AKTYAJIbHbIE BOMPOCbI SKCTPEHHOM XUPYPFIN JIMTEPATYPA, 1. Aprupexcos C.B. // Ypon. wecbpon. ~ 1991. - Ne 5. ~ C. 50-52. 2. Aapenxos V.A. Jlanapocxonun & xnpypriveckoM neveHnn BapuKouene y peTeN / AsTope. ANC, KAHA, M@fL Hayk. = M., 1996. 3. Honeuxnii C.A. O6uyne Bonpoces ReTcKOH xupyprun. M., 1984. 4. Epoxmi A.11. Bapukouene y aereit (Knniko-akcnepamenTanbHoe nccnenosatue) / AsToped. anc. ROKT. MER. HayK. ~ M., 1979, 5. Jlonarknt H.A., Moposos A.B., LUutHinkosa J1.H., Yepenaoga T.C. // Ypon. Hedpon. - 1981. — Ne 5.-C.3-8. 6, Maes C.B., Jloponnn B.©. // Cospemennuie TexHonormn 8 negMatpun u peTcKoi xupyprun / Marepuants I! Poc. kourpecca AeveKnx xupypros. ~ M., 2003. 7. Munaee C.B., Jlopoxni B.., Masniox H.H. // Xupyprna. ~ 2003. - Ne 1. ~C. 16-18, 8. Mypra B.B. Dnarhocruka m neveHne sapmKouene: cpasHuTenbHan xapakTepactika cnoco6os one- paruaHoro neveHnA / ABToped. AC. ...kalia. MER. Hayk, ~ Taepe, 1995. 9. Nopay6uei7 V.B., Dapenkos A.M, Dporos A.©. w ap. // SpocKon. xup. ~ 1996. - Ne 1.-C. 17-19, 10. Nonay6Heii V.B., DpoHos A.®., KopsHiiKosa V.H. ap. // [leTcKaa xp. ~ 1998. - Ne 1. -C. 31-35. 11. Crenanos B.H., Mymaanse P.., Kaauipo 3.4. wap. // Ypon. Hedpon. - 1997. — Ne 1. -C. 3-5, 12. Tapycn 2.M1., Pymnuwes A.T., AkonaH A.C. wap. // LleToKoe snpaBooxpanenne Poccnm: crpaTerin pagent / Marepuanti IX ceesna neavarpos Poccun. ~ M., 2001, ~ C. 12-16. 13. Palomo A. // J. Urol. (Baltimore). ~ 1949. - 61. ~ P. 604-607. UCNOMIbSOBAHME JIASEPHOLO JIYYA AIA EYEHNA, XMPYPIMYECKON MH@EKUM Y ETE PAHHETO BOSPACTA B.M. Yexmapee, M.T. Anexcandpoe, A.E. Mawkoe, M.A. Axmedoe, B.B. Ocoxunt BudHosckan palionHan GonbHuua, MOHUKY um, M.®. Bnadumupexozo lo Hactosujero epemenn mano usyYeHa npoGnema NpMMeHEHNA pagnn4nbyx B= AOB hasepHoro Many¥eHWA NPM BOCNaNMTeNbHbIX 3aSonesaHNAX xupypruvecKoro Npocpuna y Aertel. He paspa6oTanb! MeTOAMKH AVarHOCTHKH, OnepaTMBHOrO NeYeHUA, TexHMika OnepauMi C NOMOLbIO NasepHoro CKanbnena, NoKasaHMA kK Nepal u ee NpMMeHeHHA B pasnn4nble cbasbi TeNeHNA XMpyPrM4ecKoli VHeKUNMN, METOAIbI KOMN- seKcHoro npwmeHeHna CO,-nasepHoro ckanbnena, AO3MpOBKa HUSKOMHTEHCHBHOrO slasepHoro (HMM) vany4eHun 8 3aB/CHMMOCTH OT xapakTepa naTonorun m Boapacra pe- Genka, MeTOmbI KOHTpONA 3a TeEYEHHeM BOCTANeHMA C NOMOUIbIO NasepHO GUOoTO- MeTpuu (JIB@M) w nasepHoli ponnneposcKon cbnoymeTpun (14). B AocTynHoi Ham OTeYeCTBEHHOM M sapyGexHON NuTepaType MbI HALLINM AMLb EAMHVUHBIe COOBUIeHUA Ha oty Temy. Uccneqosannamn nocnegHux net AoKasaHa GeaBpenHocts ucnonb30- BaHMA sa3epHOro OOnyyeHna B aneKBaTHbIx A03ax [2, 4, 8]. Bce BuILenanoxKeHHOe o6ycnasnueaet HeEOGxoqMMOCTb UccNegoBaHnii B STOM HarpasneHnn. OTH AaHHbIe NOATBeEPXKAAIOT XuPyPrM MHOrHXx perMoHoB Poccun u 3a py6exom [3, 5, 6, 7]. Hamu Obino o6cnegoBaHo u nponeveHo 95 pete pakHero rpygHoro Bospacta © xupyprinvecKoi uHcpeKuMel, B KOMNNeKCHOM NeYeHA KOTOPEIX NpMMeHANCA CO,- ASEPHbIN CKANbNeMb (A=10,6 MKM), JIB@M (4=0,63 km; 2=0,89 km), JIA (1=0,63 Mk), MectHoe HMJ1-Bosgelictene (4=0,63 mkm; 4=0,89 mm) 8 03e 0,25 Dx/em? nv 0,01 Lx/cm? cooTBetcTeeHHo. Kpome storo, sce GonbHble AeTH No NoKagaHuAM No- AYYAAN VHty3MOHHO-TpaHCysMoHHylo Tepanio, CAMNTOMATHYECKOe NeYeHNe, aH- Tu6noTHkn, uonpenaparel, nepesasKn. OGocHoBaHneM K NPMMEHEHWIO BLICOKOMHTeHCHBHOTO NagepHOrO VaNyYeHHA B 151AKTYAJIbHBIE BOMPOCbI SKCTPEHHOM XMIPYPr npaktuke xupypriu geTe paxHero rpyakoro Bospacta ABNAOTCA: 1) TOHHOCTb pas- pesa; 2) MuHuManbHaa Tpasmatusauna TkaHeli; 3) ObpasoBanue Ha NoBepxHOCTH paspega KOarynAUMOHHO MNeHKK, CNocoOGCTBYIOWIEM MagKOMy saXnBNeHMIO Patt 4) xopoumit KocMeTMMeCKHiA adeexT nocne OnepaTMBHOrO BMeWATeNLCTEA, NPOHs- BeAeHHOFO «NazepHbIM Ckanbnenem; 5) MAHMMaNIbHaA KPOBONOTEPA BCMEACTEME KO- arynaun cocyaos 10 2 mM 8 ANameTpe; 6) GakTepvumaHoe AelicTene; 7) 8 HANH TeNbHO MeHbWe CTeneHn Gonesbie OWyLeHMA NOCHE Onepaymn. VisBecTHO, 4TO B NPOWCCe NEYeHUA MECTHO! XUpyPrM4ECKO! MHdeKUMM MeHA- joTcA onTHYeCKNe xapakTePCTHKN TkaHeli N3-3a NSMeHeHNA TeMneparypsl, OKPACKH, NnoTHOCTH, KpoBeHaNonHeHNA TkaHei. COOTBETCTBEHHO MEHAETCA UM CTENeHb NOMIO- wena v oTpaxexia HMJI-uanyyenua [1] Cyte JIB@M sakniovaetca 8 usMepeHMn Koodduunenta oTpaxeHna (nponycka- Hua, nornowjenua) uccnezyeMoro y4aCTka TKAHM OTHOCHTE/IbHEIM MeTOAOM M0 KON yectey OTpaxeHHOrO (NOrMOWeHHOrO, NPoWeAWero) NasepHOrO Ay4UCTOTO NOTOKA, BOCNPMHMMaeMOrO VaMePHTENLHLIM, NPOMBILNEHHO BbINYCKAeMBIM NPMOOPOM ~ Na- 3ePHbIM GuocpoTOMeTpOM, H NocneAyIOWero yueTa STHx XapakTePUCTHK NpH pacieTe adbbekTuBHoit Aosbi NasepHOrO Many4eHUA MW OObEKTUBHOFO KOHTPONIA 3a TEHEHVEM socnanutenbHoro npouecca [1}. ina pacuera aexsaTHoro apemenn Bognevicrana HAM-uanyyeHnem nponssoA~n- nw 6vodoTOMeTpMNECKve VaMepeHHA Nepen KaxNO NPOUeAYpON Nasepotepannn, Bpema nosepxHocTHoro o6ny¥eHua paccunTbisann No opmyne: axs Px (I-p) rae 0 - nosa o6nyseHun ({k/cm) — sHepretuyeckaa akcnOsMuns; S — nnowanp o6nyyenna (cm); P— ebixoatan moUlHocTs nazepa (BT); p — KoadduUneHT OTPAXKEHA. Dns o6bexTHBHOn OWeHKH AMHaMMkH xupyprH4ecKol UHdeKUNH NasepHbIM ON0- cbotometpom ¢uKcuposann oTHOCMTeNbHbIE NoKasaTeNM KOshdnuneHTa OTPAKeHHIA nagepHoro uanyYeHnA ANMHON BosHbI X=0,63 MKM 1 1.=0,89 MKM 8 YeHTpe BocnaneHHA (A,}, Ha ero rpanmue (A,), 4 Ha paccTosHM 2 CM OT Hee (Ag), a TaKKE B CAMMETPIYHDIX um o6nacTax (B,; Bp; By) 4 penepHoit TouKe (B) — nanonriaa NOBEPXHOCTe MOKTeBOrO cruOa. Peaynutatel ANA KAKO” CuMMeTPHYHON OGnacTH BbINMCAANH No copmyne: B-A, B-5, —: a= Ay BA, B+B, Bennunna «fl» coctasnaet 8 Hopme 0,960,06 M He 3aBMCHT OT BETA KOXKM, BOS- pacra, cyrouHLx 6HOpHTMoB 1 CoHOBON NaTonormu. Mo Mepe AMKBMAAUWMN BOCTANM- TenbHOro Mpoulecca OHa BHOBL BO3EPAu\aeTCA K NepsoHayasIbHbIM UIMdpam. CnenoBa- TenbHo, BOsBpalijeHne noKasatena ({1) k ACXODHOMY YPOBHIO CNYKUT B Ka4eCTBE ONHOTO ua KpuTepnes acbcbexTHBHOCTH NeveHMA FHOMHO-BOCNANMTeNbHbIx 3aGoneBaHHi. Onpenenerve rpaxiub! BOcnaneHiA COCTORHMA TkAHM y GOMbHbIX C MeCTHOI THOMHON XHpypriMvecKolt MHdeKuNeN c NOMOWBIO JIL nposoAMnu cnenyioum o6- pagom, BHauane uxKcposann noKagaTenn AaTunKa nasepHoro ¢noymeTpa B saBe- JOMO BNByANbHO HeNOpaxKeHHOM yHacTke KOK. aTeM AATHMK yCTaHaBANBANH Ha 182AKTYAJIbHbIE BONPOCbI SKCTPEHHOM XUPYPFIN YMACTOK Tena, PachONOXeHHbIi PALOM ¢ NaTONOrM4eCKHM NPOYECCOM M MMeIOWINA MokasaTenn kanAANAPHOTO KPOBOTOKA, MaKCHMANLHO GIVSKHE K HOPMANLHbIM. Ip npoaswxeHin AaTauka B CTOPOHY NaTONOrMYECKH HSMEHEHHO! TkaHN UKCMpOBANN AakHble onnneporpaMMel, Mu npw MaMeHeHiMM NoKasaTeneli cpenHeapudmeTnuecko- Fo napameTpa Miukpoupkynaumn (M) Ha 0,3, a koadbuunenTa acumMeTpun (K — oT- HOUIeHKe pasHOCTH NoKasaTenei k Ux NONYCyMMe B ABYX CAMMETPHUHEIX TONKAX Tena O6cneayemoro) Ha 0,03 onpenenann rpatmuy BocnaneHuA TkaHn (MlaTeHT Ha ug06pe- Tenne Poccniickoro arenToTea no nareHTam 4 ToBapHbim sHakam No2140198). Jlevenne ompannra. Cpeannii cpok neveHun 8 cTauMoHape peTeli ¢ TaKol nato~ Rormeli cocrasnser 13-15 w Conee aveit m He rapanTupyer OTCYTCTENA PeUMANEOR. ThaANUMOHHble MeTOALI NeYeHMA sa4acTyiO He NaloT KenaTeNbHOrO addekTa, 410 Mow 2keT OCNOKHUTECA reHepannsauneli BOCNaNMTeNbHOFO NPOUeCca. O6cnenosann 29 aeTei, u3 Hux 11 c KaTapanbHoli, a 9 C dnermoHOsHoH op- Moi omcbanua. ¥ Hx 80 BpeMs OnepauMn ucnonbsoBann CO,-nagepHblli cKanbnenb & KoMnneKCe C aHTHGakTepnanbHoli, CuMNTOMaTH4eCKON Tepanneli, OLeyKpennalo- LMM NENEHKEM, HUSKOMHTeHCHBHOM nasepoTepannel. OcranHble 9 AeTel Nonyua- nw OuenpuHATOe neNeHine (OnepaTHBHOS, aHTHGUOTHKU, dusHOTepANHA, O6WEYK- Dennmowee severe, CamnTomaTmyeckan Tepania) 4 BxOgWnH B rpynny CpaBHEHiA, Onepaunio nasepHtim Ckanbnesem NPOUSBOAMAM Nog sauIMTO! BRAKHbIx canterox, OKPYPKAIOLIEH NyNOK KO2xN. NyNosHOe KOMbLIO MaKCHMaNbHO BbIBOPaYHBanH u pacho- KycnpoBakibim ny4om CO,-nasepa MOoWHOCTbIO 30 Br npousBoAMnn OGpaboTKy BOC- NasMTeNbHO-WSMeHEHHbIX TKaHelt 10 rpaHMUb! CO SnOpOBbIMN yYacTKamn. O6pasonas- unlica CTpyn yaanann BnaxHor canderKoii n patesyio noBepxHOCTs obpaGaTsiBann HACBILIEHHbIM PaCTBOPOM NepMaHranara Kanu, B NocneazyIOUKeM NPONSBOANAN exe- AHeBHyio OSpaGorky NoBepxHOCTH crpyna KpeNkMM pacTaopom nepmanratiara Kanna nv GpunnvarToaon seneHn, no NomHOl anirennsaunn pail. Y GONbHbX, KOTOpbIM & nocneonepauMOHHOM Nepnoge npnmeHsNM MecTHOe BOSpeNCTENe renMii-HEOHOBbIM 7asepom B TeveHne 6 AHeN 8 BOspacTHOM AOE No Paspa6oTAHHOM HAMM MeTOANKe, onuTenMsauna pale! Hactynana Ha 3-4 AHA paHbWwe, 4eM B rpynne CpasHeHna. Sc- extusHocre paspaGoTaHHoro HaMM MeTOna NeYeHNA OMManuITa C NOMOLIbIO BbICO- KomHTeHcHBHoro w HUSI-ny4a AemoHcTpupyerca B TaGnuue 1 Ta6nuya 1 Caoanbie pesynttarel nevenua omdannra u ero npeumywiectea Nip ucnonesosanun nasepxoro nyya Tpynnia GonbHix Cpoxn nesenun Peunnnass Hopmannaauwa noKa- saTeneh N5O u NAO Tpynna cpasnennn 15,2#2,1 14% Wa 13-14. mene Tipmmenenne . 7 CO,-nasepa 6,841,7 Her Ha 5-6 pens Kak BUAHO 43 npMBeReHHON Ta6nnUss, NpeMMyWecTBA neYeHHA OMdanmTa C no- MoulbIO nasepHoro nyya O4esnaHbi: 82 pasa COKPATHNACb AIMTENbHOCTS NpeObIBAHIA OonbHtix B CTauHoHape, ucKmovanics peuMANBLI sa60NeBaHNA, ObiCTpee HacTynana Hopmannsays noKagateneli SIBOM u Jib Takum o6pasom, npnMeHeHne BbICOKOMHTeHCHBHOFO NazepHOrO Ay4a NosBoNAeT CoxpaTiTb AnnTenbHOCT neveHns B xypyprnveckoM OTAeNeHMN D0 6-7 AHEM, c noc- 153AKTYAMIbHbIE BOMPOCbI SKCTPEHHOM XUPYPFUIN JAYIOWWMM aMGynaTopHbIM NeYeHneM c NoMOUIbIO HMJ1-oGnyueHuA. Jlevenne runeprpanynembl 8 O6nacTH nynka, Cpoku neveHna STON NaToNOrMM NPA OSwenpuHATOM MeTone neYeHHA cocTaBnAIOT 15-16 AHEM M He UCKMIONAIOT BOSHAKHO- Benne peunausos. Hamu o6cnegogaxo 18 aeTeli c dbyrrycoM, u3 KOTOpEIX 11 AeTeM onepypoBAHO ny4om CO,-nasepa, a 7 GonbHbix COCTaBM/M rpynny CpaBHeHUA, B KOTOPON NeNeHVE NposogMAoch No O6wenpuHATOA MeTOANKe. Onepaunto nasepHbim ckanbnenem jenann cneayiowm o6pagom. Non, c6wer aHecTesnei nposoanan ucceyeHue runeprpaHyneMmbt 10 OCHOBaHKA, B Npenenax S8AOPOBLIx TKAHeN, ChOKYCMPOBAHHbIM AYOM nagepa MOWWHOCTEIO 30 Br. SAopoBbie TkaHM 3aU\MWNANN OT NOBpexAaloUlero AeUICTANA NasepHoro UENyYeHUA BNaxHbIMA cancberkamn. BaxHo CTporo KoHTponmpoBaTs my6ny OGpa6oTkn TKaHel NasepHbiM Ckanibniesiem 13-34 BOSMOXHOCTH NOBPeXxMEHHA OKPY>XAlOUIMX MAITKHX TKAHEM, a TAKKE ckBo3HOrO NoBpexnaeHMA NepeAHeN OPIOUIHO! CTeHKH M paHeHMA OpraHoB 6PIOWHOH Nonoctn. B nocneaylowem o6pa6orky paHesov noBepxHocTn nposoAMAN HacBILeH- HbIM pacTBopom nepmaHraxaTa Kanus un 6punnuaHToBON 3eneHN 0 NonHol ann- Tenugaumn paki. Npvmexexve 8 nocneonepauvoHHOM nepuoge rennii-HeoHOBOrO jazepa B BOspACTHO! AOSMpORKe COKPATHNO CpoKK NeYeHMA Ha 3-4 HA. ShbextnsHocTs neveHna dyxryca noKasaHa B Tabnnue 2. Ta6nnya 2 Ceoanbie peaynsratei neveHna runeprpanynembi 8 o6nacTu nynka ero npeumyuwiectaa npu AcnonbsoBanun nasepHoro nyua Tpynna GonbHtix Cok neverna Peumaneni Hopmanusaua noKa- saTened NBO u Nd Tpynna cpasnenna 14, 521.8 Ho 32% Ha 10-12 pene Tpumenerne 7 conser 5,241.3 Her Ha 5-6 pene Takum 06pasom, ucnonbsoBakve CO,-nazepHoro ckanbnena u HVJI-uanyweHua Npw runeprpakyneme 8 OGnacTu nynka NosBOAAeT yMeHbUIMTS CPOKM NpeBBIBAHMA Gonbierx feTeM 8 CrauMoHape Ha 7-8 AHeli, MCKMIONNT» peuMAMBbI 3aGoneBaHA npn 9TOM Naronormn. CoBmoneHve TexHHKN onepaunn, Mep GegonacHocTn, uoKmioNaeT BOSHVIKHOBeHNe OCNOXKHEHMT Nn onepaunn nagepHbIM nyoM. Y 8cex OnepupoBakHbKx GonbHbIx Nony4eHb! XopoUe Bninxaiiume u oTAaneH- Hole KocMeTHYecKne (0 6 eT HaGmMOREHMA) PesynbraTbl. OGpasoBbiBanca TOHKMiA, Hextbili py6eu, BckpbiTne HEKpOTHYECKOM dnerMoHb! HOBOPOXAEHHEIX. Tp C6WMPHOH nno- WaAN (nerMone! BoKPLITHE OBbIMHLIM CkKaNbneneM CoNPOBOXKAaeTCA sHaNMTENbHON kpoBonoepeli, KoTOpas 3aBMCHT OT KONMYECTRA HaHECeHHIX Ha KOxY HaceueK. M3-3a cyObexTHBHO OYeHKN pacnpocTPaHeHHOCTH rpaHul, BOCNANeHMA, HACEYKM Ha KOXE ga4acTylo HaHOCATCA NGO B U36EITOYHOM, NGO B HEMOCTATONHOM KONMNECTBe, 4TO BERET K MSNMUIHEH KpOBONOTepe M ONepalMOHHON TpaBMe, UNM JaNbHEMWeMy pac- Npoctpavenmo socnanenus, NoBTopHbim onepauMam. MosTOMy HEOOXOAMME! OGb- ekTHBHbIE MeTOgbI ONPeAeNeHHA rpaHnl BOCNANeHHA HW KOHTPONA 3a ero AMHAMMKO paseutna. B nocneonepayMoHHoM nepuone Kpan Hace4eK savacTyio CnanaloTcA, 4TO 154AKTYAJIbHbIE BOMPOCbI SKCTPEHHOM XUPYPrMA SaTPYAHAeT OTTOK paveBoro CoAePxMMOrO M NpenATCTAyeT BEICTPOMy KyNUpOBAHMIO BocnanmrensHoro npoyecca. OniicaHHbie Bbile NpeMMyUlecTBa AeViCTEMA nasep- Horo Ckanbnens Ha TKaHM No3BONMAM C yCTeXOM NDMMeHHTb ero NPM NeYeHMM STON TaxKeNOM KaTeropnn onbHbix AeTeH. Hamu o6cneno8aH 21 GonsHoli 8 Bospacre oF 15 axel 20 3 MecALIes 13 KOTOPLIX y 11 AeTev npoussoqMn BCKpEITHE dnerMoHbI NaepHbIM CKanbnenem, ay 10 GonbHLix onepauns Geina nponsBenena OObIMHbIM Ckanbnesem. Bce GonbHbie Nony¥ann o6ule- NDMHATBIe MeTONBI NeYeHMs: aHTHOMOTHKH C yYETOM HYBCTBMTENBHOCTH K HMM MUKpO- Proper, cumntomaru4eckyio, MHYSHOHHO-AeSMHTOKCHKALMOHYIO, UMMyHOTepanmMIo lO NoKasaHMsM, nnaaMo- 4 reMoTpPAHCbysnio. Onpegenenne rpanny HeKpoTM4ecKol dnermoHel 8 ANHaMNKe nponasonMnn PaspaGoratitibim Ham MeTonOM JIBOM u JJ. Bo spema onepaunu, non o6uiel anectesveli, Ha KOxy HaHOCMNM nepdopauMn CokyCupOBAHHbIM BbICOKOMHTeHCHE- HbIM ASePHBIM AY4OM MOWHOCTHIO 60 BT TOYEYHBIM BOSAe/ICTBNEM ANUTENHOCTHIO 3-4 cek. Mp HeoGxoaMmocTH nepdopaLMoHHoe OTBEPCTHE pacUIMpANN 3aKMMOM AO NOABNEHNA FHOMHOTO OTMENseMOrO. Mlocne soxpwitia ¢nermoxe! HaknanbiBarin NOBASKY C ruNepTOHMYECKM pacTBO- Pom. HecomHeHHoe npenmyuectso HaHeceHia nepdopaunii nasepHbi ckanbnenem SaKniovaeTes 8 NpaKTH4eCkM NONHOM OTCYTCTEMM KPOBONOTepH, MeHbLeM Becno- kolictse peGenka nocne onepauyn, GbICTPOM O4NWJeHMM Patel. OCOGEHHO saMeTeH Femocratuvecknit a¢cekr npn Sonbwwol nnowaan BocnaneHuA, Kora KpoBonoTepA Nv onepaunn MeTannu4eckiM CkanbneneM AOCTHTAeT HECKONBKHX AeCATKOB MUNA JMTPOB, 4TO B BHAYMTeNbHON CTeneHu CkaabIBaeTCA Ha nlocneonepaunOHHOM TeYeHMA y STOW KaTeropnn GonbHbx AeTeli. Mepdopauinn, HaHeCeHHBIE aZepHLIM yom, He cnaganvict AO MlonHoro npekpaweHua CeposHO-rHoMHOrO OTAeNAeMOrO, MMeNN OK- Pyrylo opmy pasmepom 200 0,4-0,6 om. Mocne ctuxania socnanurenbHoro npouec- Ca, YMeHbUeHHA KONMYECTBa CeposHO-rHOMHOFO OTeNAeMoro HaCTynana 6EICTpAA oniTesngauna pat C XOpOUuMM KOCMETHYeCKUM addexrom. FleveHne npoBoaMnn Now, ©XefHEBHbIM KOHTPONEM NOKagaTeneit JIBDM, 4To NosBonano Takxe KOPPUrMpoBaTs AO3y HUSKONHTeHCHBHOFO NasepHOTO OGNYHEHMA B PasHble cagbi TeYeHMA BOCNANn- TenbHoro npouecca. O6beKTushoe onpeseneHne rpaHnu M AMHAMUKH TeYeHMA BOC- NanutenbHOro NPOUeCCa B PeaNbHOM MaCUUTAGe BPeMeHH C NOMOUIbIO SLO ui SIEM AaBaNO BOSMOKHOCTS CBOEBPEMEHHO AVAFHOCTHPOBAT OCNOKHEHHOE TeYEHME HE- KpoTwyeckoii bnerMoHb! M NPOBOAMTS afeKBaTHoe neYeHue. ChasnuTenbHbie 2aHHble pesynbTaToB NeYeHNA HEKPOTHYECKOI dbserMOHbI HOBO- POXOEHHEIX TPAAMUMOHHEIM MeTOAOM HC NOMOLbIO NazepHoro BosgerCTBNA NpMBe- enti 8 Ta6nnue 3. 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Kak cnegyer v3 npuBeneHHbix 8 TAGNMLe AAHHbIX, NPMMeHEHHe NasepHoro Many- 4eHMA npM neveHnn riceBAObypyHKynesa MOSBONAND YMeHbUIMT KPOBONOTEpIO NU onepaTusHOM BMeWaTeNbCTBe 40 MUHMMyMa, CTMMynMpoBaTb Npouecct! pereHe- pau, Mo6maN30BaTb 3aLIMTHBIe CMNbI OpraHnama peGeHka, 4TO B MTOre COKpaTMNO CPpoku npeSbiBaHua B CTauMoHape B 1,4 pasa.AKTYAFIbHBIE BONPOCbI SKCTPEHHOM XMPYPr Ta6nnua 4 Noxasatenu aneksatHok socnanutenbHod peaxunn y aeteh € ncesgodypynkynesom npu TpaqMunoHHom neveHMn wneveHnu nasepHbim ny4om Teynna Cpokn | Hopmanwaauna | epwon Teproa CpoKi Gonbitix nevenma | noxasarenen | rsxenoro | nuxopa Hopma- (ann) JBM cocronma | nosnoro | nvaawan (amin) coctonima | dopmynut (anu) Kposn (an) Tpynna cpasnenun 11.2#1,6 1281.6 6,720.9 7.5214 10,120,5 Boxpurtine C05 - na- 7 n sepium cxanrenea | 8880.7 8,120.3 5,4t1,1 6.320,7 7,440.6 Bexpere COp-nase- | 7 619.6 7,620,8 5,240,8 5,740.8 6,240.8 pom + HANI Bce BbiulensnoxeHHoe He OsHataeT, 4TO NasepHbiii CKANBTENb MOKET SaMeHuTb Bce cylecTByIOLIMe CnOCO6tI OnepaTMBHOTO NeYeHHIA THOMHEX SaGONeBAHMi y Ae- Teli. VasectHo, 410 npuMeneHue nasepHoro ckanbnena Ana AMHeMHbIX paspesos, NPM BCKPBITHN THOVIHEIX NONOCTEH NPHBOAUT K YAAMKHEHMIO CDOKOB 3AKHENEHHA paH. MpumeeHue >e BbicoKOsHEPreTH4ecKOrO NaSepHOrO AYA ANIA TONeYHEX paape- 308 4 O6pa6orku NonocTu rHoHOr ONara COKpau\aeT CPOKN NeYeHUA, HO NpMMe- HsiTb ero HeOGxoAMMO CTporo No NokasaHuAM. Np CTporom CoBmonernn TexHuKn onepaumn Mi CooTBeTCTBYIOWUNx NpakTM4eCKHXx HaBbIKAX y XAPypra 9TH OCAOKHEHUA hoKmovatorca. JIA uv JIBOM, senace HeEMHBASMBHbIMN MeTODaMN uccnegosanna, AalOT UHOpmaunio B peanbHom MaculTabe Bpemenu, nepcnektuBHbl B AMarHocTu- ke W O6bekTHBHOM OUeHKe TeHeHHA XAPyPrUNECKON MdeKUNM, a TaKKe aneKBaTHO Aosmposke (HM) oGny4eHna y AeTel paHHero rpyaHoro Bospacta. VicnonbsoBaHne fasepHoro Ay¥a NPM HeYeHIAA xupyprM4ECKOH HHcbeKUMMM y AeTeD yMeHBUaeT CpoKA Ae4eHMs B CTaLMOHape B 1,3 pasa. JWTEPATYPA, 1. Anexcarapos M.T. // Cospementioe coctontize npoSneme! npUMEHeHHA nagepHom MeANUMNCKOA TexHikH B KnHHAYECKOI MpaKTike, / Te3. HOKN., 4. 1. —M.,1992. ~ C. 135-136. 2. Bpanb TE., Anntia O.P., Benanna CV. wap. // Marepvansi Mexayriap. xoHd. «Homsle gocTinxe- Hua NasepHor menue. — CN6., 1993. -C. 250-251 3. Kpacinos B.D. Yynpos 1.M., Kngosnios A.A. // Matepnansi VI xoHrpecca nenuarpos Poccnm «Heornoxttie coctonuis y nereli». ~ M., 2000. —C. 156. 4. Yrucenko B.V., Bansko B.B., Yrucenko E.T. // Marepuansi MexnyHap. xonbep. «Hosuie aocru- xeHMA NasepHol MeanuMHibI». ~ CTIG., 1993. -C. 318-319 5. Uyman BP, Wep6ivia B.M., Mauikos A.E.,w ap. // C6. noknanos, crareli, cooBweHnit u uccneno- Banu «Mlasepel n aspononss 8 Guomenmunter. - Kanyra - O6HMHcK, 1997. - C, 202-204. 6. Yexmapes B.M., Anexcanapos M.T., Axmenos M.A. // Matepuanu IV Mexnyriap. xoxrpecca «Mpo- Gnemu! nasepHoli MeanumHst». ~M.~Bugnoe, 1997. -C. 100-101 7. Yekmapes B.M., Anexcannpos M.T., AxMenoB M.A., w ap. // AnbMaHax KnMHivecKoa MenMUMHis, T V. «AkryambHie npoBNeMb! NaTonorMn AeTCKOrO BOSpacTa>. -M., 2002. ~C. 147-153, 8. Yepnanues A.l., Kycenumat A.1., Mamonroesa A.B. // Tes. HaysHo-npakta\. Kon. poccitlicKnx yweHtix «Aktyanbible acnexris nasepHolt MeaMunHbim. ~ M. - Kanyra, 2002. - C. 298-300.