Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / @xirurgi_2025 / @xirurgi_2025 - 1367 - файл
.pdf
31
https://t.me/med1917
ad[H*CaIJGUbFId*L* CaGJ`TJZ*aHCXDHWIdZ*EKJIFW*XJTHFIECL*D*LCDXJ[HEF[NIdYH*
`JaC[FLJIHSYH*KHcFVIHKJ*H*(q:ŸPjo >**
*****œ„^h* SL[SFEDS* YFRHJECGCY* GJIIFMC* CELFEJ<* DFKGFEHGUFEDS* XGFHYUfFDELFIIC*
YJKGC_JMJYH<*.^[HY_CTHEJYH*H*gIRCEF[HCTHEJYH<*J*EJKbF*gIEFGCTHEJYH<*M[JLIdY*
DEHYU[SECGCY* DHIEF`J* XFVFINe* aF[KCL* CDEGCW* _J`d<* XGC[H_FGJTHH* H*
RH__FGFITHGCLKH* ’^* K[FECK<* FMC* UGCLFIN* XCLdcJFEDS* L* EFVFIHF* j* VJDCL* XCD[F*
DEHYU[J* H* DCZGJISFEDS* XFGLdF* Qj*VJDJ* IJ* _CIF* ESbF[CMC* (q:ŸPji >* „€|Ž‡* y>* ž*
DCJLE>*CXGFRF[H[H<*VEC*U*ICLCGCbRFIIdZ*D*(q:*DdLCGCECVIdF*UGCLIH*œ„^h*H*œ„^i*
ad[H*`IJVHEF[NIC*LdcF*XC*DGJLIFIHe*D*Y[JRFITJYH*D*RHDKHIF`HFW*2:.<*XGH*gECY*
IF* ad[C* CaIJGUbFIC* `IJVHEF[NIdZ* GJ`[HVHW* YFbRU* UGCLIFY* œ„^h* H* œ„^i* U*
ICLCGCbRFIIdZ* D* RHDKHIF`HFW*XC* DGJLIFIHe* D* ICLCGCbRFIIdYH* aF`* XGH`IJKCL*
IFXFGFICDHYCDEH* gIEFGJ[NICMC* XHEJIHSŸPjP >* Œ}•ƒ†}ŠŠ* „>* ž* žCJLE>*
XGCRFYCIDEGHGCLJ[H<* VEC* UGCLIH* œ„^i* H* œ„^h* `IJVHEF[NIC* LdcF* L* MGUXXF*
ICLCGCbRFIIdZ<* XCEGFaCLJLcHZ* ZHGUGMHVFDKCMC* [FVFIHS* (q:ŸPjj >* …‡Ž~•Ž¤‡†}**
y>*H*DCJLE>*CEYFEH[H*aC[FF*IH`KHW*UGCLFIN*EGJID_CGYHGUefFMC*_JKECGJ*GCDEJ^²*H*
œ„^Q*L*KGCLH*H*aC[FF*LdDCKHF*UGCLIH*œ„^i*U*RFEFW*q(9.*H*(q:ŸPj™ >*%IJ[CMHVIC*
x‡††}•*…>*D*DCJLE>*CaIJGUbH[H<*VEC*KCITFIEGJTHS*L*X[J`YF*œ„^h*ad[J*XCLdcFIJ*L*k*
H*P]*GJ`<*DCCELFEDELFIIC<*U*ICLCGCbRFIIdZ*D*DCVFEJIHFY*(q:*H*aJKEFGHJ[NICMC*
DFXDHDJ<*XC* DGJLIFIHe*D*Y[JRFITJYH* EC[NKC*D*DFXDHDCY* H*KCIEGC[NICW* MGUXXCW*
ICLCGCbRFIIdZ* D* CEGHTJEF[NIdYH* MFYCKU[NEUGJYHŸPjh >* :GCYF* ECMC<*
DdLCGCECVIdW*UGCLFIN*œ„^h*ad[*`IJVHEF[NIC*LdcF*U*UYFGcHZ*RFEFW<*XC*DGJLIFIHe*
D*LdbHLcHYH*XCD[F*XFGFIFDFIICMC*(q:>*…‡†•}‚*£>*H*DCJLE*LdSLH[H*XCLdcFIIdW*
UGCLFIN*œ„^h* IJ*o^W*RFIN* bH`IH*U* ICLCGCbRFIIdZ<*U*KCECGdZ*GJ`LH[DS*(q:<* XC*
DGJLIFIHe*D*ICLCGCbRFIIdYH*DC*DXCIEJIICW*KHcFVICW*XFG_CGJTHFWŸPQ™ >*
*****œ„^P]<* XC* RJIIdY* [HEFGJEUGd<* SL[SFEDS* CDICLIdY* XGCEHLCDXJ[HEF[NIdY*
THECKHICY*H<*EJKHY*CaGJ`CY<*XCLdcFIHF*FMC*UGCLIS*YCbFE*DLHRFEF[NDELCLJEN*Ca*
JKEHLJTHH*`JfHEIdZ*KCYXFIDJECGIdZ*YFZJIH`YCL*R[S*XCRJL[FIHS*LCDXJ[HEF[NICW*
GFJKTHHŸPjO >* ˆ}ŠŠ}‚ƒ* ”>* D* DCJLE>* L* gKDXFGHYFIEJ[NIdZ* GJaCEJZ* IJ* bHLCEIdZ*
CEYFEH[H*XCLdcFIHF*UGCLIS*œ„^P]*XCD[F*`JLFGcFIHS*CDEGCW*_J`d*LCDXJ[FIHS*XGH*
(q:* H* DFXDHDFŸPk] >* -GCLFIN* œ„^P]* XCLdcJFEDS* L* KGCLH* U* ICLCGCbRFIIdZ* D*
32
https://t.me/med1917
ESbF[dY* (q:ŸPjO >* =CYHYC* gECMC<* YJEFGHIDKCF* YC[CKC* DCRFGbHE* L* aC[NcCY*
KC[HVFDELC* JKEHLIdW* œ„^P]<* DIHbFIHF* bF* FMC* UGCLIS* L* MGURICY* YC[CKF*
JDDCTHHGCLJIC* D* ULF[HVFIHFY* VJDECEd* (q:* U* IFRCICcFIIdZ*
ICLCGCbRFIIdZŸPkP >**
*****.JKbF*ad[C*XCKJ`JIC<*VEC*”z¯°*XCLdcFI*U*XJTHFIECL*D*(q:<*CI*DEHYU[HGUFE*
YHMGJTHe* [FWKCTHECL* H<* KJK* D[FRDELHF<* CDEGC_J`IdW* CELFE<* H* HMGJFE* GC[N* L*
JXCXEC`F*gIEFGCTHECL*H*MFIF`F*MFYCRHIJYHVFDKHZ*IJGUcFIHWŸPkQ >*
*****4`UVFIHe* THECKHICLCMC* XGC_H[S* KJ[J* ICLCGCbRFIICMC* XGH* `JaC[FLJIHSZ*
KHcFVIHKJ*L*CE[HVHF*CE*DdLCGCECVICMC*XGC_H[S*XCDLSfFId*FRHIHVIdF*GJaCEd<*H*
RJIIdF* HZ* XGCEHLCGFVHLdŸPkO<* Pkj >* .JK<* :CIIHKCLJ* ">* D* DCJLE>* XGCLCRH[H*
HDD[FRCLJIHF* THECKHICLCMC* XGC_H[S* KJ[J* IFRCICcFIIdZ* ICLCGCbRFIIdZ* * XGH*
GJIIFY* H* CE[CbFIICY* IJVJ[F* q=ŸPkk >* =C* HZ* GF`U[NEJEJY* XC`RIFF* IJVJ[C* q=*
pXCD[F* O^Z* DUECK* bH`IHr* JDDCTHHGCLJIC* D* LCDXJ[FIHFY* L* KHcFVICW* DEFIKF* H*
XCLdcFIHFY* _FKJ[NIdZ* YJGKFGCL>* œ„^i* ad[* `IJVHEF[NIC* XCLdcFI* L* MGUXXF*
XC`RIFMC*IJVJ[J* q=<* J*DCCEICcFIHF* œ„^P]mœ„^i* `IJVHEF[NIC*DIH`H[CDN* L* RJIICW*
MGUXXF>*=GH*gECY*RCDECLFGIdF*H`YFIFIHS*L*THECKHICLCY*XGC_H[F*KGCLH*XC[UVFIC*
IF* ad[C>* .JKbF* JLECGd* CEYFVJeE<* VEC* UGCLFIN* THECKHICL* L* KJ[F* IF* `JLHDF[* CE*
DUaDEGJEJ* q=<* VEC* XC`LC[SFE* XGFRXC[CbHEN<* VEC* XGFLJ[HGUefHY* HDECVIHKCY*
THECKHICL*SL[SFEDS*gIRCMFIIJS*XGCRUKTHS>**
*****.JKHY*CaGJ`CY<*XGHIHYJS*LC*LIHYJIHF*GF`U[NEJEd*XGCLFRFIIdZ*HDD[FRCLJIHW<*
H`UVFIHF*THECKHICLCMC*XGC_H[S*KJ[J*XCDGFRDELCY*CXGFRF[FIHS*DCCEICcFIHS*XGC^*
H* XGCEHLCLCDXJ[HEF[NIdZ* THECKHICL* L* `JLHDHYCDEH* CE* CalFYJ* H* DUaDEGJEJ*
gIEFGJ[NICMC*XHEJIHS*IFRCICcFIIdZ*ICLCGCbRFIIdZ*YCbFE*adEN*XFGDXFKEHLIdY*
YFECRCY*RHJMICDEHKH*EC[FGJIEICDEH*K*gIEFGJ[NICYU*XHEJIHe*U*RJIICW*KJEFMCGHH*
ICLCGCbRFIIdZ>*
*
33
>****************
https://t.me/med1917
ГЛАВА 2. МАТЕРИАЛЫ И МЕТОДЫ ИССЛЕДОВАНИЯ
2.1 Характеристика основных групп исследования
*****$JaCEJ*LdXC[IFIJ*L*!+0-*5(946*%+=*HY>*/>4>*:U[JKCLJ?*9HI`RGJLJ*$CDDHH*
pRHGFKECG* \* JKJRFYHK* $%(<* R>Y>I><* XGC_FDDCG* +>.>,UZHZr>* :[HIHVFDKJS* VJDEN*
GJaCEd* LdXC[IFIJ* L* 4IDEHEUEF* IFCIJEC[CMHH* H* XFRHJEGHH* pRHGFKECG* \* R>Y>I><*
XGC_FDDCG*/>/>@UaKCL>r*L*CERF[FIHH*GFJIHYJTHH*H*HIEFIDHLICW*EFGJXHH*HY>*XGC_>*
%>+>%IECICLJ* p`JLFRUefHW* \* R>Y>I><* RCTFIE* )>/>4CICLr<* CERF[FIHSZ* XJEC[CMHH*
ICLCGCbRFIIdZ*H*IFRCICcFIIdZ*RFEFW*p)=((#r*p`JLFRUefJS*)=((#*\*R>Y>I><*
XGC_FDDCG* 4>4>$eYHIJ<* `JLFRUefJS* )=((#Q\* K>Y>I>* ">/>+GCcFLJr* !+0-*
5(946* %+=* HY>* />4>* :U[JKCLJ?* 9HI`RGJLJ* $CDDHH* H* L* +0-@* 59CDKCLDKHW*
Ca[JDEICW*XFGHIJEJ[NIdW*TFIEG?*pM[JLIdW*LGJV*\*R>Y>I>*)>!>*,FGCLJ<*`JYFDEHEF[N*
M[JLICMC* LGJVJ* XC* XFRHJEGHVFDKCW* VJDEH* K>Y>I>* %>,>* =FEGCLJr* L* CERF[FIHH*
GFJIHYJTHH* H* HIEFIDHLICW* EFGJXHH* ICLCGCbRFIIdZ>* ,XFTHJ[NIdF* YFECRd*
HDD[FRCLJIHS* CDUfFDEL[S[HDN* L* [JaCGJECGHH* THEC[CMHH* p`JLFRUefHW* \* K>a>I>*
%>9>:GJDIdWr*!+0-*5(946*%+=*HY>*/>4>*:U[JKCLJ?*9HI`RGJLJ*$CDDHH>*/DFMC*
L*HDD[FRCLJIHF*LCc[H*kP™*IFRCICcFIIdZ*ICLCGCbRFIIdZ*RFEFW>*
Критерии включения в исследование: *
• IFRCICcFIIdF*ICLCGCbRFIIdF*+/OQ*IFRF[H*H*YFIFF>*
Критерии исключения:
• IFRCICcFIIdF* ICLCGCbRFIIdF* D* YICbFDELFIIdYH* XCGCKJYH* GJ`LHEHS<*
KGHEHVFDKHYH* LGCbRFIIdYH* XCGCKJYH* DFGRTJ<* IJD[FRDELFIIdYH* aC[F`ISYH*
CaYFIJ*LFfFDELš*
• IFRCICcFIIdF*ICLCGCbRFIIdF*D*CEFVICW*_CGYCW*MFYC[HEHVFDKCW*aC[F`IHš*
• IFRCICcFIIdF* ICLCGCbRFIIdF<* XCDEUXHLcHF* H`* RGUMCMC* DEJTHCIJGJ
pE>K>*HDD[FRCLJIHF*XGFRXC[CMJFE*LK[eVFIHF*XJTHFIECL*D*XFGLCMC*RIS*bH`IHrš*
• IFRCICcFIIdF*ICLCGCbRFIIdF<*UYFGcHF*RC*IJVJ[J*gIEFGJ[NICMC*XHEJIHS>
34
Недоношенные новорожденные ГВ <32 недель, вскармливающиеся
N = 317
Основная группа:
N=55
Критерии
N = 85
https://t.me/med1917
*****@JKCIIdYH* XGFRDEJLHEF[SYH* LDFZ* RFEFW<* LK[eVFIIdZ* L* HDD[FRCLJIHF<* ad[H*
XCRXHDJId* HI_CGYHGCLJIIdF* DCM[JDHS>* :[HIHVFDKCF* HDD[FRCLJIHF* CRCaGFIC*
KCYHDDHFW*XC*gEHKF*aHCYFRHTHIDKHZ*HDD[FRCLJIHW*pXGCECKC[*•PP*CE*P™*RFKJaGS*
Q]P™*M>r*XGH*!+0-*5(946*%+=*HY>*/>4>*:U[JKCLJ?*9HI`RGJLJ*$CDDHH>**
*****#[S*GFcFIHS*P^CW*`JRJVH*ad[*XGCLFRFI*JIJ[H`*JIEFIJEJ[NIdZ*H*XCDEIJEJ[NIdZ*
_JKECGCL* GHDKJ* GJ`LHEHS* (q:* pGHDUICK* Q>Pr>* /* GFEGCDXFKEHLICF* HDD[FRCLJIHF*
ad[H* LK[eVFId* QOQ* IFRCICcFIIdZ* ICLCGCbRFIIdZ* +/* YFIFF* OQ* IFRF[N<*
XGCZCRHLcHZ* [FVFIHF*L* )$4.* HY*%>+>%IECICLJ* L* Q]Po\Q]Q]*MM><* KCECGdF* ad[H*
GJ`RF[FId*IJ*Q*MGUXXd—**
P*MGUXXJ*\*CDICLIJS*MGUXXJ\*RFEH*D*RHJMICDEHGCLJIIdY*(q:*P^O*DEJRHH*XC*’~ŠŠš**
Q*MGUXXJ*\*MGUXXJ*DGJLIFIHS*\*RFEH*aF`*RHJMIC`J*(q:*
*
*
*
согласно клиническим рекомендациям 2015 г, проходившие лечение в
*
ОРИТН 2017-2019 гг
*
*
*
исключения
*****
*
*
232 недоношенных новорожденных
*
*
*
Новорожденные,
*
развившие
НЭК I-III по Веll
Группа сравнения:
дети без НЭК
N=177
*
$HDUICK*Q>P*\*#H`JWI*HDD[FRCLJIHS*R[S*GFcFIHS*`JRJVH*P*
*
*
#[S* GFcFIHS* Q^W* H* O^W* `JRJV* ad[C* XGCLFRFIC* YU[NEHTFIEGCLCF*
XGCDXFKEHLICF*GJIRCYH`HGCLJIICF*HDD[FRCLJIHF*IJ*aJ`F*RLUZ*TFIEGCL—*)$4.*HY*
XGC_>* %>+>* %IECICLJ* !+0-* 5(946* %+=* HY>* JKJR>* />4>* :U[JKCLJ?* 9@* $!* H*
35
https://t.me/med1917
)$4.(* +0-@* 59CDKCLDKHW* Ca[JDEICW* XFGHIJEJ[NIdW* TFIEG?* L* XFGHCR* D* HeIS*
Q]Q]*MCRJ*XC*RFKJaGN*Q]QP*MCRJ>**
*****/DFMC* L* HDD[FRCLJIHF* LCcF[* OkP* ICLCGCbRFIIdW>* $JDXGFRF[FIHF* L* MGUXXd* L*
`JLHDHYCDEH* CE* YFECRHKH* LDKJGY[HLJIHS* CDUfFDEL[S[CDN* YFECRCY*
DEGJEH_HTHGCLJIICW* LdaCGKH* XC* +/>* hj* XJTHFIEJ* Ldad[H* H`* HDD[FRCLJIHS* XC*
KGHEFGHSY* HDK[eVFIHS<* )KCIVJEF[NIdW* CalFY* HDD[FRCLJIHS* DCDEJLH[* Qio*
XJTHFIECL*MFDEJTHCIICMC*LC`GJDEJ*QjmO*\*OQm]*IFRF[N*YJDDCW*EF[J*XGH*GCbRFIHH*CE*
jok* M* RC* QQik* M>* 4I_CGYHGCLJIICF* DCM[JDHF* Ca* UVJDEHH* L* HDD[FRCLJIHH* ad[C*
XC[UVFIC*CE*GCRHEF[FW*LDFZ*XJTHFIECL>**
*****)afHF* XGHITHXd* gIEFGJ[NICMC* XHEJIHS<* `JKGFX[•IIdF* L* K[HIHVFDKHZ*
GFKCYFIRJTHSZ* pQ]Pk* MrŸP <* EJKHF* KJK* IJVJ[C* q=* L* LC`GJDEF* h* VJDCL* bH`IH<*
XGHCGHEFE* MGURICMC* LDKJGY[HLJIHS<* LLFRFIHF* YC[C`HLJ* D* XFGLdZ* VJDCL* bH`IH<*
KGJEICDEN* H* DXCDCad* KCGY[FIHS<* XCKJ`JIHS* K* LGFYFIICW* CEYFIF* q=<*
XGCEHLCXCKJ`JIHS*K*q=<*_JKECGd*GHDKJ*DIHbFIHS*XFGFICDHYCDEH*q=<*CXGFRF[FIHF*
H* J[MCGHEY* RFWDELHW* XGH* LC`IHKICLFIHH* IFXFGFICDHYCDEH* q=<* DCZGJIS[HDN* L*
IJcFY*HDD[FRCLJIHH*R[S*LDFZ*XJTHFIECL>**
*****(CLCGCbRFIIdF* +/* aC[FF* Qi* IFRF[N* ad[H* GJ`RF[FId* IJ* RLF* MGUXXd—*
XGCMGJRHFIEICMC*H*DEJIRJGEICMC*IJGJfHLJIHS*gIEFGJ[NICMC*XHEJIHS*pGHDUICK*Q>Qr>*
*****qIEFGJ[NICF*XHEJIHF*L*MGUXXF*XGCMGJRHFIEICMC*IJGJfHLJIHS<*L*KCECGUe*LCc[H*
PP™* XJTHFIECL<* XGCLCRH[CDN* L* DCCELFEDELHH* D* YFECRHKCW* XGCMGJRHFIEICMC*
IJGJfHLJIHS* q=* D* DUECVIdY* ULF[HVFIHFY* CalFYJ* IJ* O]* Y[mKMmDUE>* 9FECRHKJ*
XGCMGJRHFIEICMC* IJGJfHLJIHS* `JK[eVJFEDS* L* ULF[HVFIHH* CalFYJ* KJbRCMC*
KCGY[FIHS*IJ*GJLIUe*LF[HVHIU*L*EFVFIHF*DUECK>*
36
https://t.me/med1917
*
*
*
*
*
*
*
*
*
$HDUICK*Q>Q*\*#H`JWI*HDD[FRCLJIHS*R[S*MGUXX*RFEFW*D*+/*Qi^OQ*IFRF[H*
*
*
*****(JYH* GJ`GJaCEJIJ* XGCMGJYYJ<* KCECGJS* XC`LC[SFE* CRICYCYFIEIC* XC[UVHEN*
DUECVIdW*X[JI*LDKJGY[HLJIHS*GFaFIKJ*D*UKJ`JIIdY*CalFYCY*GJ`CLCMC*KCGY[FIHS—*
R[S*GJDVFEJ*[FVJfFYU*LGJVU*IFCaZCRHYC*LLFDEH*_JKEHVFDKUe*YJDDU*EF[J*GFaFIKJ*H*
DEJGECLdW*DUECVIdW*CalFY*KCGY[FIHS>*=GH*LC`IHKICLFIHH*K[HIHVFDKCW*DHEUJTHH<*
EGFaUefFW*DIHbFIHS*EFYXCL*DUECVICMC*ULF[HVFIHS*CalFYJ*q=*YFIFF*O]*Y[mKMmDUE<*
XGCMGJRHFIEIdW* ZJGJKEFG* IJGJfHLJIHS* DCZGJISFEDS>* =GHYFG* X[JIJ* DUECVICMC*
KCGY[FIHS*GFaFIKJ*XGFRDEJL[FI*IJ*GHDUIKF*Q>O>*
*
*
$HDUICK*Q>O*\*=GHYFG*DZFYd*XGCMGJRHFIEICMC*IJGJfHLJIHS*q=*
*
*
*****:CIEGC[NIJS* MGUXXJ<* L* KCECGUe* LCc[H* PP™* RFEFW<* LDKJGY[HLJ[JDN*
EGJRHTHCIIdY*DXCDCaCY<*DCM[JDIC*XGHISECYU*L*)$4.*HYFIH*XGC_>*%>+>*%IECICLJ*
37
https://t.me/med1917
LIUEGFIIFYU* XGCECKC[U*gIEFGJ[NICMC* XHEJIHS>* #JIIdW* XGCECKC[*XCRGJ`UYFLJFE*
RLUZgEJXICF* ULF[HVFIHF* DUECVICMC* CalFYJ* q=* L* O]* Y[mKMmD* R[S* RFEFW*
MFDEJTHCIICMC*LC`GJDEJ*Qi*IFRF[N*H*aC[FF*\*XC*Pk*Y[mKM*RLJ*GJ`J*L*DUEKH>**
*****(CLCGCbRFIIdF*MFDEJTHCIICMC*LC`GJDEJ*YFIFF*Qi*IFRF[N*ad[H*GJDXGFRF[FId*L*
O*MGUXXd—*XFGLJS*p‚³Pkr*\*D*XGCMGJRHFIEIdY*IJGJfHLJIHFY*gIEFGJ[NICW*IJMGU`KH*
D* FbFRIFLdY* ULF[HVFIHFY* IJ* O]* Y[mKM<* LECGJS* p‚³Phr* \* D* XGCMGJRHFIEIdY*
IJGJfHLJIHFY*DUECVICMC*CalFYJ*gIEFGJ[NICW*IJMGU`KH*Q]*Y[mKMmDUE<*EGFENS*p‚³Pir*
\* D* EGJRHTHCIIdY* IJGJfHLJIHFY* Q]* Y[mKMmDUE* \* RLJ* GJ`J* `J* DUEKH* IJ* P]* Y[mKM*
pGHDUICK*Q>jr>**
*
*
$HDUICK*Q>j*\*#H`JWI*HDD[FRCLJIHS*R[S*MGUXX*RFEFW*D*+/*YFIFF*Qi*IFRF[N*
*
*
*****#[S* GFcFIHS* j^CW* `JRJVH* DCaHGJ[HDN* CaGJ`Td* KJ[J* IFRCICcFIIdZ*
ICLCGCbRFIIdZ*MFDEJTHCIICMC*LC`GJDEJ*YFIFF*OQ*IFRF[N<*XGCZCRHLcHZ*[FVFIHF*L*
)$4.*HY*%>+>%IECICLJ*L*XFGHCR*D*HeIS*Q]Q]*XC*RFKJaGN*Q]QQ*MCRJ<*FbFRIFLIC*IJ*
XGCESbFIHH*XFGLdZ*Pj*RIFW*bH`IH*IFRCICcFIIdZ*ICLCGCbRFIIdZ>*/DF*CaGJ`Td*
ad[H* `JYCGCbFId* DGJ`U* XCD[F* `JaCGJ* XGH* EFYXFGJEUGF* ^i]* £* H* ZGJIH[HDN* L*
[JaCGJECGHH*aHCaJIKJ>*/DFMC*ad[C*DCaGJIC*Okh*CaGJ`TCL>*
*****#[S*JIJ[H`J*ad[H*LdaGJId*CaGJ`Td*jh*ICLCGCbRFIIdZ—*YFKCIHW*L*XFGLdF*RLCF*
DUECK*bH`IH<*CaGJ`Td*KJ[J<*DCCELFEDELUefHF*RISY*RCDEHbFIHS*CalFYJ*q=*P]]*H*
Ph]* Y[mKMmDUE<* J* EJKbF* DCCELFEDELUefHF* GJ`LHEHe* gXH`CRJ* IFXFGFICDHYCDEH*
gIEFGJ[NICW*IJMGU`KH*H[H*(q:>*
38
https://t.me/med1917
2.2 Характеристика методов исследования
*
*****Клинико-анамнестический метод* LK[eVJ[* L* DFaS* H`UVFIHF* DCYJEHVFDKCMC* H*
JKUcFGDKC^MHIFKC[CMHVFDKCMC*JIJYIF`J*YJEFGH<*EFVFIHS*aFGFYFIICDEH*H*GCRCL>**
*****=GCLFRFI*JIJ[H`*EJKHZ*XCKJ`JEF[FW<*KJK*MFDEJTHCIIdW*LC`GJDE<*YJDDJ^GCDECLdF*
XJGJYFEGd*XGH*GCbRFIHH*RFEFW<*CTFIKJ*XC*cKJ[F*%XMJG*L*KCITF*P^W*H*k^W*YHIUE*
bH`IH<* GF`U[NEJEd* K[HIHKC^[JaCGJECGIdZ* H* HIDEGUYFIEJ[NIdZ* YFECRCL*
HDDD[FRCLJIHS<*XCEGFaICDEN*L*HILJ`HLICWmIFHILJ`HLICW*GFDXHGJECGICW*EFGJXHH*H*
FF* R[HEF[NICDEN<* XCEGFaICDEN* L* XGCLFRFIHH* HICEGCXICW* EFGJXHH* H* FF*
HIEFIDHLICDEN<*ZJGJKEFG*DUaDEGJEJ*gIEFGJ[NICMC*XHEJIHS>*/*KJVFDELF*KCIEGC[NIdZ*
ECVFK*CTFIHLJ[HDN*D[FRUefHF*XCKJ`JEF[H—*DGCKH*RCDEHbFIHS*CalFYJ*XHEJIHS*P]]*
Y[mKMmDUE* pCalFY* gIEFGJ[NICMC* XHEJIHS<* XGH* KCECGCY* `JLFGcJFEDS* HI_U`HS*
bHGCLdZ* gYU[NDHWr*H* Ph]* Y[mKMmDUE<*KC[HVFDELC* RIFW* L*XFGLdF* j* IFRF[H* bH`IH*
GFaFIKJ<*CalFY*q=*L*KCECGdZ*ad[*GJLFI*H*XGFLCDZCRH[*P]]*H*Ph]*Y[mKMmDUE*pKJK*
XCKJ`JEF[N*EC[FGJIEICDEH* K*q=r<* R[HEF[NICDEN*_UIKTHCIHGCLJIHS* TFIEGJ[NICMC*
LFIC`ICMC* KJEFEFGJ* H* XFGH_FGHVFDKCMC* LFIC`ICMC* KJEFEFGJ<* VJDECEJ* gXH`CRCL*
HI_FKTHCIICMC* XGCTFDDJ<* XCEGFaCLJLcHZ* IJ`IJVFIHS* XCLECGICMC* KUGDJ*
JIEHaJKEFGHJ[NICW* EFGJXHH<* VJDECEJ* GJ`LHEHS* D[UVJFL* HIEC[FGJIEICDEH* K*
gIEFGJ[NICW*IJMGU`KF*L*LHRF*IFKGCEH`HGUefFMC*gIEFGCKC[HEJ*P*DE*H*RHDKHIF`HH*
2:.>* (FDXFTH_HVIdYH* K[HIHVFDKHYH* XGCSL[FIHSYH* (q:* H* RHDKHIF`HH* 2:.*
SL[S[HDN—*L`RUEHF*H*IJXGSbFIHF*bHLCEJ<*aC[F`IFIICDEN*XGH*XJ[NXJTHH<*CaH[NICF*
DGdMHLJIHF<*ULF[HVFIHF*CalFYJ*CDEJECVICMC*DCRFGbHYCMC*bF[URKJ*aC[FF*k]s*CE*
GJ`CLCMC* CalFYJ*KCGY[FIHS<* EFYIC^`F[FICF* CKGJcHLJIHF* bF[URCVICMC* JDXHGJEJ>*
#HJMIC`*(q:*UDEJIJL[HLJ[DS*XGH*LdSL[FIHH*[JaCGJECGIdZ*XGH`IJKCL*DHDEFYICMC*
LCDXJ[HEF[NICMC* CELFEJ* L* DCVFEJIHH* D* HIDEGUYFIEJ[NIdYH* XGH`IJKJYH—*
U[NEGJ`LUKCLdYH*L*LHRF*UVJDEKCL*CEFKJ<*GHMHRICDEH<*XIFLYJEC`J*KHcFVICW*DEFIKH<*
JDTHEJ<* MJ`J* L* DCDURJZ* DHDEFYd* LCGCEICW* LFId* XFVFIHš* GFIEMFIC[CMHVFDKHZ*
XGH`IJKCL* \* XJGF`* KHcFVIHKJ* D* CEFKCY* DEFIKH<* XIFLYJEC`<* MJ`* XC* ZCRU* LFELFW*
LCGCEICW*LFId<*XIFLYCXFGHECIFUY<*CTFIKJ*ESbFDEH*EFVFIHS*(q:*XGCLCRH[JDN*XC*
KGHEFGHSY* XC* ’~ŠŠŸPkh >* #HJMIC`* RHDKHIF`HH* 2:.* UDEJIJL[HLJ[DS* XGH* IJ[HVHH*
39
https://t.me/med1917
XGH`IJKCL*HIEC[FGJIEICDEH* K* gIEFGJ[NICW*IJMGU`KF<* EGFaUefFW* XC[ICW* CEYFId*
gIEFGJ[NICMC*XHEJIHS*IJ*DGCK*aC[NcF*Qj*VJDCL<*IC*IF*RHJMICDEHGCLJIICW*KJK*(q:*
Q*H*O*DEJRHH*XC*/~ŠŠ>*.JKbF*CTFIHLJ[JDN*VJDECEJ*GJ`LHEHS*IFCIJEJ[NICMC*ZC[FDEJ`J*
KJK* CD[CbIFIHS* R[HEF[NICMC* XJGFIEFGJ[NICMC* XHEJIHS* H* MFYCRHIJYHVFDKCMC*
`IJVHYCMC* JGEFGHJ[NICMC* XGCECKJ>* /* KJVFDELF* LECGHVIdZ* ECVFK* CTFIHLJ[HDN—*
XGCRC[bHEF[NICDEN*XGFadLJIHS*L*)$4.(<*CafJS*XGCRC[bHEF[NICDEN*XGFadLJIHS*
L* DEJTHCIJGF<*YJDDC^GCDECLdF*XCKJ`JEF[H* XGH* RCDEHbFIHH* XCDEKCITFXEUJ[NICMC*
LC`GJDEJ* Oh* IFRF[N* H* XGH* LdXHDKF* H`* DEJTHCIJGJ>* #[S* CTFIKH* XCKJ`JEF[FW*
_H`HVFDKCMC* GJ`LHEHS* ICLCGCbRFIIdZ* ad[H* HDXC[N`CLJId* DEJIRJGEd* R[S*
IFRCICcFIIdZ*œz”t‘w‘{Œ”x^QP>*/*KJVFDELF*ICGYJ[NICMC*GJ`LHEHS*XGHIHYJ[H*
XCKJ`JEF[H* L* XGFRF[JZ* CE* P]* RC* ™]* XFGTFIEH[FW>* #CXC[IHEF[NIC* XGCLCRH[JDN*
CTFIKJ* YJDDC^GCDECLdZ* XCKJ`JEF[FW* XC* cKJ[F* §^•ž€†~D* GJDVFECY* §^XCKJ`JEF[S*
pKC[HVFDELC*DEJIRJGEIdZ*CEK[CIFIHW*CE*DGFRIFMC*`IJVFIHSrŸPko >*
*****#HJMIC`*LIUEGHbF[URCVKCLdZ*KGCLCH`[HSIHW*p/2:r*UDEJIJL[HLJ[DS*DCM[JDIC*
K[JDDH_HKJTHH*$CDDHWDKCW*JDDCTHJTHFW*DXFTHJ[HDECL*XFGHIJEJ[NICW*YFRHTHId>*
#HJMIC`* XFGHLFIEGHKU[SGICW* [FWKCYS[STHH* p=/&r* UDEJIJL[HLJ[DS* D* UVFECY*
RJIIdZ*IFWGCDCICMGJ_HH* H*YJMIHEIC^GF`CIJIDICW*ECYCMGJ_HH* p9$.r*MC[CLICMC*
YC`MJ<* RHJMIC`* GFEHICXJEHS* UDEJIJL[HLJ[DS* DCM[JDIC* YFbRUIJGCRICW*
K[JDDH_HKJTHH* GFEHICXJEHH* IFRCICcFIIdZ* pœ£‘{vr<* RHJMIC`* aGCIZC^[FMCVICW*
RHDX[J`HH* p0&#r* \* DCM[JDIC* KGHEFGHSY* y>x>* ˆ€¡~* H* t>’‡‚ž‡Š‡†}* L*
XCDEKCITFXEUJ[NICY*LC`GJDEF*Oh*IFRF[N>*
Лабораторные методы
P>* /DFY* XJTHFIEJY* LdXC[IS[HDN* DEJIRJGEIdW* KCYX[FKD* K[HIHKC^[JaCGJECGICMC*
CaD[FRCLJIHS* DCM[JDIC* LIUEGFIIHYH* XGCECKC[JYH* )$4.<* LK[eVJefHW* L* DFaS—*
K[HIHVFDKHW* JIJ[H`* KGCLH<* K[HIHVFDKHW* JIJ[H`* YCVH<* CXGFRF[FIHF* UGCLIS* ,^
GFJKEHLICMC* aF[KJ<* XGCKJ[NTHECIHIJ<* aHCZHYHVFDKHW* JIJ[H`* KGCLH<*
GFIEMFICMGJ_He* CGMJICL* MGURICW* K[FEKH<* YHKGCaHC[CMHVFDKCF* HDD[FRCLJIHF*
KGCLH<* DKGHIHIM* KGCLH* YFECRCY* XC[HYFGJ`ICW* TFXICW* GFJKTHFW* p=6$r* IJ*
aJKEFGHJ[NIUe<* MGHaKCLUe<* LHGUDIdF* XJIF[H* p`JLFRUefJS* K[HIHKC^
RHJMICDEHVFDKCW* [JaCGJECGHFW* R>Y>I>* .>1>4LJIFT><* `JLFRUefJS* [JaCGJECGHFW*
40
https://t.me/med1917
K[HIHVFDKCW* HYYUIC[CMHH* R>Y>I>* &>/>:GFVFECLJ><* `JLFRUefJS* [JaCGJECGHFW*
YHKGCaHC[CMHH* R>Y>I>* .>/>=GHXUEIFLHV<* `JLFRUfHW* [JaCGJECGHFW* YC[FKU[SGIC^
MFIFEHVFDKHZ*YFECRCL*K>Y>I>*%>">#CIIHKCLr>*
Q> )XGFRF[FIHF* KCITFIEGJTHH* THECKHICL* œ„^Q<* œ„^j<* œ„^h<* œ„^i<* œ„^P]<* w…^£u¯<*
œ¯z´*H*”z¯°*XGCLCRH[H*YU[NEHX[FKDIdY*YFECRCY*D*HDXC[N`CLJIHFY*DEJIRJGEICW*
i^X[FKDICW*EFDE^DHDEFYd* ’}€^vŠ~®*v†€*x•¦‡‚* £‹•€“}‚~*i^–Š~®* y••‡‹*p’}€^‘‡|r*IJ*
XGCECVICY* [J`FGICY* HYYUICJIJ[H`JECGF* ’}€^vŠ~®* Q]]* u‹••~¦* p’}€^‘‡|r>*
$F`U[NEJEd*CaGJaJEdLJ[H*D*XCYCfNe*XGH[CbFIHS*’}€^vŠ~®*…‡‚‡ƒ~†*h<]*v†€–~†•}~•*
p’}€^‘‡|r>*(FXCDGFRDELFIIC*XFGFR*HDD[FRCLJIHSYH*CaGJ`Td*KJ[J*ICLCGCbRFIIdZ*
GJ`YCGJbHLJ[H*IJ*[NRU>*#J[FF*CEaHGJ[H*]<P*M*CaGJ`TJ<*L*KCECGdW*RCaJL[S[H*]<™*M*
[FRSICMC*GJDELCGJ*’vu>*=CD[F*gECMC*XC[UVFIIdW*GJDELCG*MCYCMFIH`HGCLJ[DS*XGH*
XCYCfH* LCGEFKDHGCLJIHS>* /DF* XGCTFRUGd* XGCLCRH[H* IJ* [NRU>* #J[FF*
MCYCMFIH`HGCLJIIdW* GJDELCG* TFEGH_UMHGCLJ[H* Pk]]]* ƒ* Pk* YHI* XGH* j* µ£>*
)ECaGJIIdW* DUXFGIJEJIE* HDXC[N`CLJ[H* L* YU[NEHX[FKDICY* JIJ[H`F>* ,CRFGbJIHF*
THECKHICL*XGFRDEJL[FIC*L*XMmY[>*p`JLFRUefHW*[JaCGJECGHW*K>a>I>*%>9>*:GJDIdWr>*
Инструментальные методы исследования
P>-[NEGJ`LUKCLCF* HDD[FRCLJIHF* \* IFWGCDCICMGJ_HS<* gZCKJGRHCMGJ_HS<* H*
DD[FRCLJIHF*CGMJICL*aGecICW*XC[CDEH*^**LdXC[IS[CDN*L*P<*O<*o*D>b><*RJ[FF*P*GJ`*L*
o^P]* RIFW<* RCXC[IHEF[NIC* XC* XCKJ`JIHSY>* -[NEGJ`LUKCLdF* HDD[FRCLJIHS*
XGCLCRH[HDN* IJ* XGHaCGJZ* •}-}|^¶* w~‚~†‡Š* tŠ~ž•†}ž<* vŽ}Š}–•* £›k]* DCEGURIHKJYH*
CERF[J* U[NEGJ`LUKCLCW* RHJMICDEHKH* L* IFCIJEC[CMHH* H* XFRHJEGHH* p`JLFRUefJS*
CERF[CY*K>Y>I>*">%>!H[HXXCLJ>r>*
Q>*$FIEMFICMGJ_HS*CGMJICL*MGURICW*K[FEKH*H*aGecICW*XC[CDEH*LdXC[IS[JDN*LDFY*
M[UaCKC* IFRCICcFIIdY* ICLGCbRFIIdY* XGH* XCDEUX[FIHH* L* )$4.<* RJ[FF* XC*
XCKJ`JIHSY*L*DCCELFEDELHH*D*K[HIHVFDKHYH*XGCECKC[JYH*)$4.<*XGH*XCRGC`GFIHH*
IJ* GJ`LHEHF* (q:<* XFG_CGJTHe* KHcFVIHKJ>* $FIEMFIC[CMHVFDKCF* HDD[FRCLJIHF*
XGCLCRH[CDN* D* XCYCfNe* YCaH[NICMC* GFIEMFICLDKCMC* JXXJGJEJ* œ”y„‘y•* •†Š*
£€¦–‡ž•* t^P]]‘* x¯* ›QQ* p`JLFRUefHW* CERF[FIHFY* [UVFLCW* RHJMICDEHKH* K>Y>I>*
/>+>0dVFIKCr>*
*
Соседние файлы в папке @xirurgi_2025