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
41
https://t.me/med1917
Статистические методы исследования
*****,LFRFIHS* C* KJbRCY*XJTHFIEF* ad[H* `JIFDFId* L* aJ`U* RJIIdZ<* LdXC[IFIIUe*L*
DEJIRJGEICW*_CGYF*XGCMGJYYICMC*XGH[CbFIHS*t®ž~Š*pLFGDHS—*…}ž†€•€±•*{±±}ž~*t®ž~Š*
Q]QQr>**
*****,EJEHDEHVFDKJS*CaGJaCEKJ*RJIIdZ*LdXC[IFIJ*D*XCYCfNe*XGCMGJYYd*œ’…*uvuu*
u•‡•}••}ž•*•Qh*H*u•‡•”~žŽ*->*Q>i>O>*=GH*ICGYJ[NICY*GJDXGFRF[FIHH*KC[HVFDELFIICW*
XFGFYFIICW*LdVHD[S[H*DGFRIFF*JGH_YFEHVFDKCF*p9r<*DGFRIee*CcHaKU*p·¦r<*™ks*
RCLFGHEF[NIdW*HIEFGLJ[*p#4r>*=GH*IFICGYJ[NICY*GJDXGFRF[FIHH*KC[HVFDELFIIdZ*
XFGFYFIIdZ*R[S*KJbRCMC*XJGJYFEGJ*LdVHD[S[H*YFRHJIU*p9Fr*H*HIEFGKLJGEH[NIdW*
GJ`YJZ* pœ‰‘r* Qk\ok^MC* XFGTFIEH[S>* #[S* KJVFDELFIIdZ* RJIIdZ* CXGFRF[S[H*
XCKJ`JEF[N* VJDECEd* psr<* R[S* CTFIKH* L[HSIHS* _JKECGCL* GHDKJ* GJDDVHEdLJ[H*
CEICDHEF[NIdW*GHDK*p)$r*D*™ks*#4>*=FGFR*XGCLFRFIHFY*DGJLIHEF[NICMC*JIJ[H`J*
KC[HVFDELFIIdZ* RJIIdZ* L* HDD[FRUFYdZ* MGUXXJZ* XGCLFGS[H* DCCELFEDELHF*
ICGYJ[NICYU* GJDXGFRF[FIHe*pEFDE* :C[YCMCGCLJ\,YHGICLJ<* MGJ_HVFDKHW* JIJ[H`*
RJIIdZr>* =GH* ICGYJ[NICY* LHRF* GJDXGFRF[FIHS* RJIIdZ* R[S* CTFIKH* GJ`[HVHW* L*
MGUXXJZ* HDXC[N`CLJ[H* YFECRd* XJGJYFEGHVFDKCW* DEJEHDEHKH* p•^KGHEFGHW*
,ENeRFIEJr>*
*****=GH* GJDXGFRF[FIHH* XGH`IJKCL<* CE[HVJefHZDS* CE* ICGYJ[NICMC<* XGHYFIS[H*
YFECRd*IFXJGJYFEGHVFDKCW*DEJEHDEHKH>*#[S*XCXJGICMC*DGJLIFIHS*KC[HVFDELFIIdZ*
RJIIdZ*HDXC[N`CLJ[H*˜^KGHEFGHW*9JIIJ\-HEIH<*KGHEFGHW*:GUJDKF[J^-C[[HDJ*R[S*
DGJLIFIHS* RJIIdZ* L* IFDKC[NKHZ* MGUXXJZ>* ,GJLIFIHF* RHZCECYHVFDKHZ* RJIIdZ* H*
UDEJICL[FIHF* DEJEHDEHVFDKH* `IJVHYdZ* GJ`[HVHW* YFbRU* IHYH* XGCLCRH[H* D*
XCYCfNe* YFECRJ* ¸Q* =HGDCIJ* pR[S* FMC* LdVHD[FIHS* XGHaFMJ[H* K* XCDEGCFIHe*
EJa[HTd* 5Q¹Q?r<* J* EJKbF* ECVIdW* KGHEFGHW* !HcFGJ* R[S* IFaC[NcHZ* LdaCGCK>*
,EJEHDEHVFDKH* `IJVHYdYH* DVHEJ[H* GJ`[HVHS* XGH* G* ¥]<]k>* #[S* HDD[FRCLJIHS*
L`JHYCDLS`H* CRICW* `JLHDHYCW* XFGFYFIICW* D* IFDKC[NKHYH* IF`JLHDHYdYH*
HDXC[N`CLJ[H* YFECR*XCDEGCFIHS* RFGFLJ* GFcFIHW*£xyœ¨*p£Ž}* u¶•‡†~|* y••€¦‡•}ž*
œ‚•~†‡ž•}€‚* ¨~•~ž•}€‚r<* ‰˜tu”* p‰•}ž“<* ˜‚¡}‡•~|<* t±±}ž}~‚•* u•‡•}••}ž‡Š* ”†~~r<* £‘”*
p£Š‡••}±}ž‡•}€‚*‡‚|*‘~ƒ†~••}€‚*”†~~•r>*=CHDK*IJHaC[FF*RCDECLFGIdZ*_JKECGCL*GHDKJ*
ad[* CXGFRF[FI* D*XCYCfNe* [CMHDEHVFDKCMC* GFMGFDDHCIICMC* JIJ[H`J* D* DC`RJIHFY*
42
https://t.me/med1917
UGJLIFIHS* [CMHDEHVFDKCW* GFMGFDDHH<* XCDEGCFIHS* ‘{£^KGHLCW<* X[CfJRNe* XCR*
KGHLCW* ^* y˜£<* XCRDVFEJ* RCLFGHEF[NICMC* HIEFGLJ[J<* VULDELHEF[NICDEH<*
DXFTH_HVICDEH<* RHJMICDEHVFDKCW* ECVICDEH>* :JVFDELC* YCRF[H* L* `JLHDHYCDEH* CE*
y˜£*pX[CfJRN*XCR*KGHLCWr*CXGFRF[S[CDN*HDZCRS*H`*D[FRUefFW*MGJRJTHH—*]<™^P<]*\*
CE[HVI€Fš*]i<^]<™*\*CVFIN*ZCG€cFFš*]<o^]<i*\*ZCGCcFFš*]<h^]<o*\*D–FRIFFš*YFINcF*]<h*
\* IFURCL[FELCGHEF[NICF>* )TFIKJ* XGCMICDEHVFDKCW* `IJVHYCDEH* HDD[FRUFYdZ*
XCKJ`JEF[FW*XGCLCRH[JDN*IJ*CDICLJIHH*‘{£^JIJ[H`J>*
43
НЭК 1а
16%
НЭК1б
13%
НЭК 2а
49%
НЭК2б
11%
НЭК 3а
2%
НЭК 3б
9%
НЭК 1а НЭК1б НЭК 2а НЭК2б НЭК 3а НЭК 3б
https://t.me/med1917
ГЛАВА 3. РЕЗУЛЬТАТЫ СОБСТВЕННЫХ ИССЛЕДОВАНИЙ
*
3.1 Определение факторов риска развития некротизирующего
энтероколита у глубоко недоношенных новорожденных
*
*****=GCLFRFI*JIJ[H`*QOQ*HDECGHH*aC[F`IH*M[UaCKC*IFRCICcFIIdZ*ICLCGCbRFIIdZ*
MFDEJTHCIICMC* LC`GJDEJ* YFIFF* OQ* IFRF[N<* XGCZCRHLcHZ* [FVFIHF* L* )$4.* HYFIH*
XGC_>*%>+>%IECICLJ*!+0-*5(946*%+=*HY>*JKJR>*/>4>*:U[JKCLJ?*9@*$!*L*Q]Po^
Q]P™*MCRJZ>*4`*QOQ*RFEFW*U*kk*ad[*RHJMICDEHGCLJI*IFKGCEH`HGUefHW*gIEFGCKC[HE*
P^O*DEJRHH*XC*’~ŠŠ*pGHDUICK*O>Pr>*
*
*
$HDUICK*O>P*\*$JDXGFRF[FIHF*D[UVJFL*(q:*XC*ESbFDEH*DCM[JDIC*K[JDDH_HKJTHH*/~ŠŠ*
*
*
*****4`*kk*D[UVJFL*(q:*U*Qo*pj™sr*YJIH_FDEHGCLJ[*L*XFGLdF*o*RIFW*bH`IH<*DGFRH*
IHZ*iPs*pQQr*(q:*Q*DEJRHH*H*aC[NcF>*
*****AJGJKEFGHDEHKJ*XJTHFIECL*XGFRDEJL[FIJ*L*EJa[HTF*O>P>**
*
*
*
44
Показатель
НЭК
n=55
Контроль
n=177
p
ГВ, недель,
Me [IQR]
28
[26,7-30,7]
30
[29-31,4]
<0,0001*
Масса, г,
Me [IQR]
975
[746,5-1105]
1280
[985-1490]
<0,0001*
Длина, см,
Me [IQR]
34
[32-37]
38
[35-40]
<0,0001*
Апгар 1 минута, балл,
Me [IQR]
5 [4 - 7]
6 [6 - 7]
<0,0001*
Апгар 5 минута, балл,
Me [IQR]
7 [6 – 7,5]
7 [7 - 8]
0,002*
Пол мальчики/девочки
30/25 (54,5/ 45,5)
104/72 (59/ 41)
0,673
https://t.me/med1917
.Ja[HTJ*O>P*\*AJGJKEFGHDEHKJ*XJTHFIECL*
*
*
*****(FRCICcFIIdF* H`* MGUXXd* (q:* HYF[H* aC[FF* IH`KHW* +/<* YJDDU* EF[J* XGH*
GCbRFIHH<*aC[FF*IH`KUe*CTFIKU*XC*cKJ[F*%XMJG*L*KCITF*P*H*k*YHIUE*bH`IH>*
*****%IJ[H`HGUFYdF*XCKJ`JEF[H*LK[eVJ[H*L*DFaS*JIEF^*H*XCDEIJEJ[NIdF*_JKECGd>*4`*
JIEFIJEJ[NIdZ* _JKECGCL* L* JIJ[H`* LCc[H—* ZGCIHVFDKHW* gIRCYFEGHE<*
DJ[NXHIMCC_JGHE<*ZGCIHVFDKHW*XHF[CIF_GHE<*YCVFKJYFIIJS*aC[F`IN<*aJKEFGHUGHS*
U*YJEFGH<*GCDE* XJECMFIICW*YHKGC_[CGd*L*XCDFLF* H`*TFGLHKJ[NICMC*KJIJ[J*XFGFR*
GCRCGJ`GFcFIHFY<* JIEHaJKEFGHJ[NIJS* EFGJXHS* YJEFGH* LC* LGFYS* aFGFYFIICDEH<*
XGFgK[JYXDHS<* IJ[HVHF* MFDEJTHCIICMC* DJZJGICMC* RHJaFEJ<* JIFYHH* U* YJEFGH<*
YICMCX[CRIJS* aFGFYFIICDEN* pRHZCGHJ[NIJS* H* YCICZCGHJ[NIJSr<* HDEYHKC^
TFGLHKJ[NIJS* IFRCDEJECVICDEN* H* XGCLFRFIHF* FF* ZHGUGMHVFDKCW* KCGGFKTHH<*
IJGUcFIHS* YJECVIC^X[JTFIEJGICMC* H* _FEC^X[JTFIEJGICMC* KGCLCECKJ* XGH*
RCXX[FGCMGJ_HVFDKCY* HDD[FRCLJIHH<* XGCLFRFIIJS* XGC_H[JKEHKJ* $#,* X[CRJ<*
CEDGCVFIICF*XFGFbJEHFmDTFbHLJIHF*XUXCLHId>*(JY*IF*URJ[CDN*LdSLHEN*`IJVHYCMC*
L[HSIHS*RJIIdZ*_JKECGCL*IJ*LC`IHKICLFIHF*(q:>*
*****4`*XCDEIJEJ[NIdZ*_JKECGCL*L*JIJ[H`*LCc[H—*MFDEJTHCIIdW*LC`GJDE<*YJDDJ*EF[J*
XGH* GCbRFIHH<* CTFIKJ* XC* cKJ[F* %XMJG* IJ* P* H* k* YHIUEF<* LLFRFIHF* YC[C`HLJ* L*
GCRH[NICY* `J[F<*IJ[HVHF* H[H* CEDUEDELHF* HI_FKTHCIICMC* RHJMIC`J*pLGCbRFIIdW*
DFXDHD<* LGCbRFIIJS* XIFLYCIHS<* GFDXHGJECGIdW* RHDEGFDD* DHIRGCYr<* IJ[HVHF*
+@!%=<* XGCLCRHYJS* EFGJXHS* IFRCICcFIICMC* ICLCGCbRFIICMC* pGFDXHGJECGIJS*
EFGJXHS* L* GCRH[NICY* `J[F<* KJGRHCECIHVFDKJS* EFGJXHS<* EFGJXHS* +@!%=*
45
https://t.me/med1917
HaUXGC_FICY<* EGJID_U`HH* gGHEGCTHEDCRFGbJfHZ* KCYXCIFIECL* KGCLH* pq,:r* RC*
GJ`LHEHS*(q:r<**_UIKTHCIHGCLJIHF*KJEFEFGH`HGCLJIICW*XUXCVICW*LFId*H*JGEFGHH<*
DEJGECLdW* CalFY* gIEFGJ[NICMC* XHEJIHS* H* CalFYd* DUECVICMC* ULF[HVFIHS*
gIEFGJ[NICW*IJMGU`KH<*[JaCGJECGIdF*XCKJ`JEF[H*K[HIHVFDKCMC*JIJ[H`J*KGCLH*IJ*P*
H*O*DUEKH*bH`IH*H*LC*LGFYS*LC`IHKICLFIHS*(q:<*IJ[HVHF*JTHRC`J*L*XFGLdF*O*DUECK*
pRC*PQ*VJDCL<*PQ^Qj*VJDJ*bH`IH<*Qj^oQ*VJDJ*bH`IHr*XC*RJIIdY*KHD[CEIC^CDICLICMC*
DCDECSIHS*p:),r>*
*****=CDEGCFIIJS*YFECRCY*RFGFLJ*GFcFIHW*XGCMICDEHVFDKJS*YCRF[N*XCKJ`J[J<*VEC*U*
M[UaCKC*IFRCICcFIIdZ*RFEFW* MFDEJTHCIICMC*LC`GJDEJ*YFIFF* Qomk*IFRF[N<*YJDDCW*
EF[J* YFIFF* ojkM* XGH* MFDEJTHCIICY* LC`GJDEF* aC[FF* Qomk* IFRF[N* GJ`LHEHF* (q:*
XGCMIC`HGUFEDS*DC*DXFTH_HVICDENe*io<ks*H*D*VULDELHEF[NICDENe*ki<Qs>*)afHW*
XGCTFIE*LFGIC*XGFRDKJ`JIIdZ*D[UVJF*(q:*\*i]<Q·Q<hs>*9CRF[N*XGFRDEJL[FIJ*IJ*
GHDUIKF*O>Q>*
*****%IJ[H`* YFEJaC[HVFDKHZ* IJGUcFIHW* L* XFGLdF* O* DUECK* XGCRFYCIDEGHGCLJ[*
L[HSIHF*YFEJaC[HVFDKCMC*JTHRC`J*L*XFGLdF*PQ*VJDCL*bH`IH*D*RF_HTHECY*CDICLJIHW*
aC[FF*PQ*YYC[Nm[>*=GH*RJIIdZ*XCKJ`JEF[SZ*YFEJaC[HVFDKCMC*JTHRC`J*L*XFGLdF*PQ*
VJDCL* bH`IH* GJ`LHEHF* (q:* XGCMIC`HGUFEDS* DC* DXFTH_HVICDENe* ™k<ks* H* D*
VULDELHEF[NICDENe*P™<hs>*/FGIC*XGFRDKJ`JIIdZ*D[UVJFL*(q:*\*iP<o·j<Ps>*
*****4`* JIJ[H`J* LC`YCbICMC* L[HSIHS* IJ* GJ`LHEHS* (q:* XGCLCRHYCW* L* )$4.(*
EFGJXHH* LdSL[FIC<* VEC* IJHaC[NcFF* L[HSIHF* CKJ`dLJFE* EGJID_U`HH*
gGHEGCTHEDCRFGbJfHZ* KCYXCIFIECL* KGCLH>* -* M[UaCKC* IFRCICcFIIdZ*
ICLCGCbRFIIdZ<*XC[UVJLcHZ* EGJID_U`HH*q,:*GJ`LHEHF* (q:*XGCMIC`HGUFEDS*DC*
DXFTH_HVICDENe* ™h<hs* H* D* VULDELHEF[NICDENe* kQ<is>* /FGIC* XGFRDKJ`JIIdZ*
D[UVJF*(q:*\*ih<h·O<Os>**
*
46
https://t.me/med1917
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
$HDUICK* O>Q* \* =GCMICDEHVFDKJS* YCRF[N<* XCDEGCFIIJS* YFECRCY* RFGFLJ* GFcFIHW*
£xyœ¨**
*
*
*****=GH* JIJ[H`F* LC`YCbIdZ* GJIIHZ* XGFRHKECGCL* (q:* L* RJIIdZ* CafFMC*
K[HIHVFDKCMC* JIJ[H`J* KGCLH* XC[UVFIJ* D[FRUefJS* RHJMICDEHVFDKJS* YCRF[N*
pGHDUICK*O>Or>*
47
https://t.me/med1917
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
$HDUICK*O>O*\*=GCMICDEHVFDKJS*YCRF[N<*XCDEGCFIIJS*YFECRCY*RFGFLJ*GFcFIHW*£‘”**
*
*
***-* M[UaCKC* IFRCICcFIIdZ* RFEFW* XGH* UGCLIF* EGCYaCTHECL* YFIFF* Pki*ºP]9m[<*
[HY_CXFIHH*YFIFF*oO]*K[FECK*mYK[*L*K[HIHVFDKCY*JIJ[H`F*KGCLH*IJ*O*DUEKH*bH`IH*
H* [FWKCXFIHH* YFIFF* j<hkºP]
9
m[* L* XFGLdF* DUEKH* bH`IH* GJ`LHEHF* (q:*
XGCMIC`HGUFEDS*DC*DXFTH_HVICDENe*™j<™s*H*D*VULDELHEF[NICDENe*kj<ks>*)afHW*
XGCTFIE*LFGIC*XGFRDKJ`JIIdZ*D[UVJF*(q:*\*ik<O·Q<Os>*
*****#CXC[IHEF[NIC*XGCLFRFI*JIJ[H`*_JKECGCL*GHDKJ*GJ`LHEHS*(q:*Q*DEJRHH*H*aC[FF>*
=CDEGCFIIJS* YFECRCY* RFGFLJ* GFcFIHW* XGCMICDEHVFDKJS* YCRF[N* XCKJ`J[J<* VEC* U*
M[UaCKC* IFRCICcFIIdZ* RFEFW<* GCbRFIIdZ* MFDEJTHCIIdY* LC`GJDECY* YFIFF* Qomk*
IFRF[N*XGH*CEDUEDELHH*YH[KHIMJmCEDGCVFIIICMC*XFGFbJEHS*XUXCLHId<*YJDDCW*EF[J*
YFIFF*ojkM*XGH*MFDEJTHCIICY*LC`GJDEF*aC[FF*Qomk*IFRF[N*H*CTFIKCW*XC*cKJ[F*%XMJG*
YFIFF* k* aJ[[CL* L* KCITF* k* YHIUEd* GJ`LHEHF* (q:* XGCMIC`HGUFEDS* DC*
DXFTH_HVICDENe* ™o<js* H* D* VULDELHEF[NICDENe* k]<]s>* )afHW* XGCTFIE* LFGIC*
XGFRDKJ`JIIdZ*D[UVJF*(q:*\*i™<h·O<is>*9CRF[N*CECaGJbFIJ*IJ*GHDUIKF*O>j>*
48
https://t.me/med1917
*****.JKHY* CaGJ`CY<* _JKECGJYH* GHDKJ* GJ`LHEHS* (q:* U* M[UaCKC* IFRCICcFIIdZ*
ICLCGCbRFIIdZ* SL[SeEDS—* MFDEJTHCIIdW* LC`GJDE* YFIFF* Qomk* IFRF[N<* YJDDJ* EF[J*
YFIFF* ojkM* XGH* MFDEJTHCIICY* LC`GJDEF* aC[FF*Qomk* RF_HTHE* CDICLJIHW* aC[FF* PQ*
YYC[Nm[*L*XFGLdF*PQ*VJDCL*bH`IH<*XGCLCRHYdF*EGJID_U`HH*gGHEGCTHEDCRFGbJfHZ*
9
KCYXCIFIECL* KGCLH<* UGCLFIN* EGCYaCTHECL* YFIFF* PkiºP]
m[<* [HY_CXFIHS* YFIFF*
oO]**K[mYK[*IJ*O*DUEKH*bH`IH*H*[FWKCXFIHH*YFIFF*j<hkºP]
9
m[*L*XFGLdF*DUEKH*bH`IH>*
!JKECGJYH*GHDKJ*GJ`LHEHS*(q:*aC[FF*Q*DEJRHH*RCXC[IHEF[NIC*SL[SFEDS*CEDUEDELHF*
XGCLFRFIHS*YH[KHIMJmCEGCVFIICMC*XFGFbJEHS*XUXCLHId*H*CTFIKJ*XC*cKJ[F*%XMJG*
YFIFF*k*aJ[[CL*L* KCITF*k*YHIUEd*U*RFEFW* D*+/*aC[FF*Qomk*IFRF[N*H* YJDDCW*EF[J*
YFIFF*ojk*M*>*
49
https://t.me/med1917
$HDUICK*O>j*\*=GCMICDEHVFDKJS*YCRF[N<*XCDEGCFIIJS*YFECRCY*RFGFLJ*GFcFIHW*£‘”**
*
*
* *
50
Показатель
Группы исследования
p
Проградиентное
наращивание ЭП
(n=119)
Стандартное
наращивание ЭП
(n=119)
ГВ, недель, Me [IQR]
31,2 [30 - 32]
31,2 [30 - 32]
0,924
Масса, г, Me [IQR]
1490 [1235–1772]
1482 [1180 –
1790]
0,801
Длина, см, Me [IQR]
40 [37 – 42]
39 [36-42]
0,960
Окружность головы, Me [IQR]
29 [27-31]
29 [27,6– 30]
0,488
Апгар 1 минута, балл, Me [IQR]
6 [6 - 7]
6 [6 - 7]
0,665
Апгар 5 минута, балл, Me [IQR]
7 [7 - 8]
7 [7 - 8]
0,389
Кесарево сечение, абс (%)
103 (86,6)
109 (91,6)
0,212
ОНМТ, абс. (%)
41 (34,5)
40 (33,6)
0,891
ЭНМТ, абс. (%)
20 (16,8)
19 (16,0)
0,861
Пол мальчики/девочки
63/56
63/56
1,0
Малый и маловесный для ГВ, абс.
(%)
19 (15,9)
21 (17,6)
0,599
Масса менее 3 перцентиля, абс. (%)
11 (9,2)
10 (8,4)
0,754
Отсроченное пережатие пуповины,
абс. (%)
76 (63,9)
63 (52,9)
0,357
Профилактика РДС, абс. (%)
93 (78,2)
86 (72,3)
0,293
https://t.me/med1917
3.2 Оценка безопасности и эффективность методики проградиентного
наращивания энтерального питания недоношенных новорожденных
гестационного возраста 28 - 32 недели в сравнении с традиционной
практикой вскармливания
*
*****=GH* XGCLFRFIHH* JIJ[H`J* ICLCGCbR•IIdZ* MFDEJTHCIICMC* LC`GJDEJ* Qim]^OQm]*
IFRF[N* XC[UVFId* D[FRUefHF* RJIIdF—* DGJLIHLJFYdF* MGUXXd* RCDECLFGIC* IF*
GJ`[HVJ[HDN*XC*MFDEJTHCIICYU*LC`GJDEU*ICLCGCbRFIIdZ<*YJDDF*EF[J*XGH*GCbRFIHH<*
XC[U<*CTFIKF*XC*cKJ[F*%XMJG<*DXCDCaU*GCRCGJ`GFcFIHS<*KC[HVFDELU*IFRCICcFIIdZ*
gKDEGFYJ[NIC*IH`KCW*YJDDd*EF[J<*CVFIN*IH`KCW*YJDDd*EF[J<*YJ[dY*GJ`YFGCY*R[S*
MFDEJTHCIICMC* LC`GJDEJ<* XGCLFRFIICW* JIEFIJEJ[NICW* XGC_H[JKEHKF*
GFDXHGJECGICMC* RHDEGFDD* DHIRGCYJ* p$#,r* X[CRJ>* AJGJKEFGHDEHKJ* HDD[FRUFYdZ*
MGUXX*XGFRDEJL[FIJ*L*EJa[HTF*O>Q>*
*
*
.Ja[HTJ*O>Q*\*AJGJKEFGHDEHKJ*HDD[FRUFYdZ*MGUXX*
*
Соседние файлы в папке @xirurgi_2025