɜɚɥɢ ɤɨɠɧɨɩɨɞɤɨɠɧɵɣɥɨɫɤɭɬ, ɤɨɧɝɪɭɷɧɬɧɵɣɞɚɧɧɨɦɭɞɟɮɟɤɬɭ. ɉɪɨɢɡɜɨɞɢɥɢɝɟɦɨɫɬɚɡɫɢɫɩɨɥɶɡɨɜɚɧɢɟɦɛɢɩɨɥɹɪɧɨɣɷɥɟɤɬɪɨɤɨɚɝɭɥɹɰɢɢ. ɉɨɫɥɟɩɟɪɟɦɟɳɟɧɢɹɪɨɦɛɨɜɢɞɧɨɝɨɥɨɫɤɭɬɚɧɚ
ɪɚɧɟɜɭɸ ɩɨɜɟɪɯɧɨɫɬɶ ɜ ɦɟɠɴɹɝɨɞɢɱɧɨɣ
ʋ1x2008 iɬɨɦ 16
Ɋɢɫ. 3. ɋɯɟɦɚɪɚɞɢɤɚɥɶɧɨɣɨɩɟɪɚɰɢɢɫɢɫɩɨɥɶɡɨɜɚɧɢɟɦɩɪɨɬɨɱɧɨɩɪɨɦɵɜɧɨɝɨɞɪɟɧɢɪɨɜɚɧɢɹ. 1 – ɤɪɚɣ
ɪɚɧɵ; 2 – ɦɚɬɪɚɰɧɵɣɲɨɜ, 3 – ɞɪɟɧɚɠ.
Ɋɢɫ. 4. ɋɯɟɦɚɪɨɦɛɨɜɢɞɧɨɣɩɥɚɫɬɢɤɢɧɚɡɚɜɟɪɲɚɸɳɟɦɷɬɚɩɟ. 1 – ɹɝɨɞɢɰɵ; 2 – ɩɨɞɤɨɠɧɚɹɤɥɟɬɱɚɬɤɚ; 3 –
ɤɨɠɚɹɝɨɞɢɰ; 4 – ɤɨɠɚɩɟɪɟɦɟɳɟɧɧɨɝɨɤɨɠɧɨɩɨɞɤɨɠɧɨɝɨɥɨɫɤɭɬɚ; 5 ɢ 6 – ɲɜɵɞɥɹɫɛɥɢɠɟɧɢɹɢ
ɮɢɤɫɚɰɢɢɤɨɠɧɵɯɤɪɚɟɜɪɚɧɵ, ɚɬɚɤɠɟɥɨɫɤɭɬɚɥɢɧɟɣɧɨɣɪɚɧɵɹɝɨɞɢɰɵ; 7 – ɩɢɬɚɸɳɚɹɧɨɠɤɚɥɨɫɤɭɬɚ; 8 –
ɩɨɞɤɨɠɧɚɹɤɥɟɬɱɚɬɤɚɩɟɪɟɦɟɳɟɧɧɨɝɨɥɨɫɤɭɬɚ; 9 – ɤɪɟɫɬɟɰ; 10 – ɞɪɟɧɚɠɧɚɹɬɪɭɛɤɚ.
ɫɤɥɚɞɤɟɩɨɞɤɨɠɧɵɟɤɪɚɹɨɛɟɢɯɩɨɜɟɪɯɧɨɫɬɟɣɮɢɤɫɢɪɨɜɚɥɢɭɡɥɨɜɵɦɢɲɜɚɦɢɜɢɤɪɢɥɨɦ ʋ 4, ɚ ɤɨɠɧɵɟ ɤɪɚɹ – ɚɬɪɚɜɦɚɬɢɱɟɫɤɢɦɢɧɢɬɹɦɢʋ 3 ɩɨȾɨɧɚɬɢ. Ɂɚɬɟɦɚɧɚɥɨɝɢɱɧɨɭɲɢɜɚɥɢɨɛɪɚɡɨɜɚɜɲɭɸɫɹɥɢɧɟɣɧɭɸɪɚɧɭɧɚɹɝɨɞɢɰɟɩɨɫɥɟɩɟɪɟɦɟɳɟɧɢɹ
ɥɨɫɤɭɬɚ. Ɋɚɧɭɞɪɟɧɢɪɨɜɚɥɢɜɚɤɭɭɦɞɪɟɧɚɠɨɦ. ȼɬɟɱɟɧɢɟ 10 – 11 ɫɭɬɨɤɛɨɥɶɧɵɯɩɟɪɟɜɹɡɵɜɚɥɢ ɟɠɟɞɧɟɜɧɨ, ɡɚɬɟɦ ɫɧɢɦɚɥɢ
ɤɨɠɧɵɟɲɜɵ.
Ⱦɥɹɫɪɚɜɧɟɧɢɹɩɪɢɦɟɧɟɧɧɵɯɦɟɬɨɞɢɤ
ɨɰɟɧɢɜɚɥɢ ɱɚɫɬɨɬɭ ɨɫɥɨɠɧɟɧɢɣ, ɞɥɢɬɟɥɶɧɨɫɬɶɧɟɬɪɭɞɨɫɩɨɫɨɛɧɨɫɬɢ, ɤɨɥɢɱɟɫɬɜɨɪɟɰɢɞɢɜɨɜ.
Ɋɟɡɭɥɶɬɚɬɵɢɨɛɫɭɠɞɟɧɢɟ
ȼɩɟɪɜɨɣɝɪɭɩɩɟɜɪɚɧɧɟɦɩɨɫɥɟɨɩɟɪɚɰɢɨɧɧɨɦɩɟɪɢɨɞɟɤɨɥɢɱɟɫɬɜɨɝɧɨɣɧɨɜɨɫ-
ɩɚɥɢɬɟɥɶɧɵɯɨɫɥɨɠɧɟɧɢɣɩɪɢɢɫɩɨɥɶɡɨɜɚɧɢɢ 1-ɝɨɫɩɨɫɨɛɚɫɨɫɬɚɜɢɥɨ 12,5±2,9% (ɭ 3
ɦɭɠɱɢɧɢ 1 ɠɟɧɳɢɧɵ), ɚɩɪɢɩɪɢɦɟɧɟɧɢɢ
2-ɝɨɫɩɨɫɨɛɚ – 6,7±2,7% (ɭ 1 ɦɭɠɱɢɧɵɢ 2
ɠɟɧɳɢɧ). ɇɚɝɧɨɟɧɢɹɩɨɫɥɟɨɩɟɪɚɰɢɨɧɧɵɯ
ɪɚɧɪɚɡɜɢɜɚɥɢɫɶɧɚ 3 – 6-ɵɟɫɭɬɤɢ. ȼɰɟɥɨɦ
ɜɤɨɧɬɪɨɥɶɧɨɣɝɪɭɩɩɟɩɨɫɥɟɨɩɟɪɚɰɢɨɧɧɵɟ
ɨɫɥɨɠɧɟɧɢɹɫɨɫɬɚɜɢɥɢ 9,33±1,2%.
ȼɨɜɬɨɪɨɣɝɪɭɩɩɟɭ ɛɨɥɶɧɵɯ, ɤɨɬɨɪɵɦ
ɢɫɫɟɤɚɥɫɹɗɄɏɢɩɪɢɦɟɧɹɥɨɫɶɩɪɨɬɨɱɧɨɩɪɨɦɵɜɧɨɟɞɪɟɧɢɪɨɜɚɧɢɟ, ɧɚɝɧɨɟɧɢɟɩɨɫɥɟɨɩɟɪɚɰɢɨɧɧɨɣ ɪɚɧɵ ɜɨɡɧɢɤɥɨ ɧɚ 6-ɵɟ
ɫɭɬɤɢɩɨɫɥɟɜɵɩɨɥɧɟɧɢɹɪɚɞɢɤɚɥɶɧɨɣɨɩɟɪɚɰɢɢ ɜɨɞɧɨɦɫɥɭɱɚɟ (1,1%).
ɍɜɫɟɯ ɩɚɰɢɟɧɬɨɜ ɜɬɨɪɨɣ ɝɪɭɩɩɵ, ɤɨɬɨɪɵɦɧɚɜɬɨɪɨɦɷɬɚɩɟ ɛɵɥɨɩɪɨɢɡɜɟɞɟɧɨ
ɢɫɫɟɱɟɧɢɟ ɗɄɏ ɫ ɪɨɦɛɨɜɢɞɧɨɣ ɤɨɠɧɨɣ
ɩɥɚɫɬɢɤɨɣ, ɩɨɫɥɟɨɩɟɪɚɰɢɨɧɧɵɣ ɩɟɪɢɨɞ
ɩɪɨɬɟɤɚɥɛɥɚɝɨɩɪɢɹɬɧɨ. ɋɨɫɬɨɹɧɢɟɥɨɫɤɭ59
”ɇɨɜɨɫɬɢɯɢɪɭɪɝɢɢ
Ɍɚɛɥɢɰɚ 1
ɉɪɨɞɨɥɠɢɬɟɥɶɧɨɫɬɶɜɪɟɦɟɧɧɨɣɧɟɬɪɭɞɨɫɩɨɫɨɛɧɨɫɬɢ
ɜɨɛɟɢɯɝɪɭɩɩɚɯɛɨɥɶɧɵɯ
ȼɚɪɢɚɧɬɵ
ɡɚɜɟɪɲɟɧɢɹ
ɨɩɟɪɚɰɢɣ
Ɇɚɬɪɚɰɧɵɣɲɨɜ
ɫɞɪɟɧɢɪɨɜɚɧɢɟɦ
ɪɟɡɢɧɨɜɨɣ
ɩɨɥɨɫɤɨɣ
ɉɨɞɲɢɜɚɧɢɟ
ɤɪɚɟɜɪɚɧɵɤɨ
ɞɧɭ
Ɇɚɬɪɚɰɧɵɣɲɨɜ
ɫɩɪɨɬɨɱɧɨɩɪɨɦɵɜɧɵɦ
ɞɪɟɧɢɪɨɜɚɧɢɟɦ
Ɋɨɦɛɨɜɢɞɧɚɹ
ɤɨɠɧɚɹɩɥɚɫɬɢɤɚ
ɉɪɨɞɨɥɠɢɬɟɥɶɧɨɫɬɶɜɪɟɦɟɧɧɨɣɧɟɬɪɭɞɨɫɩɨɫɨɛɧɨɫɬɢ (M±ɭ)
Ʉɨɧɬɪɨɥɶɧɚɹɝɪɭɩɩɚ
ɋɬ.
Ⱥɦɛ.
ȼɫɟɝɨ
21,1r7,2 12,9r5,9 34,0r8,3
ɞɧ
ɞɧ
ɞɧ
23,8r6,4 13,3r5,1
ɞɧ
ɞɧ
37,1r7,3
ɞɧ
-
-
-
-
-
-
13,8r3,6
ɞɧ
9,6r3,0
ɞɧ
23,4r4,4
ɞɧ
-
-
-
14,1r7,5
ɞɧ
8,1r5,9
ɞɧ
22,2r9,0
ɞɧ
ɬɚɭɜɫɟɯ 20 ɛɨɥɶɧɵɯɜɬɟɱɟɧɢɟ 10–11 ɫɭɬɨɤ
ɛɵɥɨɧɨɪɦɚɥɶɧɵɦ, ɤɨɠɚɢɦɟɥɚɛɥɟɞɧɨɪɨɡɨɜɭɸɨɤɪɚɫɤɭ, ɢɲɟɦɢɢɥɨɫɤɭɬɚɧɟɜɵɹɜɥɟɧɨ ɧɢ ɜ ɨɞɧɨɦ ɫɥɭɱɚɟ, ɨɬɟɤ, ɝɢɩɟɪɟɦɢɹ ɜ
ɡɨɧɟɧɚɥɨɠɟɧɢɹɲɜɨɜɛɵɥɢɧɟɡɧɚɱɢɬɟɥɶɧɵɦɢ. Ƚɧɨɣɧɨɧɟɤɪɨɬɢɱɟɫɤɢɯɨɫɥɨɠɧɟɧɢɣɭ
ɷɬɢɯɛɨɥɶɧɵɯɧɟɛɵɥɨ.
Ⱦɚɧɧɵɟɨɩɪɨɞɨɥɠɢɬɟɥɶɧɨɫɬɢɜɪɟɦɟɧɧɨɣɧɟɬɪɭɞɨɫɩɨɫɨɛɧɨɫɬɢɜ ɨɛɟɢɯɝɪɭɩɩɚɯ
ɛɨɥɶɧɵɯ ɩɪɟɞɫɬɚɜɥɟɧɵ ɜ ɬɚɛɥɢɰɟ 1. Ʉɚɤ
ɜɢɞɧɨɢɡɬɚɛɥɢɰɵ, ɞɥɢɬɟɥɶɧɨɫɬɶɩɪɟɛɵɜɚɧɢɹɜɫɬɚɰɢɨɧɚɪɟ, ɚɬɚɤɠɟɩɪɨɞɨɥɠɢɬɟɥɶɧɨɫɬɶ ɚɦɛɭɥɚɬɨɪɧɨɝɨ ɥɟɱɟɧɢɹ ɭ ɛɨɥɶɧɵɯ
ɜɬɨɪɨɣ ɝɪɭɩɩɵ ɫɭɳɟɫɬɜɟɧɧɨ ɧɢɠɟ, ɱɟɦ ɜ
ɩɟɪɜɨɣ, ɜɧɟɡɚɜɢɫɢɦɨɫɬɢɨɬɜɚɪɢɚɧɬɚɡɚɤɪɵɬɢɹɪɚɧɟɜɨɣɩɨɥɨɫɬɢ.
Ɋɟɰɢɞɢɜɵ ɡɚɛɨɥɟɜɚɧɢɹ ɜ ɩɟɪɜɨɣɝɪɭɩɩɟɛɨɥɶɧɵɯɜɵɹɜɥɟɧɵɭ 5 (8,63,2%) ɩɚɰɢɟɧɬɨɜ (ɭ 2 ɦɭɠɱɢɧ ɢ 3 ɠɟɧɳɢɧ). ɍ 3 ɢɡɧɢɯ
ɪɟɰɢɞɢɜɵɜɨɡɧɢɤɚɥɢɧɚɜɬɨɪɨɦ, ɬɪɟɬɶɟɦɢ
ɱɟɬɜɟɪɬɨɦɦɟɫɹɰɟɩɨɫɥɟɨɩɟɪɚɰɢɢɧɚɮɨɧɟ
ɢɦɟɜɲɢɯɫɹɪɚɧɧɢɯɩɨɫɥɟɨɩɟɪɚɰɢɨɧɧɵɯɨɫ60
Ɉɫɧɨɜɧɚɹɝɪɭɩɩɚ
ɋɬ.
Ⱥɦɛ.
ȼɫɟɝɨ
-
ɥɨɠɧɟɧɢɣɢɞɥɢɬɟɥɶɧɨɧɟɡɚɠɢɜɚɜɲɢɯɪɚɧ.
ɍ 2 – ɪɟɰɢɞɢɜɵɜɨɡɧɢɤɥɢɧɚ 12-ɨɦɢ 17ɨɦɦɟɫɹɰɟɫɨɨɬɜɟɬɫɬɜɟɧɧɨɫɦɨɦɟɧɬɚɜɵɩɨɥɧɟɧɧɨɣɞɜɭɯɷɬɚɩɧɨɣɨɩɟɪɚɰɢɢ. ȼɫɟɪɟɰɢɞɢɜɵ, ɧɟɡɚɜɢɫɢɦɨɨɬɜɚɪɢɚɧɬɚɜɬɨɪɨɝɨ
ɷɬɚɩɚ ɨɩɟɪɚɰɢɢ, ɜ ɷɬɨɣ ɝɪɭɩɩɟ ɛɨɥɶɧɵɯ
ɩɪɨɢɡɨɲɥɢɭɨɞɧɨɝɨ (3,5±2,3%) ɢɡ 28 ɦɭɠɱɢɧɫɝɥɭɛɨɤɨɣɦɟɠɴɹɝɨɞɢɱɧɨɣɫɤɥɚɞɤɨɣ
ɢɨɠɢɪɟɧɢɟɦ, ɢɭɬɪɟɯ (20,0±10,3%) ɢɡ 15
ɠɟɧɳɢɧ. ɍɛɨɥɶɧɵɯ ɫɜɵɪɚɠɟɧɧɵɦɨɜɨɥɨɫɟɧɢɟɦɦɟɠɴɹɝɨɞɢɱɧɨɣɨɛɥɚɫɬɢɢɹɝɨɞɢɰɪɟɰɢɞɢɜɜɵɹɜɥɟɧ ɭɨɞɧɨɝɨɩɚɰɢɟɧɬɚ
(4,7±2,7%) ɢɡ 21 ɦɭɠɱɢɧɵɷɬɨɣɤɚɬɟɝɨɪɢɢ.
ȼɨɜɬɨɪɨɣɝɪɭɩɩɟɩɚɰɢɟɧɬɨɜɜɨɬɞɚɥɟɧɧɵɟ
ɫɪɨɤɢɪɟɰɢɞɢɜɡɚɛɨɥɟɜɚɧɢɹɜɵɹɜɥɟɧɜɨɞɧɨɦɫɥɭɱɚɟ (1,1%). ɍɷɬɨɝɨɛɨɥɶɧɨɝɨɪɚɧɟɟ
ɛɵɥɨɜɵɩɨɥɧɟɧɨɬɨɥɶɤɨɢɫɫɟɱɟɧɢɟɗɄɏɫ
ɢɫɩɨɥɶɡɨɜɚɧɢɟɦ ɩɪɨɬɨɱɧɨɩɪɨɦɵɜɧɨɝɨ
ɞɪɟɧɚɠɚ. ɉɪɢ ɧɟɨɞɧɨɤɪɚɬɧɵɯ ɨɫɦɨɬɪɚɯ
ɛɨɥɶɧɵɯɩɨɫɥɟɪɨɦɛɨɜɢɞɧɨɣɩɥɚɫɬɢɤɢɪɟɰɢɞɢɜɚɡɚɛɨɥɟɜɚɧɢɹɧɟɜɵɹɜɥɟɧɨɧɢɜɨɞɧɨɦɫɥɭɱɚɟ.
ʋ1x2008 iɬɨɦ 16
ɉɪɨɜɟɞɟɧɧɵɟɢɫɫɥɟɞɨɜɚɧɢɹ ɩɨɤɚɡɚɥɢ,
ɱɬɨɞɜɭɯɷɬɚɩɧɨɟɪɚɞɢɤɚɥɶɧɨɟɯɢɪɭɪɝɢɱɟɫɤɨɟɥɟɱɟɧɢɟɚɛɫɰɟɞɢɪɭɸɳɟɝɨɗɄɏ, ɩɪɟɞɭɫɦɚɬɪɢɜɚɸɳɟɟɢɫɫɟɱɟɧɢɟɝɧɨɣɧɨɝɨɨɱɚɝɚɜ
ɩɪɟɞɟɥɚɯ ɬɤɚɧɟɣ, ɢɧɮɢɰɢɪɨɜɚɧɧɵɯ ɝɧɨɟɪɨɞɧɵɦɢɦɢɤɪɨɨɪɝɚɧɢɡɦɚɦɢ, ɧɚɮɨɧɟɚɞɟɤɜɚɬɧɨɣ ɚɧɬɢɛɢɨɬɢɤɨɬɟɪɚɩɢɢ, ɨɛɟɫɩɟɱɢɜɚɟɬɷɮɮɟɤɬɢɜɧɨɫɬɶɢɪɚɞɢɤɚɥɶɧɨɫɬɶɥɟɱɟɧɢɹ
ɜ ɬɟɱɟɧɢɟ ɨɞɧɨɣ ɝɨɫɩɢɬɚɥɢɡɚɰɢɢ, ɩɪɢɜɨɞɢɬɤɫɧɢɠɟɧɢɸɱɚɫɬɨɬɵɩɨɫɥɟɨɩɟɪɚɰɢɨɧɧɵɯɝɧɨɣɧɨɜɨɫɩɚɥɢɬɟɥɶɧɵɯɨɫɥɨɠɧɟɧɢɣ,
ɫɪɨɤɨɜ ɜɪɟɦɟɧɧɨɣ ɧɟɬɪɭɞɨɫɩɨɫɨɛɧɨɫɬɢ ɢ
ɭɪɨɜɧɹɪɟɰɢɞɢɜɨɜ.
ɈɩɬɢɦɚɥɶɧɵɦɢɜɚɪɢɚɧɬɚɦɢɪɚɞɢɤɚɥɶɧɨɝɨɜɦɟɲɚɬɟɥɶɫɬɜɚɧɚɜɬɨɪɨɦɷɬɚɩɟɹɜɥɹɸɬɫɹɢɫɫɟɱɟɧɢɟɗɄɏɨɤɚɣɦɥɹɸɳɢɦɢɪɚɡɪɟɡɚɦɢ ɫ ɭɲɢɜɚɧɢɟɦ ɪɚɧɵ ɦɚɬɪɚɰɧɵɦɢ
ɲɜɚɦɢɢɩɪɢɦɟɧɟɧɢɟɦɩɪɨɬɨɱɧɨɩɪɨɦɵɜɧɨɝɨ ɞɪɟɧɢɪɨɜɚɧɢɹ, ɚ ɬɚɤɠɟ ɢɫɫɟɱɟɧɢɟ
ɗɄɏɫ ɪɨɦɛɨɜɢɞɧɨɣɤɨɠɧɨɣɩɥɚɫɬɢɤɨɣ.
ɉɟɪɜɵɣ ɜɚɪɢɚɧɬ ɫɥɟɞɭɟɬ ɩɪɢɦɟɧɹɬɶ
ɩɪɢɞɢɚɦɟɬɪɟɩɨɥɨɫɬɢɚɛɫɰɟɫɫɚɦɟɧɟɟ 2 ɫɦ,
ɨɬɫɭɬɫɬɜɢɢɫɜɢɳɟɜɵɯɡɚɬɟɤɨɜ, ɜɢɡɭɚɥɶɧɨɣ
ɜɨɡɦɨɠɧɨɫɬɢɫɨɩɨɫɬɚɜɥɟɧɢɹɤɪɚɟɜɪɚɧɵɛɟɡ
ɧɚɬɹɠɟɧɢɹ, ɚ ɬɚɤɠɟ ɧɟɝɥɭɛɨɤɨɣ ɦɟɠɴɹɝɨɞɢɱɧɨɣ ɫɤɥɚɞɤɟ, ɧɟɜɵɪɚɠɟɧɧɨɦ ɨɜɨɥɨɫɟɧɢɢɹɝɨɞɢɰ.
ɂɫɫɟɱɟɧɢɟɗɄɏɫɪɨɦɛɨɜɢɞɧɨɣɤɨɠɧɨɣ
ɩɥɚɫɬɢɤɨɣɩɨɤɚɡɚɧɨɩɪɢ ɪɚɡɦɟɪɚɯɝɧɨɣɧɨɣ
ɩɨɥɨɫɬɢɛɨɥɟɟ 2 ɫɦ, ɦɧɨɠɟɫɬɜɟɧɧɵɯɫɜɢɳɟɜɵɯ ɡɚɬɟɤɚɯ, ɭɜɟɥɢɱɢɜɚɸɳɢɯ ɩɥɨɳɚɞɶ
ɢɫɫɟɱɟɧɢɹ, ɫɨɯɪɚɧɹɸɳɟɣɫɹɢɧɮɢɥɶɬɪɚɰɢɢ
ɤɪɚɟɜ ɪɚɧɟɜɨɣɩɨɥɨɫɬɢ ɧɚ 6 – 7-ɵɟ ɫɭɬɤɢ
ɩɨɫɥɟɜɫɤɪɵɬɢɹɚɛɫɰɟɫɫɚ, ɭɬɭɱɧɵɯɛɨɥɶɧɵɯ
ɫɝɥɭɛɨɤɨɣɦɟɠɴɹɝɨɞɢɱɧɨɣ ɫɤɥɚɞɤɨɣ, ɩɪɢ
ɜɵɪɚɠɟɧɧɨɦɨɜɨɥɨɫɟɧɢɢɹɝɨɞɢɰɢɦɟɠɴɹɝɨɞɢɱɧɨɣɫɤɥɚɞɤɢ.
ȼɵɜɨɞɵ
1. ɉɪɢɚɛɫɰɟɞɢɪɭɸɳɟɦɗɄɏɨɩɬɢɦɚɥɶɧɵɦɜɚɪɢɚɧɬɨɦɹɜɥɹɟɬɫɹɞɜɭɯɷɬɚɩɧɨɟɨɩɟ-
ɪɚɬɢɜɧɨɟɥɟɱɟɧɢɟɜɬɟɱɟɧɢɟɨɞɧɨɣɝɨɫɩɢɬɚɥɢɡɚɰɢɢ.
2. ȼɵɛɨɪɜɚɪɢɚɧɬɚɪɚɞɢɤɚɥɶɧɨɝɨɜɦɟɲɚɬɟɥɶɫɬɜɚɧɚɜɬɨɪɨɦɷɬɚɩɟɞɨɥɠɟɧɨɫɭɳɟɫɬɜɥɹɬɶɫɹɫɭɱɟɬɨɦɚɧɚɬɨɦɢɱɟɫɤɢɯɨɫɨɛɟɧɧɨɫɬɟɣ ɤɪɟɫɬɰɨɜɨɤɨɩɱɢɤɨɜɨɣ ɨɛɥɚɫɬɢ ɢ
ɯɚɪɚɤɬɟɪɚɩɚɬɨɥɨɝɢɱɟɫɤɨɝɨɩɪɨɰɟɫɫɚ.
ɅɂɌȿɊȺɌɍɊȺ
1. Ⱦɢɮɮɟɪɟɧɰɢɚɥɶɧɵɣ ɩɨɞɯɨɞ ɤ ɯɢɪɭɪɝɢɱɟɫɤɨɦɭ
ɥɟɱɟɧɢɸɧɚɝɧɨɢɜɲɢɯɫɹɷɩɢɬɟɥɢɚɥɶɧɵɯɤɨɩɱɢɤɨɜɵɯ
ɯɨɞɨɜ / ȼ. ɇ. Ɇɭɯɢɧɚ [ɢɞɪ.] // Ʉɥɢɧɢɱɟɫɤɚɹɯɢɪɭɪɝɢɹ. – 1990. – ʋ 2. – ɋ. 40-41.
2. ɇɚɡɚɪɨɜ, Ʌ. ɍ. Ʌɟɱɟɧɢɟɝɧɨɣɧɢɱɤɨɜɵɯɩɨɪɚɠɟɧɢɣ
ɩɪɨɦɟɠɧɨɫɬɢ ɢ ɤɪɟɫɰɨɜɨɤɨɩɱɢɤɨɜɨɣ ɨɛɥɚɫɬɢ /
Ʌ. ɍ. ɇɚɡɚɪɨɜ, Ɋ. Ⱥ. Ⱥɦɛɚɪɭɭɦɹɧ, ɗ. Ȼ. Ⱥɤɨɩɹɧ // ɏɢɪɭɪɝɢɹ. – 1990. – ʋ 6. – ɋ. 79-82.
3. Banerjee, D. The aetiology and management of
pilonidal sinus / D. Banerjee // J. Wound. Care. – 1999. –
Vol. 8, N 6. – Ɋ. 309-310.
4. Ⱦɭɥɶɰɟɜ, ɘ. ȼ. ɗɩɢɬɟɥɢɚɥɶɧɵɣɤɨɩɱɢɤɨɜɵɣɯɨɞ /
ɘ. ȼ. Ⱦɭɥɶɰɟɜ, ȼ. Ʌ. Ɋɢɜɤɢɧ. - Ɇ: Ɇɟɞɢɰɢɧɚ, 1988. –
125 ɫ.
5. Ʌɟɱɟɧɢɟɷɩɢɬɟɥɢɚɥɶɧɨɤɨɩɱɢɤɨɜɨɝɨɯɨɞɚɜɫɬɚɞɢɢ
ɨɫɬɪɨɝɨɜɨɫɩɚɥɟɧɢɹ / ɉ. Ɇ. Ʌɚɜɪɟɲɢɧ [ɞɪ.] // Ⱥɤɬɭɚɥɶɧɵɟɩɪɨɛɥɟɦɵɤɨɥɨɩɪɨɤɬɨɥɨɝɢɢ. – Ɋɨɫɬɨɜ - ɧɚ Ⱦɨɧɭ, 2001. – ɋ. 43-44.
6. Morell, V. Surgical treatment of pilonidal disease:
comparison of three different methods in fifty-nine cases
/ V. Morell, B. Charlton, N. Deshmukh // Mil. Med. –
1991. – Vol. 156, N 3. – Ɋ. 144-146.
7. Ⱥɝɚɜɟɥɹɧ, Ⱥ. Ɇ. Ɍɚɤɬɢɤɚɥɟɱɟɧɢɹɨɫɬɪɵɯɧɟɨɩɭɯɨɥɟɜɵɯɩɪɨɤɬɨɥɨɝɢɱɟɫɤɢɯɡɚɛɨɥɟɜɚɧɢɣ / Ⱥ. Ɇ. Ⱥɝɚɜɟɥɹɧ, Ⱥ. Ʉ. ɗɧɮɟɧɞɠɚɧ // ȼɟɫɧ. ɯɢɪ. Ⱥɪɦɟɧɢɢ. –
2001. – ʋ 3. – ɋ. 193-197.
8. Bascom, J. Pilonidal sinus: experience with the
Karydakis flap [letter] / J. Bascom // Br. J. Surg. –
1998. – Vol. 85, N 6. – Ɋ. 874.
9. Il trattamento radicale della cisti pilonidale
sacrococcigea / L. Rosato [ɟt ɚt.] // Minerva. Chir. –
1997. – Vol. 52, N 10. – Ɋ. 1277-1279.
10. Brieler, H. Dr infizierte Sinus pilonidalis / H. Brieler /
/ Langenbecks-Arch. Chir. Kongressbd. – 1997. – Vol.
114. – Ɋ. 497-500.
11. Collazo, E. Obeid’s technique for treatment of
pilonidal sinus [letter] / E. Collazo, M. Luna // Dis.
Colon. Rectum. – 1994. – Vol. 37, N 7. – Ɋ. 731-732.
12. Recurrent pilonidal sinus after excision with closed
or open treatment: final result of a randomised trial /
K. Sondena [et al.] // Eur. J. Surg. – 1996. – Vol. 162, N
3. – Ɋ. 237-240.
ɉɨɫɬɭɩɢɥɚ 13.11.2007 ɝ.
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