6.9, Bpouxoxormueckme merous! Hce-TeEHOBANIIS, Bponxonoriecknte meroan eesestopants (BML) nosy munpoxoe pacrpoerpasehH He on suatrpni We TOsIKO {LIN OLLEHKH COCTONH TpaxeoGPOHXHAEHOTO ACpeRA M HANIA necreumcpa cxoro winan TyGepxysestoro rlopaxesiia Gporrxon 0 V-VI nopaka BKiLOSHTeBHO, HO. B HEDIS epetb, suk rosysentia oaOyruTesa TyGepKyesa Hs osara rlopaxenis, BMH nossoai6t nosy4a srarepiast He TONBKO 13 GPOHKOD, HO 13 serONHOH TKAHH, AMIaTHECKIS y310B CPEAOCTN A © 1 viene rox xoxrpozea 91410 Y3HL, aro oGecriewmpaer suarHocTHeCKHIT Mpottece u NOSBONAET YAY funrn noseune Tyepxye%a NyTeM onIpereteHHs criekTpa SyBCTBHTENHOCTH BOROYAHTES KPO! potyGepkyste3itbiM periaparant Semoenonntueckie MeTOAM HCIIOMG3YIOT B CHIOKHBIX CHYHAAK JIMA HOCTHKH TYGEPRY ESA OPTA usxanua y si Ges GakrepHonbuteNenn II B cayHAAX HOXOSpeHHIA Ha coweTaTHiO® saGoneat (wane seero TySepKyales H Pak slerKoro). 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CHowtinie BIZ one “apes6porrxnaststaa (rpancGporxnamsiias) Gxioncus nerkix (ABIL wa TBBJI), B tom este oyabrpasnyxosoit nanrautelt, H uraOKHIE acrumpanontiite GHOrTe HT “aunnparHeckHx y3108, vtmeate © owtoyaorpaanyKOBLIM KONTpONeM, TPeGYIOT BHIcoKOKRALTHXpHILHPOBAHOT? TePSOHas cHuinit BHAAMH GHOncHit aBmMorer acnupar (OPC aii rawax. Ma 272porocrosueit annapatypst. On oGecrtesiBaior MaTepHat UIA MHKPOGHONOFHYECKOrO, LHTOTOHY ckoro H riicrouornyeckoro HecnenoRaHit B 90-95% cayyaen. TIpu HespexTuBHocTH aMarHocTHKH OporxouoruyeckHMM MeToRAMH HcHONESytOT Gostee HHBAINBHIe H 3arpaTubIe XUpyprisecKue sWHa- rocTIeckHe BMeMIaTeABCTBA Acriupar wan Gpouxnacpunstit embin co canancroit Spoxon PasHOBHAHOCT %KMAKOCTHO! GHOTICHH, HMeeT MPOCTy! MeTOAHKY BEITIOAHeHA, NpaKTHYecKH He BBIBIBAA OCTORNCHU, MaHUNYASLLNA BLINOIIUAETCS MPH GPOHXOCKONIHH MIYTeM CMBIBAHHA HeOOTb- MIM OGbeMom dpusHo.torH4ecKoro pacrBopa (10-15 M1) comeprkUMOTO GpoHXoB 3-5 MOpAKa ¢ 10- creaylomeli actmpansieit, Matepiia npuroxex ToabKO WIA MIKPOGHOAOrH4eeKOrO HecHeOBAHILA, MOCKOIBKY HE COEPAHT KIETOUNLIX deMeHTOR, B OTANUHE OT KHAKOCTH BAJL. Iror But GHoneHH MOAHO PeKOMCHLIOBATS MPH HAIN B GPOHXAX BOCKAAHTEABHOTO CeKpeTa, CCuIH KOHCHCTEHUNA ero He NosBoAseT MpORECTH ACTIMpaLtO Hepes Kaas GpouxocKora. Bponxoan.neotspustii sapax (BAIT) 2KurKoctuiaa Guoncua aa noayueHNA GpouxoambseorspHOrO cMBIBA (CHHOHNM — akILIKOCTHL GporxoaneeonspHoro staBarka (BAJDK)) nposoaiires Bo pews GpoHXocKONIMH HyTeM APOGHOTO BBE AeHus bu3nosorH4ecKoro pacrBopa (Bcero 100-150 Mut) B GpoHxoassAconspHoe MpocTpartcTBO ¢ 110- caleaytomeli acnpannteli (puc. 6.9.1). Pricynox 6.9.1. Hposesteane BAI. Suaodoro. Onno 113 nepsorx cooSmennit B sapyGertHEIx mKypHaTaX O6 HeHONBIORAKNH BAJI sux GakrepHoo- HiMeckoli uarHocTHKH Ty6epKysiesa Obi0 cretaHO Baughman R.P. u coanr, 1991, Bomburoji BkIa B pasBiiTHe Ht pacnpoctpareHite 9TOrO MeTosa Bo (prHsHaTpHH BHeCIH, Hasta ¢ 1980 r., compysHHKH UHHH: Onsmmnnos B.IL., Jlosasesa O.B., Esryuienxo I.B., XmempKosa HP, Tapkoscxas H.9. 1 ap. [ 2, 3,4, 5, 6], oGesteaonan 615 GombHbIx akTHBHbIM TyGepKysIeI0M OPraHOR JALIXAHH, HoKasA:Ta, 4TO mposeacune BAJI He Biever 3a coGoii oGocrpenns TyGepKysesHOro mpouecca u pacnpocrpanenns cro Ha pyre YuacTKH JerKHX, YBCHHMHBAeT IpEKTHBHOCTS BELIBIEHHA BOI6ysNTEAIA 1 HOIBOAAET naGmOIaT ANAMEKY KeTONHBIX HonyAUHit GpoHxoaaBReOAAPHOTO Mpocrpancraa. B nactoamice Bpema ra MerosHKa ocraeTca caMoii BocTpeSoBaHHOli H >peKTHBHOI JWI HOLY. ‘enna GaxrepHosorn4eckoti BepudbuKaunH y GombHBIX TyGepKy:1e30M (B:TOM HICH, ¥ AeTeH) Ges Bb aeacuna MBT, a racKe yereumo ncnomsyeres suis suddpepenunanbuoli auarHoctHKH TyGepKysIe3a. 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B Hactosiiee apeMs nlosBiLiach BOIMO‘HOCTS HoBHILIeHHs 9ieKTHEHOCTH MpoBexeHHa UBBIL Tp nepiibepu4eckiX OGPAsOBAHIAX B ZePKHX, B TOM “HAE H TYGEPKysIe3HIOl4 9THOMOTHH, 3a CHET HCNOAG3ORAHIA YABTPASBYKOBLIX PAAMAADHIX MUHHGOHIOB JIA TONHOTO HapeneHHA OHorcHiitoro ineTpysentra Ha naromornueckuii oGbeKt (Puc. 6.9.3). MeToanka pHesIperta H yerIeuIHO HeTOABsyeTCA B HHT [9 a oSee Pucynox 6.9.3. a) exat KT OFK aunenrra ¢ opazonannen (ryGepxyctemoii) » SI mpasoro aerKoro, 6) syiOCOHOrpaMa pasIQIbiIbIM MIHZON-IOM OGpasowaKits c roMOreHHO!i IxOCTPYETypoll, KAABUNEATOM It POR~ uoit neripepuibiioll rinepaxorenoit rpannueti Kaaceieckas Tpane6pouxnastbuas urionast acnmpanuin/6uoncust (TBHA) B Tlepouim ory mpoueaypy seinominia n onucas Schieppati E. w 1949 r. [10]. Ivor Bi. Guoricu aK- 274TuBHO Ht yenemmo mpuMeHsica 8 LIHHMT (11, 12], nauas ¢ kota 60-x roxoB npoutoro crosterus Bo BpeMa PHFHUO!i GPOUXOCKONNH C HCMONBIOBANHEM ALIA HYHKUNH KECTKOA HTT (Puc. 6.9.4) F Pucyxox 6.9.4. parent pentrenorpasiel OTK, shinoaeHHOli 8 npouecce tpancOporxmaHoll nyHK- UH BHLYTPHTPYAHOTO UMM aTHMeCKOTO 31a MO PeHTTEHTEsIEBISHOHHDIM KOHTPOsIEM TH ACCTKOI: OPOHXO- exon. B cospementiom ucnosmeniin 9ra GHoncHs HpoRosutTes BO BpeMs GPOHXOCKONIHH creupatbHbIMEL uiamn. Mecro nynkunn 4epes crenky Gpouxa H MayOuHa MPOHHKHOReHHA BEIOHpaloTes 3apaHee NO Aaunoim KT OPK wun s110conorpadun, Tawxe yaHTbIBAeTes 9HAOCKONMMeCKaA KapTHHa. 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HeeMOTps Ha HPOCTOTY BBITIO-IHeHA, NpOU:ypa TpeGyeT OCTOPOK- HOCTH, TAK KaK BOSMO:KIO MOBPEKILCHHE COCYOB, CHIOCOGHEIX BLIBBATE Cepueatoe Kpoporesenne [13] Uerounas Guonenst (Gpam-Guoncns) cauancroii Gpouxon SlaaseTcs pasHOBILIHOCTEIO IHAOOPOHXHATbHbIX GHOTICHII H 3aK04 THM C108 CUSHCTOI GpoHXos crleunabHOii ULETKOI (pu. 6.9.6). TCA B CKAPHpHKALHH Ht CHA 275Pucytiox 6.9.6. Llerounas Guoricns (Spanr-Guonieus) cnnsucroii Gpouxa. IHAohoro. [lerounas Guonens npunenscres 218 noaysenns Guorrrara cxU3HCTOH KPyNHBIX Ht MeNKHX Gpor- XoB, HCMOMBIYeTCA MPH HANTHHH BILIUMBIX HAMeHeHH, a TAICKE B rettepauiAX OpoHxos, HexOcTyT~ HDX BIByaTbHOMY OGc:Ie1oBAHIO. LleTosHaN GuoneHA — caMblli pacrpoctpaxenHEtit BH GHOnCHiT bo ¢Tv3Harpunt, TAK KAK ABLIAeTeR YOOHON 1 GesonacHOi npH BoIoAHeHUN, HenombayeTes MpH AHA rHocrike TyGepKysic3a GpoHXoR 1 B KoMTUIeKce GuoncHit 21 ANddepenuHaTHO! AUArHOCTHKE TY- Gepkysiesa nerkux. Marepuai ucriomsayercs UIs GakTepHOAOTHMeCKO! I UMTONOrHYECKO! BepHDHKA- nH mponiecea. HenocrarkoM aRIAeTCA HEBOIMOAHOCTH MONYTeH OGPasta JIA THCTOTOTHYECKOTO ucesrestonaniia Bponxockonmueckne 1 9320>arockommueckne GuoncuH, BBINO! 0-¥3H K aaHHbIM MeTOAaM OTHOCSTCA IHAOCKONMYECKHE GHOTICHH, CTABIINE BOSMOAKHIMH MOC BHE- “Apert B MpAKTHKY KOHBEKCHIX YABPAIBYKORKIX IHAOCKOTIOB CO CHCUMVIDIBIM KAHALTON JAR HPO- BENCH HITOBBIX NYHKUAIK, DHAOCKOIINYECKHE TOHKOMPONBHBIC HYHKIUN BHYTpHTpyAubIX MMA TIMECKHX Y210B OCYMLECTBAMOTER CTIELIELIBHBINL HITAMIL BO BPENA IHNOCKOMILN YoIBTPAsBYKOBBIN GpoHXocKOHOM IH TACTPOCKOTIOM ¢ BOSMOXHOCTHIO HOCOHOrpadpHH. «HawesreHMe Ha Hesb) Ht CaNa YNKIUI KOHTPOSHPYIOTEA YaBTPAIBYKORIN CKAHMPORAHHEM C BOSMOAHOCTHIO PacHOsHABAIINs| KPO~ BeHOCHBIX CocysoB (OM-TepoBeKOE CkaHMpoRaHHe). [LHarHOCTHKA TyGepKysIe3a sTHNpATH4ECKUX Y3~ OB cpe_OcTeHHs BOIMOAHA TIP! HOpaAKCHHH ONPEEACHHBIX TPYNIN, AOCTYMHBIX JUts ITOH; MeTOAUKH. Meroanxa ucnonesyerea 8 LHHMT, ocHopisin nokasainem 2414 mpopesenna 9THx OuoncHit spaaeT- ca audpibepeniinasHas juarHoctuKa TyGepKy:1e3a ¢ ONYXONEBBINH, MeTACTATHNeCKHMH MOLEC i mmchonpoamdeparupnbimnt 3aGonenannsimn [14] Pagauriaior caeayioutne BiLIb Guoncuii Hox KoHTpoxew 91L10-¥3H [1] + TpAHCOpOHXHaTbHaa TOHKONTOABHAS AcHMpanMOHHAA GOTCHA 110 KOHTPOsIEM 91:1OG6POUXH- anbuoil yasrpaconorpadun (9BYC-TTAB) ocyurecrssiseres Bo BpeM GPOHXOCKOMHH GPOHNOCKOTIOM KOHBEKCHBIM aTHHKOM ¢ ROIMOAHOCTHIO IHOCOHOrpapuH (Puc. 6.9.7); + TOHKONTONBHaS acrMpanHOHHan GHONCHA MOA KOHTpOTeM 9HuL0yaTPacouorpacpiH (IYC- TAB) ocyutectaaseres 80 BpeMa 930(parOcKOMIN € HCHOTSSOBAHHEM TACTPOCKOTIA € BOSMOAHOCTHIO oHaoconorparprii; © TOHKOHTOTbHAA ACTMpANHOHHaR GHOTICHA ¢ HICHIONIOBAHHeM GPOHXOCKOMIA MO KOHTPOsIEM suaoyatsrpaconorpadun (¥C-6-TAB), specrmmesoatias ¢ icronb30BarHeM GpouXocKona ocyte- CTR:NETCR BO BPEMs 930% Ar OCKOTIHH OPOHXOCKOIIOM C BOIMOAHOCTEIO 9HOCOHOrparbuH (PHC. 6.9.8), NHEMbIE HO, KONTPOLTEM 9H ‘aM 276Pucynox 6.9.7. 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BoGaacrbix (kpaeBbIX, OKPYKHBIX, PECTYGIHKAHCKIN) MEHEUHCKIX opranmaauniax cySueK- row PO pit HenoaMorxtHocTH HeKsHOeHnA TyGepKysIesA HlocTe NpOBEAEHINM ToAHOTO KANE c0-11460- patopiioro HecesonaHist 1 Ha:THSHA HOKABAuIH MPOBOAITER OPOHROCKOTIDS ¢ KOMELTENON Suoncnit riot RuTTOsOTHMCCKHX, FHCTOTOTHECKHX, MHKPOGHOTOFHSECKHX, MOeK)sAPHO-TEHETHYCEKIR CCIE slonaniii FB MeAMHIHCKHX OpraHHGALAX MyHULHTAIDHOTO YPOBHA, OKAIBAIOLIUEX crTeLHAHSHPO RIS ayto MeaMUMCKyI0 TloMoMLs Ho HpodpiL0 «dprisHarprs>», HpH HEOBXOUMOCTH sepribukaui at0- aoevinceroro mpottecea 1 nponestenta uipepenunta.tbioi: ANarHoeruKH MpOBO.LITEA 6POHNOCKOTINE © KOMIEKCOM GHONCH: C HeTbIO MONYYeHUA AMArHOCTHeCKOFO MATCPHANA TUM irrosorH4eckoro, « hcromoriieexoro MikPOOHO:IOTHMECKOTO H MOsIEKYANpHHO-TeHETHYECKOTO HEesENOBAHT 1B oGnacrttan (KPACBBIX, OKPYAHBIX, pecrlyOsH4KAHCKHN) MENHAUHCKHX OPraHHsAKHAK COREA tox PO, oxaspinaiouiix cHeniKATHGHpORAHY!O MEsIMLUTHCKYIO TloMOMD HO MporbAao «rHaHaTPHI, Iipi cOMHeHH B KAYeCTRENHON BBITONENHM WeCIeAOBAI, Ha NPEABLAY NS Tara suarHocTHKH vont la yeraHonuteHHA AnHaMiIKK Mpowlecca rice LOBAHHEA, B TOM HHesTe GPOHXOCKOTA, HECICIORA. ‘Hua OBTOpsIOTCA. Jlnreparypa 1. 9¥C6yKa. PyronoserBo 110 o1izocKoMIsecKOli ystsrpaconorpadist HOH pea. Mesum’ AM. Opaova C.10., @enopowa E.]L Koaztexruna apropop 2013 r «IIpakruseckas Mes 400 + Tapxosckas H.9, BporxoatsneosspHisi stanack v nmmanbie cppaxiin aabseorsP HbR CMBR Gonunsix tyGepxyeaom oprasion jXass, Awroped), JHHeC, KANT. Mea. Hay, Moy 1982. 3. Xwenpaona HLT, Jbvarnoctia sudppysHbrx sa6os1ewari erkux € HeMOsoBAHIHEM MeTON Gpoxxoansneoxspxioro aneka. Aproped. ANCE. KaH, Mea. Hayx. Mocks, 1986 “L Eurymenko TB. Juugybepenuiasibuan srarnoctixa TyGepKyesa JerKUX ¢ HeHOTAORANET unronormiecxoro Meroda ceTeAOBANIS MaTepHAIO GpoHXocKorTHHeEKHEX GHONeH. / Apropet) ‘antec, Katya Mea. Hays, Moca, ~ 1988, $. dbiummnnos Bl. HucrpyMenranasie Meroabt AarHocTHKH. B KH. TyOepKyIes OpraHon AN xan (non peaaxuneit A.T, Xomeuso) Mockwa. Mexuiana 1988 r ¢ 127-147, 576 erp. 6. 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