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82 .
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ISBN 5 9276 ???? ?

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(.. )

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(
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(.. , .. )
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50
51
54
56
59

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62
65
67
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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
(.. , .. , .. , .. , .. )
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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .111

. . . . . . . . .115
(.. , .. , .. , .. )
. . . . . . . . . . . . . . . . . . . . . . . . . . .117
. . . . . . . . . . . . . . . . . . . . .118
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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .126

<

( )
,

126
128
128
129
130

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .130

130
131

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. . . . . . . .143
. . . . . . . . . . . . . . . . . . . .147
. . . . .149

< <

150
151


. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .151

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .153





153
155
159
163
165
168



. . . . . . . . . . . . . . . . . . . . . . . .171
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .174

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(.. , .. , .. , .. , .. )
, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .181
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186
193

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .199

199
203

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .215

. . . . . . . . . . . . . . . . . . . . . . .219
(.. , .. , .. , .. )
, , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .221
. . . . . . . . . . . . . . . . . .224
. . . . . . . . . . . . . . . . . .227



<


227
227
229
229
231
232
232
233


. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .236

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243
250

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(.. , .. )
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263

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .264

270

. . . . . . . . . . . . . . . . . . . . . . . . .271

() . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .272
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .272
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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .275
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .276
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .280

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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .291
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .292

. . . . . . . . . . . . . . . . . . . .295
(.. , .. )
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .297
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .301

302

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .303
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .304
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .308

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .311
(.. , .. )
. . . . . . . . . . . . . .313

315
316

. . . . . . . . . . . . . . .321

326
327
327
332
333

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .335





335
337
339
341
349
357

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .359
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .367

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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .380
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .383
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .383
. . . . . .385


386
387

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .389


389
391

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .397
. . . . . . . . . . . .397




,

<<

397
398
399
400
401
401
402
402
403
403
403

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .406


<

407
407
408
409

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .412



413
416
416
416

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .422
. . . . . . . . . . . . . . . . . . . . .424

. . . . . . . . . . . .424
. . . . . . . . . . . . . . . . . . . . . . . .426
. . . . . . . . . . . . . . . . . . . . . . . .428

 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .433
< ()

433
433
437

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .446
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .451

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. . . . . .454
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .454
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .455
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .456
. . . . . . . .456
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .457

. . . . . . . . . . . . . . . . . . . . . . . . . . . .457
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .460
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .464

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .465
(.. )
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .467

. . . . . . . . . . . . . . . . . . . . . . . . . . . .469
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .470
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .470
. . . . . . . . . . . . . . . . . . . .470
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .473
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .476
. . . . . . . . . . . . . . . . . . . . . . . . . . . .477
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .479
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .480
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .482
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .482
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .482
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .483

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I.


. 
Jecur aqua repletum (
). 
1872 , (. Bruns) 
.
(Eschner) 1886 ,
(Loretta) 1888 , 1896
. 
1889 .. .
, 
.

, ..
.. 1894 , 
. , ,

. 
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, 1913 
.. , 

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.. . ..
(1924)
.
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13

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Page 14

, 
. 20

. 
, 
,
 . 
.. 1929 .

.. (1964), .. (1964), .. (1963) .,
. Hjorstio (1951), . Reifferscheid (1957),
. Stucke (1959, 1972), C. Couinaud (1954, 1960) . 


 (, 
),

(Quattlebaum J.K., 1959; Tung T., 1962; Leger L., 1975 .).

.
1952 J.L. LortatJecob H.G. Robert.
..
1955 . 
1980 T.E. Starzl S. Iwatsuki.
 


, 
, .

[
.., 1979; .., 1979; .., .., 1981;
Stucke, 1971; Zhou X., Tang Z., Yu Y., 1993; Adam R., Akpinar E. et al., 1996].

. (C. Langenbuch),
1882 .
.
, .
.
. XVIIXVIII 
14

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I.

.
, . ,
. , . , . . 1767 . Herlin 
. . (J.Bobbs)
1867 .
(Th. Kocher) 1878 .
1882 (H. Marcy) ,
(Kmmel) 1884 
.

, .

..
17 1889 ., .. 7 , C. Langenbuch
1882 .
. .. 33
.
. 2 
. ,
,
1890 . . .. . 28

. 15
.
..
(1893), .. (1895). 
1896 . ..
, , 
. 
. .
1898 . .. 33 
[ .., 1981].
1887  
..
.
1903 H. Kehr 1912 .. 
,
.
1931 P. Mirizzi
. 
 
15

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, , ,
.

, 
J. Caroli 1942 . , 

 ,
1952 R. Carter G. Saypol.
80 
. 198788 
,
. 
.. 1991 .



1867 . (J.S. Bobbs) 
.
1872 (P. Bruns) .
1880 (Winiwarter)
( 2
).
1882 (C. Langenbuch)
.
1882 (H. Marcy) .
1883 (Meredith)

.
1884 .. 
.
1884 (Kmmel) 
.
1887 ..

().
1888 (F. Knig) 
.
16

Hepato_2003_Last_With_Index.qxd

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Page 17

I.

1888
1889
1889
1889
1889

(O. Riedel) .
.. .
.. .
(L.F. Terrier) .
(J. Thornton, H. Marcy) 
.
1890 .. .
1891 (R. Abbe)
.
1891  (McBurney Ch.) 
( ).
1890 (Gersuny) .
1892 (A. Jane) 
.
1892 (E. Doyen) 
.
1894 .. .. 
.
1894 .. .
1898 (Codivilla) 

1898 (J. Cerny) 
( 
).
1898 .. 
.
1898 (Cerny) .
1899 .. 
.
1900 (W.S. Halsted) 
.
1902 .. 
.
1902 (H. Kehr) 
, .
1903 (H. Kehr)
.
17

Hepato_2003_Last_With_Index.qxd

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Page 18

1904 (Monprofit A.) .


1905 (C. Garre) 
.

.
1905 (W. Mayo) , , 
(
).
1906 (J. Bakes) .
1906 (M. Champeau, P. Pineau) 
U 
.
1908 (J.W. Cohn)
.
1909 (H. Wolff) .
1909 .. .
1909 .. 
.
1911
( 
).
1912 .. 
, . . .. .
1912 .. 
.
1913 (R. Williams) 
5
.
1913 .. 
.
1913 (F. Hofmeister)
.
1918 .. .
1921 H. Burkhard W. Mller
.
1922 (A. Hildebrandt)
.
18

Hepato_2003_Last_With_Index.qxd

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Page 19

I.

1923 .. .
1925 .. (
); 1925 (H. Kehr) 
 .
1926 P. Del Valle R. Danovan
choledo
chitis scleroretractile chronique.
1928 (B.O. Pribram) 
.
1929 ..
.
1931 (P.L. Mirizzi)
.
1935 P. Huard DoHuanHop

.
1936 R. Colp, H. Doubilet, I. Gerber 
.
1942 (J. Caroli)
.
1945 (F.T. Blakemore, J.W. Long)
.
1945 A.W. Allen
. 

.
1948 (W.P. Longmire) (M.C. Sandford)
,
, (Roux)
.
1949 o (A. Dogliotti, E. Fogliatti) 
, 
.

,
(). 

. .
19

Hepato_2003_Last_With_Index.qxd

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Page 20

1951 (H. Wilgegans) ,


, ().
1951 (O. Goetze)  
, , 
.
(G. Saypol, K. Kurian, 1969)
.
1952 J.L. LortatJecob H.G. Robert 
.
1953 (Gorbandt E.)
, 
.


.
(
, ).
1953 (Couinaud C.) 
. 
.
1954 .. 
.
1955 ..

.
1956 .. 

.
1961 (R. Praderi) 
, .
1963 T.E. Starzl .
1963 . .. 
.
1965 R. Smith

, .
1967 ..
( ).
20

Hepato_2003_Last_With_Index.qxd

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Page 21

I.

1968 (McCune) 
.
19731974 
(Nakajima M., Kawai K.)
(Classen M. et al., Demling L. et al.).
1974 M. Classen, L. Demling
.
1974 .. . ..
.
1976 ..
. .. 
.
1980 T.E. Starzl S. Iwatsuki
.
1982 Ch. McBurney
.
1986 E. Mhe
( ).
1987 Ph. Mouret
.
1991 .. 
.

:
1.

. 1998. . 3. 2. . 136.

2.

.. . , 1983. 352 .

3.

.. . , 1997. 605 .

4.

.., .. . ., , 1965. 144 c.

5.

.., .., .. 
. .: . 1982. 240 .

6.

.. . : , 1966. 473 .

7.

.. . .: 
, 1971. 203 .

8.

.. .
: ,1973. 223 c.

9.

.. . .:
, 1963. 496 .

10.

.., .. 

21

Hepato_2003_Last_With_Index.qxd

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Page 22


. .:  , 2000. 201 .
11.

// . 1994. 1.

12.

// . 1995. 1.

13.

// . 1998. 1.

14.

.., .. . .: 
, 1971. 199 .

15.

.. . .: , 1974. 239
.

16.

.. . .: , 1963.
230 c.

22

Hepato_2003_Last_With_Index.qxd

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Page 23

II
(

..
..

Hepato_2003_Last_With_Index.qxd

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Page 24

Hepato_2003_Last_With_Index.qxd

10.02.2003

18:38

Page 25

II. 

. 
, 
, 
. 4 
, 5
. 10 
.
.
1200 1800 , 
1500 .
. ,
34 , 
1,52 . 
. 1
,
, . 
.
( 
), . 
, , 
, , 
. ,
, 
,
( ).


3 .
, 
2 : . 

. ,
. 
. , 3
100000 2 2 .

25

Hepato_2003_Last_With_Index.qxd

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Page 26

.
. 5
. 6 
. () , 
.
.

. ,
, 
. 
.
18 
.

(
, ,
.
. , . . ,

() ,
.
,
. ,
,
.


. , , 
, : 
, .

.
.

, 
, .
. 
,

26

Hepato_2003_Last_With_Index.qxd

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Page 27

II. 

. 
. ,
.
, 
.
, 
, ,
.
: (facies visceralis) 
(facies diafragmatica).
(lobus dext. et sin.). 


. (sulcus venae umbilicalis) 
(lig. teres hepatis),
(fossa ductus venosi) (lig. venosum) 
. , (lobus
quadratus) (lobus caudatus),

.
(fossa vesicae felleae), 
(sulcus v. cavae). 

.

.

. (porta hepatis)

 .
,
.
 . 60% 
,
.
.

.

,
27

Hepato_2003_Last_With_Index.qxd

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Page 28

, 
.
( 
I II ).
, , 
,
. , 
(v. umbilicalis), 
.
, . 
.

.

, .

(lig. falciforme hepatis), 
 () (lig. coro
narium hepatis), .
, ,
. , 
.

 (lig. hepatorenale). 
. , 
(area nuda hepatis) 
.
(ligg. triangularia dext. et sin.) 
. 
(appendix fibrosa hepatis)
.
.
  (lig. hepato
gastricum et lig. hepatoduodenale) (omentum mi
nus).  
, .
,
,
, , 
.
28

Hepato_2003_Last_With_Index.qxd

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Page 29

II. 

6
: 3 3 
(. 2.1).
, . :

;
1
7
2
8

3
9

7
4
8

6
5
10

. 2.1 ,
() () .
1 ; 2
; 3 ; 4
; 5 ; 6
; 7 ; 8 ; 9 ; 10

29

Hepato_2003_Last_With_Index.qxd

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Page 30

( ) ;

.
,
, . 
.
 ,
, . . (bursa omentalis)
.
, 
. 
, 

.
.



. ,
, , , 
, , .
, 
,
.
, ,
,
. 
, [Couinaud C.,
1957].
() , 5 8 
. ,

.
,
,
[Rex ., 1888], [Cantlie J., 1898].
, .

, 
30

Hepato_2003_Last_With_Index.qxd

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Page 31

II. 

. 2.2 ,

.

(. 2.2).

, , 
. 10% 
, ,
. . ,
. ,
. ,
, , 
, .
(. 2.3).

, . , I

. 2.3 ()
()

31

Hepato_2003_Last_With_Index.qxd

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Page 32

. 2.4 Couinaud

, , 
, , .
II , ,

. III 
. IV III
. V VI 
, VII VIII
. V VIII ,
, , VI VII 
(. 2.4). 
, 
.
. IV VI .

. 
, 
.
,
, . 
(
3 8), 3 
, ,
(. 2.5.). (I 
) , , . 
, 
.
32

Hepato_2003_Last_With_Index.qxd

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Page 33

II. 


,
, 
. 
. (
) 0,52,0 . 
,
: ,
( ), 
. , , 
, , .
,
. 
, ,
, .
, . 

. 
, ,
.

, ,
,
. , ,

( ), , 
. 

. 

,

. 
, 
, 
. ,
, 
, . 2.5 .

33

Hepato_2003_Last_With_Index.qxd

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Page 34

. 1330 
.
, , , 
,
.
, , 
, ,
. 
.
(. 2.6) ,


( ). 

. , , ,
, . 
70% 

. 2.6 ().
,
.
; ; Pit:
; ; ;
; .
( .. .. , 1989)

34

Hepato_2003_Last_With_Index.qxd

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Page 35

II. 

. 
. (Pit), 
.
, ,
.
, .


( ).
( ). 
,
. 
.

. 
, 
. .

. 
, .

,
.
( ), 
, 
.


, 
. 
.
, , .

,
.


.
, .
35

Hepato_2003_Last_With_Index.qxd

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Page 36


. 

.
, ,

, 
. ,

. 

,
 . 
. ,
.
.
,
.
, 
. 
,
. , 

, 
.
,
.
, ,
. 
. 
, 
. 

. 

.


. (
) ,
( ), 
36

Hepato_2003_Last_With_Index.qxd

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Page 37

II. 

. 
, , 
. 
. 
, 1012
.
. 
. , 
, 
, 
.

.

, 
, , 
 ,

. 

,
. 
, 
, . 
.

.
, .. 
(.. Rappaport) 50 XX .
.

.


. 
.
( 2 ),
(). 
.
, 
(). 
37

Hepato_2003_Last_With_Index.qxd

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Page 38

,
. 
, 
( ), 
.
.

(. 2.7).
( 
)
(. 2.8), . 
, ,
. ,
.
.
,
, , 

. 2.7.
1 ; 2 ; 3
(); 4 ; 5
; 6 ;
I, II, III

38

Hepato_2003_Last_With_Index.qxd

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Page 39

II. 

. (. . 2.7),
: I 
() , 
; II 
, III .


. , 
, ,
( III)
.

, 
,
. , ,
, I, III . , 
, ,

. 2.8.
1 ; 2 ( );
3 ( );
4 ; 5 ;
6

39

Hepato_2003_Last_With_Index.qxd

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Page 40

, III . ,

,
. 
, 
,
( )
( ) 
.
, ,
,

, 
. 
,
 III 
. 
, .

, , , 
.
III ,
, 
. 

.

. ,

. , 
, 
.
, 
, . 
,
,
,
.
. 

.
40

Hepato_2003_Last_With_Index.qxd

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Page 41

II. 

.

7080%.


:
, . , 

. (7075%) 
. 1,5 , . .
25% .
5080 100 
. , . . 
400 2,
.
120 . ., 812 . .,
0 5 . .
, 
( . ./ . . = 1/13,5).
20% .
70%
.

,
, .

1,9 .% , 
(
7 .%).
5070% 

, 

,



(
. 2.9
).
41

Hepato_2003_Last_With_Index.qxd

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Page 42


.


.
, ( 4080%) 
. 
57 ,
(a. hepatica communis), (truncus celia
cus).
 
 (a. gastro
duodenalis) (a. hepatica propria).
35 , 
 

(aa. hepaticae dextra et sinistra), . 

(a. gastrica dextra),
(a. cystica) .
. 
, 
, V VIII . 

, VI VII .
I IV , II
III .
. IV 
(. .
). 
,
14% . 
.

,
, 
 .

(14%), (27%) .
42

Hepato_2003_Last_With_Index.qxd

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Page 43

II. 

 ( 50%),

.
 , 

.

(515%)
(13%). 
.
 
(1219%). 
, 

.
.

(12%).  
. 2% 
. 

IIIII .
(
 .)

, ,
,  . ..
.. (1974) .
, 

( ), 
.

(v. portae) 
 , ,
.

(). 
43

Hepato_2003_Last_With_Index.qxd

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Page 44

, 
, .
, 
, (v. mesenterica superior), 
(v. lienalis) (v. mesenterica inferior).
( 90%) 
,

. 
(vv. gastricae dext. et sin.), 
(v. pancreaticoduodenalis sup.), 
(v. gastroepiploica dext.) ,
.
60% 
. 30%,
10% .
48 ,
1114 . 

(incisura pancreatis), 23% 
.

.


.
(ramus dexter) 
(ramus sinister), .

, , 80%
(. 2.9). 
, 
V VIII .
, 
VI VII .
(I ), II .

III IV . III IV
( )
.
44

Hepato_2003_Last_With_Index.qxd

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Page 45

II. 


. 
.
 , 
( 10%). 
.
 
(25%). ,

.
 ,
, 
( 8%).
 V VIII

( 8%).

.
,
.


,

(
).




. 


(. 2.10).
 

(vv. gastricae
. 2.10
breves) 
: (1), (2),
(vv. esophageae)
(3), (4)

( . , 1970)

45

Hepato_2003_Last_With_Index.qxd

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Page 46

, 
.
(v. azygos et
v. hemiazygos), . 
260280 . . 
,
. ,
, , 
,
 .
 
(vv. iliacae int.) 
.
(v. rectalis sup.)
,
(v. rectalis media et
v. rectalis inferior),
( ). 
.

(v. umbilicalis), ,
,

(vv. epigastricae superficiales), 
.
(vv. epigastricae sup. et inf.),
(vv. thoraci
cae int. )
(vv. iliacae ext. ).

.

(vv. paraumbilicales), .


, , , 
, 
, .

.
46

Hepato_2003_Last_With_Index.qxd

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Page 47

II. 



.

, 
, , 3 20
. 
, : , 
(vv. hepaticae dextra, intermedia et sinistra),
. 
, 20 .
(VI VII )
( V VIII 
).

13 , .

IV V , VIII
. 
, . .
, .

. 
. 
. 
II III IV . I
, , 
(512) ,
.
,
.
70%.
, 
.
.

, 90. 
,
.
47

Hepato_2003_Last_With_Index.qxd

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Page 48


0,51,0 2 .
.
.
,
(sulcus v. cavae), 
, (ligamentum v. cavae),
. 
.


. 

. 
1 
, .



. 

, , , 
.

. ,
. 
, , 
,
.

.


, 
, .
(ductus thoracicus). 

,
, 
48

Hepato_2003_Last_With_Index.qxd

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Page 49

II. 

,
(cisterna chyli).



.
.

.


() . 
VIIX
,
.

.
, ,
.

.

. . 

,
.

, ,

.
.




. 
,
49

Hepato_2003_Last_With_Index.qxd

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Page 50

 
.
(ductus hepaticus commu
nis). (duc
tus cysticus) (ductus choledochus).
.

,
, , 515 
.
,
. ,
, , 
25 . 
1 , .
( 5%)
. 
.


, 
.
 

1,53,0 ,
. 16% ,
. . VI VII , 
.
 5%
, .. 
( V VIII )
.
 20%
. 
III IV ,
I II . 6%

.
50

Hepato_2003_Last_With_Index.qxd

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Page 51

II. 

  ( 2%),
,

. 2 , 
.
V ,
, , 
.
 ,
(, , ) .
.

.
,

45 . 
45 .

. 
, 1130% 
.


. ,

. 
, 
. 

.
10% 
,
[Mirizzi P.,1940]. , 
.


.


51

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Page 52

, 
(papilla duodeni major, seu papilla Vateri)

(ductus pancreaticus). , 
.
, ,
2 12 . 
, , . 
57 . 58
1 . 
( ) 3 .

,

 , .

 . , 
. , ..
.. (1986) 911 
36% 
, 1215 95,2%,
, , 8 
0,8% .
: 1) 

(04 ); 2)

(12 ); 3) 
( 3 ); 4) 
() 
(12 ).
, 

 (ampulla hepatopancreati
ca) 39 , 
(porus papillae).
, ,

. 0,51,5 . 
34 
52

Hepato_2003_Last_With_Index.qxd

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Page 53

II. 

.
,
, 
.

.
.
, ,
, 

. 

,
.


.
( 7090%)
(. 2.11). 

. , ,

.

, , .
, 5585% 

.
,

. 2.11

53

Hepato_2003_Last_With_Index.qxd

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Page 54

(633%).
(46%),
(46%). 
(. 2.12).

812
, 
.
, 
(plica longitudinalis duodeni) 
. ,
, 
. 


. 
, 
.
,
, 
.

(papilla duodeni minor),

(ductus pancreaticus accessorius). 23

. 2.12

54

Hepato_2003_Last_With_Index.qxd

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Page 55

II. 

. 
 .

. 

. , 
.

, 1 . 

.
3 .

.
,
. 
, ,
, .
[Oddi R., 1887],
XVII
(Glisson F.). 

,
.
. 
15 , 
. 
.
,
, .

.

: ,
, 
[Westphal K., 1931] (. 2.13).



55

Hepato_2003_Last_With_Index.qxd

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Page 56

,
.


. , 
, ,
, ,
,
.







.

(vesica fellea)


, 
(fos
sa vesicae felleae).
, 
,
. 



. 2.13
, 

.
:

1 ;
2 ;
610 , 34 . 
3 ;
3070
4
. (1,52 ), 
;
,
5 ;

6

200 .
56

Hepato_2003_Last_With_Index.qxd

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Page 57

II. 

: , . 
(fundus vesicae felleae) 
, .

. (corpus vesicae felleae) , 
.
. ,

,
. 
.
, 
[Hartmann H.]. (collum vesicae fel
leae) , ,
.
,

. ,
. 
, 
, ,
. .
1/31/2 .
. 
,
, 
,
.

, 
. .

, ,
. , 
( , 
, ).
, ,
. .

( ) , 
57

Hepato_2003_Last_With_Index.qxd

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Page 58

. 
.
,
.

. 
, . 
 

, [Heister L., 1717].

, , .

, ,
[Lttkens U., 1926]. 
[Aschoff L.,
1909], , 
 [Rokitansky K., 1842].
, ,
, .

, .

.  ,
, 
[Luschka H., 1863]. 
.
, 
, 
. , ,

, . 
 (ducti hepatocystici) 

. .
.

( 3% ).
(0,01%), ,
, . 
.
58

Hepato_2003_Last_With_Index.qxd

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Page 59

II. 


, 
,
.
,
[Calot J.F., 1891],
, 
.
 
[Mascagni, 1788].
. 
, 
,  
. 
, , 
 
, 
. 
,
. 
.


.

, . 

. , 
, ,
.

(ductus cysticus)
3 3 .
1 7 . 5
.

,
. 34 
, . 
59

Hepato_2003_Last_With_Index.qxd

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Page 60


. 
, 
(. 2.14).
, 
.
, ,

. 

.
, 
, .
, , . 



,

.

, 
,

,
, 
, 
, 
.

.




( 35) 

. 2.14 (1)
(2) , [Heister L., 1717], 

.


.
60

Hepato_2003_Last_With_Index.qxd

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Page 61

II. 


.
. 
.

,
, 
. 
,
, .
, , .

,
.
.
.

. 

,
.



. 
. XIX Karl Ludwig
. 

,

. 
, , 
.

. , , , 

, . 
, ,
61

Hepato_2003_Last_With_Index.qxd

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Page 62

, 
, ,
,
.

.
,
.


. (8595%)
, , , , . ,
, 
, , , 
.
, , , , , 
, , .
( 50% )

,
. , 
. 
.
, . 


.

 
, .

(, , ,
). 1520%. 

.
,
, 
. 
.
62

Hepato_2003_Last_With_Index.qxd

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Page 63

II. 


.  
. 1.0091.013,
1.0261.048; pH 7,38,0, 6,8. 
:
, .
6001000
. , ..
.. (1967) . :
1)

, ;
2) ,
,
; , 

, , D, , ,
;
3) ,
,
;
4) 
, ,
;
5) ,
,
;
6) ,
.

, , ,
, , 
, 
, , 
. 

.

,  .
63

Hepato_2003_Last_With_Index.qxd

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Page 64

. 
. , 
, , ,
, . 
, . , , 
.
, 
, .
.
,
. 
, .
,
, , , 

.

, 
( ). 

. 
, 
.
.
,
.

.
1/6 1/5 .

, 
( ) 
, .

.
. 
.

.
510 , 500 . 
64

Hepato_2003_Last_With_Index.qxd

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Page 65

II. 


36 1 
, .
, 
,
, 
510 .

.
,

.
,
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, 2001. 188 .

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, 1983. 185 .

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, 1987. 328 .

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, 1977. 208 .

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8.

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9.

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71

Hepato_2003_Last_With_Index.qxd

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10.

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, 1974. 360 .

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, 1971. 208 .

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. : 
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: . . . . ., 1989. 228 .

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. . : . . , 1970. 576 .

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. . : . .
, 1973. 380 .

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. : , 1987. 192 .

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.: , 1989. 336 .

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, 1984. 320 .

22.

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23.

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, 1963. 432 .

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.. , 1918. 288 .

25.

.,  ., ., . 
: ., .: . .  . , 1976. 537 .

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. / . . .. . .: ,
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27.

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., . : . ./ .
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72

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. 


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198Au. 
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. 1910
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, 
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.

R. Korbsch (1921), H. Kalk (19291962), J.C. Rud
dock (1939), I. Wittmann (1966), K. Semm (1989) . 

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20 
, J.Sicard J.Forestier 
, ,
[. ..
., 1975].

, .. , .. , .. ,
.. , .. , .. , C. Couinaud, A.I. Dos
Santos, S. Seldinger .



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91

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.., .., 1990; Rabinowitz J.R. et al., 1974].

(2,33%) [
.., .., 1984; Rohner A., 1986; Ohtomo K. et al., 1987;
Contor R.L., Longmire W., 1988]. 

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rion 1951 .


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1951 S. Abeatici L. Campi , De S. Pereira
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1015%  
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, [ .., 1974], 
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., 1972],  [ .., 1966], 
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96

Hepato_2003_Last_With_Index.qxd

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III.

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1954 .
. 60
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zalezCarbalhaes (1959),
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Hepato_2003_Last_With_Index.qxd

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1952 H.R.Bierman . 
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, K.L. Wiechel
1971 .
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Hepato_2003_Last_With_Index.qxd

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fee M.Weiner 
. J. Rosch 
. 1975 .

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Hepato_2003_Last_With_Index.qxd

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. 3.13 :
()
,
:

,

(. 3.13).


. , 


[
.., 1997; Gattoni F. et al., 1990;
Scholz A. et al., 1994].



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101

Hepato_2003_Last_With_Index.qxd

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,
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1996; .., 1998].
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,

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cozziMessineti (1965).

 , 

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102

Hepato_2003_Last_With_Index.qxd

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.

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Hepato_2003_Last_With_Index.qxd

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104

Hepato_2003_Last_With_Index.qxd

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105

Hepato_2003_Last_With_Index.qxd

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.

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Hepato_2003_Last_With_Index.qxd

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, 

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108

Hepato_2003_Last_With_Index.qxd

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III.


(
), : 
, 2 ( 
), 3 : 5 
, 15
25 ( ).
, 
.
, 

[ .. ., 1973].

, ,

, .
Y.Caroli (1954) . 
,
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, 
.
.. (1973) , 
,

,
, 

.

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.


109

Hepato_2003_Last_With_Index.qxd

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Page 110

, . 

85% [ .., 1983].

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Hepato_2003_Last_With_Index.qxd

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III.


;

;
 
;
 
,
;
 

.
,
.


1.

..
. ./.../ . . . 
, 1997. 18 .

2.

.. //
: . . . / 
: , 1988. . 4655.

3.

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. : , 1994.
320 .

4.

.., .. . , 1984. .
331332.

5.

.. : . 
. . ., 1985. 320 .

6.

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. :
, 1996. 104 .

7.

.., .., .. .
// . . 1989. 6. . 2125.

8.

..
: . . . . .,
1985. 173 .

9.

.., .., ..
. , 1981.

10.

..  . :
, 1983. 144 .

111

Hepato_2003_Last_With_Index.qxd

10.02.2003

18:39

Page 112

11.

.., .., .. . .: ., 1972. 207 .

12.

.., ..
//
. 1967. 1. .6265.

13.

.. // . .
1966. 2. . 5860.

14.

..
: . . . . , 1998. 309 .

15.

..
. ., 1988.

16.

.., .. . : , 1990. 349 .

17.

.. . . ..
. ... ., 1983.

18.

.. . ., 1980. 516 .

19.

.. . .: ., 1987.

20.

.., .., .. .
// . 
. 1990. . 4. .126.

21.

. . .. , .. . :
, 1991. 224 .

22.

.., .. ..
// . 1973. 3. . 6974.

23.

.., .., ..
. : , 1987. 190 .

24.

.. . ., , 1974. 407 .

25.

.. . .: ., 1972. 352 .

26

. .. . .: , 1984. 478 .

27.

.., .., .. .
. .: , 1975. 266 .

28.

.., .., .. .

// . . 1982. 3. . 3441.

29.

.., .., ..
// . . . 1956. 2. . 5457.

30.

Abeatici S., Campi L. La visualizazione radiologica della porta per via splenica // MinerVa
med. 1951. V. 42. P. 593594.

31.

Barnett P.H., Zerhouni E.A., White R.I., Siegelman S.S. Computed tomography in the
diagnosis of cavernous hemangioma of the liver // Amer. J. Roengenol. 1980. V. 134. P.
438447.

32.

Bierman H.R., Byron R.L., Kelley K.N., Gradi A. Studies on the blood supply of tumors
in man. 111 vascular patterns of the liver by hepatic arterigraphy in vivo // J. Nation.
Cancer Inst. 1951. V. 12. P. 107117.

33.

Blakemore A.H., Lord J.W. The technique of using vitaliumtubes establishing portocaval
sunts for portal hypertension // Ann. Surg. 1945. V. 122. P. 476489.

112

Hepato_2003_Last_With_Index.qxd

10.02.2003

18:39

Page 113

III.

34.

Bruneton J.N., Drauillard J., Fenart D. et al. Ultrasonography of hepatic cavernous


hemangiomas // Brit. J. Radiol. 1983. V. 56. P. 791795.

35.

Caroli J., Porcher P., Gilles E. La part de l,angiocholegraphie intraveineused ans le diagnos
tic des maladies des voies biliaires. Sem. Hpit. 1954. V. 21. P. 12791294.

36.

Chuang V.P, Wallaca S. Interventional approaches to hepatic tumor treatment // Sem.


Roentgenol. 1983. V. 18, N 2. P. 127135.

37.

Child C.G., O Sullivan W.D., Payne M.A., Mc Clure R. Portal venography. Preliminary
report // Radiology. 1951. V. 57. P. 691701.

38.

Couinaud C. Le foie, etudes anatomiques et chirurgicales. Paris, 1957. 256 p.

39.

Couinaud C. Lobes et segments hepatiques // Presse med. 1954. V. 62. N 33. P.


709711.

40.

Contor R.L., Longmire W.P. Reccurent hepatic hemangiomas. Possible association with
estrogen therapy // Ann. Surg. 1988. V. 207. N 2. P. 115119.

41.

Gonzalez E.M., Garcia I.L., Kempin J.C. et al. Indikationen und Resultate der chirurgis
che Behandlung von cavernosen Hemangioma der Leber // Chirurg. 1988. Bd. 59. N 5.
S. 338342.

42.

De Souza Pereira A. La methode phlebographique dans l etude des troubles de la circu


lation du sisteme porte // Lyon chir. 1951. V. 46. P. 291302.

43.

Dos Santos R., Lamas A., Caldas J. Les recents progres dans la technique de larteri
ographie de laorte abdominales // Press. Med. 1931. V.39. P. 574577.

44.

Figley M. Splenoportography: some advantages and disadvantages // Am. J. R. 1958. V.


80. P. 313323.

45.

Gattoni F., Baldini U., Pozzato C. et al. Pure and diluted contrast media the visualization
of the portal venous system using digital angiography // Radiol. Med. 1990. V. 80. N 3.
P. 321324.

46.

GonzalesCarbalhaes O. Hepatoportographia for viena umbilical // Rev. Sanit. Milit.


1959. V. 12. P. 4248.

47.

Hanafee W., Weiner M. Transjugular percutaneous cholangiography // Radiology. 1967.


V. 88. P. 3539.

48.

Hess W. Die erkrankungen der Gallenwege und des Pankreas. Stuttgart, 1961.

49.

Hoevels J., Lunderquist A., Owman T. Complications of percutaneous transhepatic


catheterization of the portal vein and its triby tarries // Acta Radiol. Diagn. 1980. V. 21.
P. 593621.

50.

Itai Y., Ohtomo K., Araki T. et al. Computed tomography and sonography of cavernous heman
giomas of the liver // Amer. J. Roentgenol. 1983. V. 141. P. 315320.

51.

Itai Y., Ohtomo K., Furui S. et al. Noninvasive diagnosis of small cavernous hemangioma
of the liver // Amer. J. Roentgenol. 1985. V. 145. P. 11951199.

52.

Johnson C.M., Sheedy P.F., Stanson A.W. et al. Computed tomography and angiography of
cavernous hemangiomas of the liver // Radiol. 1981. V. 138. P. 115121.

53.

Kalk H. Cirrhose und Narbenleber. Stuttgart: Enke, 1957. 162 s.

54.

Kehr H. Ligation of the hepatic artery proper for aneurysme // Mnchen med. Wehnschr.
1903. V. 43. P. 1861.

55.

Lunderquist A., Vang J. Sclerosing injection of esophageal varices through transhepatic


selective catheterization of the gastric coronary vein. A preliminary report. // Acta Radiol.
Diagn. 1974. V. 15. P. 546550.

113

Hepato_2003_Last_With_Index.qxd

10.02.2003

18:39

Page 114

56.

Mallet Guy P. Television radioscopy during operations on the biliary passages. Surg.,
Gynec., Obstet. 1958. V. 6. P. 747748.

57.

Mallet Guy P., Giuria F. Reflex wirsungien et pancreatites. Analyse d,une deuxime srie
de 400 cas de rflux cholangiographique dans le cancal de Wirsung (19471956). Lyon
Chir. 1957. V. 4. P. 481496.

58.

Moreno E.A., Del Pozo R.M., Vicente C.M., Abellan A.J. Indications for surgery in treatment of
hepatic hemangioma // HepatoGastroenterol. 1996. V. 43. N 8. P. 422426.

59.

Odman P. Percutaneous selective angiography of the main branches of the aorte // Acta
Radiol. 1956. V. 45. P. 114.

60.

Ohtomo K. Hepatic hemangioma: dynamic MRI using gadolinium DTPA // Europ. J.


Radiol. 1987. V.7. N 4. P. 257259.

61.

Pierce E. Percutaneous femoral artery catheterization in man with special reference to


aortography // Surg., Gynec., Obst. 1951. V. 93. P. 5674.

62.

Rosch J., Antonovic R., Dotter C. Transjugular approasch to the liver, billiary system and
portal circulation // Am. J. R. 1975. V. 125. P. 602608.

63.

Rabinowitz S.A., McKusick K.A., Strauss H.W. Tc99m red blood cell scintigraphy in
evaluating focal liver lesions // Amer. J. Roentgenol. 1984. V. 143. P. 6368.

64.

Robinson D.A. et al. Magnetic resonance imaging of the solitary hepatic mass: direct cor
relation with pathology and computed tomography // Clin. Radiol. 1987. V. 38. N 6. P.
559568.

65.

Rohner A. Treatment of benign tumors of the liver // Schweiz. Med. Wschr. 1986. Bd.
116. N 3132. S.10441050.

66.

Seldinger S. Catheter replacement of the needle in percutaneous arteriography. New


technique // Acta Radiol. 1953. V. 39. P. 368376.

67.

Schobinger R., Ruzicka F. Vascular roentgenology Arteriography, Phlebography,


Lymphography. New York, 1964.

68.

Scholz A., Zendel W., Langer M. u.a. Qualitatskriterien der digitalen


Subtraktionsangiographie am Korperstramm // Aktuelle Radiologie. 1994. N 4. S.
7074.

69.

Taylor K.J.W. Ivestigation of the hepatobiliary system and spleen. In.: Ultrasonics in
Clinical Diagnosis /ed. P.N.T. Wells. London: Churchill Livingstone, 1978. P. 57103.

70.

Wiechel K.L. Tekniken vid perkutan transhepatisk portaunktion (PTP) // Nord. Med.
1971. V. 86. P. 912.

71.

Wolverson M.K., Jaganna I.B., Sundaram M. et al. CT as a primary diagnostic method in


evaluating abdominal abscess // Am. J. of Roentgenol. 1979. V. 133. P. 10891095.

114

Hepato_2003_Last_With_Index.qxd

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Page 115

IV

..
..
..
..

Hepato_2003_Last_With_Index.qxd

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() 1849 . ,
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. 
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.
, . 
, 
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. 4050 ,
.



. 
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1999].
,
. 
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: , , 
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, , 
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, 


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, 
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,

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,
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120

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. 
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2 6 . (1985) 
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, .
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, , .


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126

Hepato_2003_Last_With_Index.qxd

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, , , . 
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127

Hepato_2003_Last_With_Index.qxd

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., 68 , :
02.12.86 .
:
128

Hepato_2003_Last_With_Index.qxd

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IV.

. 28.11.86 , :
01.12.86.
: , , .
, . 118
1 , . 70/40 . .
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. 03.12.86
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129

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,


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130

Hepato_2003_Last_With_Index.qxd

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 .
 .

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.


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199,

.
.

.
.
, 
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, 
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.., .., 1990].

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.

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. 

.
.

.

, 
131

Hepato_2003_Last_With_Index.qxd

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.
2
. 2
.
, [Green B. et al., 1977].


,
[ .., .., 1990; Dewbury K.C. et al., 1985].

.
100% [ .., 1996].
, 
, 56,0% .
17,8% .
. 

. 

 . 

,
, [ ..,
1984; .., 1988; .., .., 1990; Ac
kery D., Smith F.W., 1985].
(), 
, 
, 7585% [Burdine J.A. et al., 1979; Ackery D.,
Smith F.W., 1985].


,
. 
Se77 Ga67,
[ .., 1988;
.., .., 1990; Kaplan E., Domingo M., 1972; Pinski S.M., Hen
kin R.E., 1976; Coakley A.J., Wraight E.P., 1980; Ackery D., Smith F.W.,
1985]. 
, , 
,
132

Hepato_2003_Last_With_Index.qxd

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Page 133

IV.

[LaVender J.P. et al., 1971; Damron J.R. et al., 1974; Fawcett


H.D. et al., 1980].
99m

. 81,4% 
, 4,3% , 11,4% 
2,9% 
.

Se77. ,
21% . , 
50% 

73,9% , 
. 

.
, 

,
.
. 

.
. 
, 
[ .., ..,1981;
Dewbury K.C. et al., 1985]. 

, 
, [Itai
Y. et al., 1979; Inamoto K. et al., 1981].
,
, 
 
.

[Dewbury K.C. et al., 1985].

, 
133

Hepato_2003_Last_With_Index.qxd

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18:39

Page 134

[Scherer U. et al.,
1978].
( ). 

. 
. 
,
, 
. , 

0,51, 0 90% [Dewbury K.C. et al., 1985].

. 


, .


, 
.
,

,
.
. 

, , 
. 

2
.


, 
. 
,
 
, 
.

[Bahr P., 1984]. , , 
134

Hepato_2003_Last_With_Index.qxd

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IV.

, , 
.



70,9% , 29,1% 
. 

, 
.
.

73,9%, 
22,1% . 

( 5 ) , 

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42,5% 
57,5% 
.

. ,

. 

, 
.
, /


,
,
, ,

.
,
,

135

Hepato_2003_Last_With_Index.qxd

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.
, , 
, .
. ,
, 
.

, 
. .. . (1981) , 
II, III, V IV 
. ,

, .
, 
, 

( , ,
). , 
,
,
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.


100 . 

. 61,5%
, 38,5% 
.
95,8% .
, 

.

136

Hepato_2003_Last_With_Index.qxd

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Page 137



,
, . 
,
, 
5 10%
[ .., 1981; .., 1992; .., 2002;
Wakabayashi H. et al., 2002].

,
, 
. , 
, 

, ,
(future remnant liver = FRL), 30%
40% . 


[ .. ., 2002].
, 

. , .. . (1992),

26,7 , 5 
614%. 
1 .

1012%.

. 

.

137

Hepato_2003_Last_With_Index.qxd

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18:39

Page 138

( ) 715 [
.., 1996; .., 1998]. 
, ,
820%. ,
, .

11 21 , 5 2040%.


. 
[
.., 1993; .., 1998].


, 100 .

. 
,

,
[ .., 1967; .., 1983; .., 1986; ..,
.., 1995].

, ,

.

:
1.
1.1
1.2
1.3
1.4
1.5
2.
2.1
2.2 ,
3.
138

Hepato_2003_Last_With_Index.qxd

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Page 139

IV.

3.1
3.2
3.3

, ,

.
. 
(. ) ,

( ), 
, ,
, 
 [ .. ., 2002].

M. Refferscheid (1957).

( , 
).
. 

. ,
,

. 

, .
(
)  
,



XII .
Rochard

. 

.
.
139

Hepato_2003_Last_With_Index.qxd

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18:39

Page 140

/


. 
94,8%,
, 
.
, 

. 
, ,
.

, .
.
, ,
.

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.
.
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.
.
.
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. 
.

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. 
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140

Hepato_2003_Last_With_Index.qxd

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IV.

.

, , , 
.  
(
) c 
.
12 . , 
.
.

.
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1894 . .. .. ,
U 
. 
.


. ,
,
.. 
, 

. 

, 11,5 
. 


[ .. ., 1986, 1987].
 


.
141

Hepato_2003_Last_With_Index.qxd

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Page 142



.
1952 . I. LortatJacob . Robert ,


.
,
.. (1967), W. Longmire (1961),
W. McDennott . (1963) . 

.

.
.
. ,
, 

. , , .


. , , . Tung
N. Quang (1963), , 
. , 
, 
. 

, .

() 
, .

. Tung, N. Quang (1963).
,
. Tung, N. Quang (1963).

,
. 

, 
.
142

Hepato_2003_Last_With_Index.qxd

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Page 143

IV.



,  
. 3 
.

(
\ , , ). 

.
.
, 
, 


23 .


. , 

, .



, ,
, 
. ,

.

1908 . 
S.H. Pringle. 
. 

, . 

. .. 
(1970) 
3540 . ,
143

Hepato_2003_Last_With_Index.qxd

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Page 144

60 
. , 
2030 .
.
, 
, 
.
o,



[Fortner I.G., Silva I.S.,
1984].

, , 
. .
,
.

. 

,
1625 ,
.
11,5 ,
.


.

, 
. .


, ,
. , 

.
,

144

Hepato_2003_Last_With_Index.qxd

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18:39

Page 145

IV.

. 
, 
, 
. 10 . .,
.

.


 
Biopump ()
.

70 .
F. ChahezPeon . (1970), S. Franke, . Urban (1979) 
 ,
. 


.
.
.. .. (1980, 1981) 
,

. 2
, 
, 
.

1993 .
70 
5 , .
3 .
.
, 
. 

9 . 1,5 .

, 2025 
145

Hepato_2003_Last_With_Index.qxd

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18:39

Page 146


. 
, 
(. 4.1 ).

,
, (. 4.1 ).

3040 ,
.

, 
.

.

. 4.1 .

( )

146

. 4.1 .

( )

Hepato_2003_Last_With_Index.qxd

10.02.2003

18:39

Page 147

IV.






. ,
2527% . 


. D. Elias . (1999),
,

, 612%.

, 


[Rous P., Larimore L., 1920].
, . ,

.
,
. 1986 . H. Kinoshita .

,
.

. , 

, [Kinoshita H., 1986].
. ,
1999 .
300 , 2001 .
100 ,
3000 . 

IV
( 2001 ., , ).
147

Hepato_2003_Last_With_Index.qxd

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Page 148


, .
,
, 
, ,
5070% . 
,
30%
[ .. ., 2002].


, , , 
.
,

.
,
, 
, .

.
, 

[ .., 2001, 2002; Yamanaka N. et al., 1993; Elias D., 1999].
. 

. 
, ,
,
. .. . (2002) 
, , ,


. 
. 
, 96%
, , , , .

, . 
, , .
148

Hepato_2003_Last_With_Index.qxd

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18:39

Page 149

IV.

,
3050% 
. 
.



. 

46 . 
80% . 515%

510% 

. , D. Elias . (1999), 

,
.

.
, 

.

. 5
2446% [Elias D., 1999].
 


. 1997 .
20 .




, 
.
.
149

Hepato_2003_Last_With_Index.qxd

10.02.2003

18:39

Page 150

, 
, , 
 .

 ,
. 
.

( 
). 
Gellsaver.


,
(Cavitron Ultrasonic Surgical Aspiration CUSA) 

, 
.
, 
, . 
, , CUSA
Cooper Medical () Alonica ().

02. 
.


.
. 

, , 
, .
, . 

,
, 
.
80 ,

150

Hepato_2003_Last_With_Index.qxd

10.02.2003

18:39

Page 151

IV.

. 
. F.P. Gall 1987 . 
110 CUSA 
, 5 
03 32% [Gall F.P., 1987].
, 
.
/ /


.
.


3 , .
. ,
,
. , 

.

,

.

, 
. .. , 10
9,5%
1,9%, 61,1% 34%,
, 50% 
, [ ..,
.., .. ., 2002].



,

151

Hepato_2003_Last_With_Index.qxd

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18:39

Page 152

2030 , 5 2045% [
.., 1993; .., 1996].
2 
:
, 
.
, 
[ .., 1998].

( 3 )
( 3 ), ( 
)
(
). .

.


, 
, (
), 
. 
,
810,0%, 
2056,2% [ .., 1992;
Silen W., 1989].
, 
, , 
.
, 


. 
, 
.
,
,
, 16,1 34,9 , 2 
47% 72%, 3 30,6% 57,5%, 5
20% 47%.
152

Hepato_2003_Last_With_Index.qxd

10.02.2003

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Page 153

IV.


.

: 
, , , 

, , 
, . , 
.. (1993) 
. , I 3
44,2%, II 24,3% III 22,7%.

. A. Yamaguchi . (1993),
, ,
1 , 
3 5 
. 
, .
.. (1993) 3
43,3% , 
, 17,5% .

, .. (1998) , 
,

.
( 
) . ,
.. , 3 , 
, 28,7% ( 
18,5%, 0,9%).




H. Kehr 1903 .
.
153

Hepato_2003_Last_With_Index.qxd

10.02.2003

18:39

Page 154

H. Haberer ,

. . 
J. Markowitz .
(1949) , , 
, . . Romien
(1952) 
,
.
.

, 
[Breedis C. et 1., 1954].
, 7580% 
2025% .
1975 . .. .. 222 
. 

, 
.
, 
. 

,

. 
, E. Mays . (1979)

, :
, 
, , , , 
. 
, 
, , ,
, .

, 
, 

. R. Doci . (1988)

154

Hepato_2003_Last_With_Index.qxd

10.02.2003

18:39

Page 155

IV.

.
, 
,
.
J.G. Fortner . (1984) , 

.

(38%), 

,
 
, ,  

.
.



, , ,
. 
,
, (
)
, 
. :
; ,
, , .

.

:
, , 
.

, ,
13 . 

.
155

Hepato_2003_Last_With_Index.qxd

10.02.2003

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Page 156


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. U. Tylen (1982), 

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, 
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,
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,

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.
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.

, . ,

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.


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. 

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102 (23 
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1.

.. . :  , 1983. 352 .

2.

.., .., ..
// . 1981. 11. . 36.

3.

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... ., 1985. 495 .

4.

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// . 1981. 11. . 3640.

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:  , 1995.

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, 1983. 144 .

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. 1981. 6. . 711.

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// . 1987. 7. . 5662.

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. 1986. 7. . 39.

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// .
1967. 1. . 6265.

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13.

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224 .

14.

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15.

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16.

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// 
. 1992. 7. . 771777.

17.

.., .., .. . 
//
. 1998. . 44. 5. . 662666.

18.

.. . :  
, 1986. 214 .

19.

.. 
: . . /.../  . . , 1970. 30 .

20.

.. // 
. .. . 1990. 2. . 148150.

21.

.., .. //
. .. . 1975. 10. . 137142.

174

Hepato_2003_Last_With_Index.qxd

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22.

..
. .: ., 1988. 240 .

23.

..
: . . /.../  . . 1993. 41 .

24.

..  
: . /.../ . . . ., 1987. 31 .

25.

.., .. . : , 1990. 349 .

26.

.. , , 
: 
. . /.../  . . , 1969. 23 .

27.

.. .
.: , 1976. 209 .

28.

.. 
: . . /.../  . . ., 1996. 26 c.

29.

.., .., .. . 
// . 1992. 3. . 5255.

30.

.. . . .: ., 1993. 544 .

31.

.., .. . .: ., 1985.

32.

.. (
) // . .. . 2001. . 160. 1. . 117121.

33.

.., .., .. . 
// 
. 2002. . 7. 1. . 713.

34.

.., ..
// . .. . 1990. 6.
. 2427.

35.

.., .., ..
// . 1998. 4. . 3336

36.

.. / . .: , 1967.

37.

.., .., .. .
// (
). 2002. 2. . 59.

38.

.. // . 1986. 2. . 37.

39.

.. . .: ,1967.

40.

Ackery D., Smith F.W. Radioisotope and nuclear magnetic resonance imaging. In: Liver
and biliary disseases R. Wright et al. London, etc., 1985. P. 537552.

41.

Bahr P. Lebertumoren und Lebeparasiten // Langenbecks. Arch. Chir. 1984. Kongres


sbericht. S. 137141.

42.

Ballet F. Traitement du cancer primitif du fois // Vie Med. 1983. 64. 7. P. 273280.

43.

Baumann R., Grodd W., Kurtz B. Nuclear spin tomographic studies in liver diseases //
RoFo. 1985. Bd. 142. S. 494504.

44.

Breedis C., Yung G. The blood supply of neoplasms.// The Am. J. of Phathology. 1954. v.
30. N 5. P. 969977.

175

Hepato_2003_Last_With_Index.qxd

10.02.2003

18:39

Page 176

45.

Chuang V.P, Wallace S. Interventional approaches to hepatic tumor treatment // Sem.


Roentgenol. 1983. V. 18. N 2. P. 127135.

46.

Chuang V.P., Wallace S., ChiuShiung S. et al. Therapeutic ivalon embolisation of hepa
tic tumors // Am. J. Rad. 1982. V. 138. N 2. P. 289294.

47.

Coakley A.J., Wraight E.P. Selenomethionine liver scanning in the diagnosis of hepatoma
// British J. of Rad. 1980. V. 53. P. 538543.

48.

Damron J.R., Beihn R.M., Selby J.B., Rosenbaum H.D. Galliumtechnetium subtraction
scanning for the localization of subphrenic abscess // Radiology. 1974. V. 113. P. 117122.

49.

Delcour C.P., Struyven J.L. Interventional radiology in oncology // Europ. J. Cancer.


1988. N 5. P. 815819.

50.

Dewbury K.C., Meire H.B., Husband J.E. Ultrasoung imaging and computed tomo
graphy. In: Liver and biliary disseases R.Wright et al. London, etc., 1985. P. 553576.

51.

Doci R., Bignami P., Bozzetti F. Intrahepatic chemotherapy for unresectable hepatocellu
lar carainoma // Cancer. 1988. V. 61. N 9. P. 19831987.

52.

Elias D., Cavalcanti A., de Baere T. et al. Resultats carcinologiques a long terme des hepatecto
mies realisees apres embolisation portale selective // Ann. Chir. 1999. Vol. 53. N 7. P. 559564.

53.

Fawcett H.D., Lantieri R.L., Frankel A., McDugall I.R. Differentiating hepatic abscess
from tumor: combined 111 In with blood cell and 99 mTc liver scans // Am. J. of Roent
genol. 1980. V. 135. P. 5356.

54.

Fortner J.G., Silva J.S. Multivariate analysis of a personal series of 247 consecutive with
liver metastases from colorectal cancer // Ann. Surg. 1984. V. 199. P. 306316.

55.

Gall F.P. // Oncologie. 1987. Vol. 10. P. 247249.

56.

Ghendon Y.Z. World Health Organization strategy for Control of Hepatitis B. Control of
Virus Disease / Ed. E. Kurstak 2 ed. // NY: Marsel Dekker Inc., 1993. P. 141164.

57.

Green B., Bree R.L., Goldstein H.M., Stanleu C. Grey scale ultrasound evaluation of he
patic neoplasms: patterns and correlations // Radiology. 1977. V. 124. P. 203208.

58.

Inamoto K., Sigiki K., Yamasaki H., Miura T. CT of hepatoma: effects of portal vein ob
struction // Am. J. of Roentgenol. 1981. V. 136. P. 349353.

59.

Itai Y., Nishikawa J., Tasaka A. Computed tomography in the evaluation of hepatocellular
carcinoma // Radiology. 1979. V. 131. P. 165170.

60.

Kanematzu T., Inokushi K., Sugimachi K. et al. Selektive effect of lipiodolized antitumor
agents // J. Surg. Oncol. 1984. V. 25. N 3. P. 218226.

61.

Kaplan E., Domingo M. 75 Seselenomethionine in hepatic focal lesions // Seminar in


Neclear Med. 1972. V. 2. P. 139149.

62.

Katagini Y., Mabuchi K., Itakura T. Adriamycinlipiodol suspension for intraarterial che
motherapy of hepatocellular carcinoma // Cancer Chemother. Pharmac. 1989. V. 23.
N 4. P. 238242.

63.

Kinoshita H., Sakai K., Hirohashi K. et al. Preoperative portal vein embolization for hepa
tocellular carcinoma // World J. Surg. 1986. Vol. 10. N 5. P. 803808.

64.

LaVender J.P., Lowe J., Barker J.R. et al. Gallium67 citrate scanning in neoplastic and
inflammatory lesions // Brit. J. of Rad. 1971. V. 44. P. 361366.

65.

Le Veen H.H., Rajagopalan P.R., Vujic J. Radiofrequency thermotherapy, local chemothe


rapy and arterial occlusion in the treatment of nonsectable cancer // Am. Surg. 1984.
V. 50. N 2. P. 6165.

66.

Longmire W. Manual of liver surgery / N.Y.,1961.

176

Hepato_2003_Last_With_Index.qxd

10.02.2003

18:39

Page 177

IV.

67.

Lortat Jecob J.L., Robert H.G. Hepatectomie droite reglee // Presse Med. 1952. V. 60.
P. 549551.

68.

Markowitz J., Rappaport A., Scott A.C. Prevention of liver necrosis following ligation of
hepatic artery // Proc. Soc. Exp. Biol.: N.Y., 1949. V. 70. P. 305309.

69.

Martin I.K., O,Connel M.J., Wiland H.S. Intraarterial floxuridine vs systemic fluoracil
for hepatic metastases from colorectal cancer. A randomized trial.// Arch. Surg. 1990.
V.125, N 8. P.10221027.

70.

Mays E.T., Conti S., Fallahzadeh H., Rosenblatt M. Hepatic artery ligation // Surgery.
1979. V. 86. N 4. P. 536543.

71.

Nakakuma K., Tashiro S., Hiraoka T. et al. Studies on anticancer treatment with an oily
anticancer drug injected into the ligated feeding hepatic artery for liver cancer // Cancer
(Philad.). 1983. V. 52. N12. P. 21932200.

72.

Pentecost M.J., Daniels J.R., Teitelbaum G.P et al. Hepatic chemoembolisation: safety
with portal wein trombosis // J. Vasc. Interv. Radiol. 1993. V. 4. N 3. P. 347351.

73.

Pinski S.M., Henkin R.E. Gallium67 tumor scanning // Semin. In Nuclear Med. 1976.
V. 6. P. 397409.

74.

Reifferscheid M. Chirurgic der Leber. Stuttgart, 1957. 289 s.

75.

Rous P., Larimore L. Relation of the portal blood to liver maintenance // J. Exp. Med.
1920. Vol. 31. P. 609632.

76.

Saffi F., Roscher R., Pralle U. et al. Regionale chemotherapie von Lebermetastasen. Die
klinische Relevonz von CEA und CA 1919 // Chir. Prax. 1988. V. 39. N 4. S. 639646.

77.

Saiton S., Ikeda K., Koida I. Small Hepatocellular Carcinoma: Evaluation of Portal Bload
Flov with CT during Arterial Portography Performed with Ballon Occlusion of the Hepa
tic Artery // Radiol. 1994. V. 193. P.6770.

78.

Scherer U., Rothe R., Einsenburg J. et al. Diagnostic accuracy of CT in circumstript liver
disease // Am. J. Roentgenol. 1978. V. 130. P. 711714.

79.

Schlag P., Hohenbergen P., Holfing Th. Hepatic arterial infusion (HAI) chemotherapy for
liver metastases of colorectal cancer using 5FU // Eur. J. Surg. Onc. 1990. V. 16. N 2.
P. 99104.

80.

Schroder R., Marincer B., Roder R. CTEvaluation der intraarteriellen Chemotherapie bei
Lebermetastasen // Helv. Chir. Acta. 1985. V. 51. N 6. S. 679682.

81.

Shciba K., Quchi A., Jamamoto K. et al. The effecacy of intraarterial infusion chemothera
py in patients with nonresectable liver metastasis from colorectal cancer. a randomisired
stady comparing FAM vensus FEM // GanToKagaku Ruoho. 1993. N 9. P.18111816.

82.

Shibata J., Fujyama Sh., Sato T. Hepatic arterial injection with cisplatin suspended in an
oily lumphografic agent for hepatocellular carcinoma // Cancer. 1989. V. 64. N 8.
P. 15801594.

83.

Silen W. Hepatic resection for metastases from colorectal carcinoma is of dubious value
// Arch. Surg. 1989. V. 124. N 9. P. 10211022.

84.

Teng G.J., He S.C., Guo J.H. et al. Preoperative transcateter hepatic arterial embolisa
tion for hepatic malignancy // Inv. Radiol. 1993. V. 28.

85.

Tung T.T., Quang N.D. A new technique for operating on the liver // Lancet. 1963. N 1.
P. 192193.

86.

Tylen U. Intraarterial Chemotherapy of Liver Tumors // Radiologie. 1982. V. 22.


P. 7173.

177

Hepato_2003_Last_With_Index.qxd

10.02.2003

18:39

Page 178

87.

Wakabayashi H., Yachida S., Maeta T., Maeta H. Indications for portal vein embolization
combined with major hepatic resection for advancedstaged hepatocellular carcinomas:
A preliminary clinical study // Digest. Surg. 2000. Vol. 17. N 6. P. 587594.

88.

Yamanaka N., Okamoto E., Kawamura E. et al. Dynamics of normal and injured human
liver regeneration after hepatectomy as assessed on the basis of computed tomography
and liver function // Hepatology. 1993. Vol. 18. 1. P. 7985.

178

Hepato_2003_Last_With_Index.qxd

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Page 179

.. ,
.. ,
.. ,
.. ,
..

Hepato_2003_Last_With_Index.qxd

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,

(1816) 
.
2,23,0% 2034% 
[ .., .., 1984; 
.., .., 1984; Contor R.L., Longmire W.P., 1988]. 
, 
7,3% [Itai J. et al., 1985].
1028% [ .., ..,
1981; .. ., 1990]. , 
[ .., 1990]. 
,
,
[ .., .., 1992; Bruce S.
et al., 1995]

, 
[ ., 1982; .., 1987]. 
, 
. .. , .. 
(1992)
(II).
(, 
) [ .., 1990]. 
,
, 
. , 2%
, 
,
[ ..,
.., 1992; Contor R.L., Longmire W.P., 1988; De Blassio R. et al., 1996].

, .

, , ,
, .
181

Hepato_2003_Last_With_Index.qxd

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: 
,
,
.

, 
,  [
.., .., 1995]. 
, ,
[ .. ., 1989].
:
 ( 60% );
 ( 30% );
 , 12
, ;
  (
),
.
5 ,
[
.., 1990].
129 .
92 (71,3%) 37 (28,7%)
12 70 . 49,2 ,
46,3 .
( 5 )
38 (30,4%) . 
( 5 ) 54 (43,2%) .
33 (26,4%) ( 9 (7,2%)
).

118 (91,5%) , 7 (5,4%) 4 (3,1%) 
.



. , 5
182

Hepato_2003_Last_With_Index.qxd

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.
, , 
45 . 

. 
,
.  (
, , , , ) 

. 40% [
.., 1972; .., 1986; .., 1990; Contor R.L.,
Longmire W.P., 1988].
58 (45%) 
, 
: 49 (38%) , 
,
3 (2,3%) ,
,
.
19 (14,7%) 
, 21 (16,3%) , ,
3 (2,3%) 
, . 
4 (3,1%) ,
28 (21,7%) .
 2,5 ( 12 8 ), 8
(6,7%) .
71 (55%) 
35 
36 .


, 
. 
, 
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zalez E.M. et al., 1988].

, 
.
183

Hepato_2003_Last_With_Index.qxd

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,
. 60
80% [ .. ., 1980; Aseni P. et al., 1987]. 
, 
[ .., 
.., 1984]. 
[TranMinh V.A. et al., 1991].


[ .. ., 1983;
.., .., 1984; .. ., 1990].
,  
[ .., .., 1984; .. ., 1985;
Gonzalez E.M. et al., 1988].
 ,
, 
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1990 . 56 
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45 39 65 11 43 58 .
56 
( 32
, 11 ,
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 , , .
7 (12,5%)
, 
. 
39 (69,6%) 
, . 
4 (7,2%)
22,5 .
6 (10,7%)
 . 

.

2 7
184

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. .
.
11 (19,6%)
34 .
39 50 .
3 . 34

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).
16.03.98 :
, .
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, . :
20 80 :
. : ,
:
1108090 .

185

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. .
5
, . :
. 8 .

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,

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5 

.
5 .
, 
. 
, , 
[
.., 1990; Sood A. et al., 1996].

34 ,
.
, ,
, 

, . 
1,0
. 
, , 4451%
[ .., .., 1991].
186

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5 , 12 5 , 20 
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.

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.
, ,

.

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. 10 (18,5%)

, .

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4 (9,5%) ,
.
4 2 .
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5 (11,9%) 
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, 2 
(. 5.1).

60,6% ,
9,1%, 
30,3%.

80,6%,
75,9%,
90,9%.
.
,
5 54,7%,
5 22,2%,
60,6% (
42,6%).
87 
, ,
(56 )
( 4, 9
18).

, 
.
, 




.





,
5 
. 5.1 ,


( )
.
188

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V.



. 

.

[Numata K. et al., 1993].
C. Reinhold . (1995) 
198 .

, . 
(4,721,72 ) 
, (0,530,75 ) . 
94%,

96% , 
(68%), 
. 

,
( 5060% 8390% 
) [Kudo M. et al., 1992; Fujimoto M. et al., 1994; Mares
ca G. et al., 1994; Veltri A. et al., 1994].

. 

[ .., .., 1991].
.. . (1991) 
5154 . 
95 (1,8%). 
( 6 ) ,
, , 87,5% 
. ( 6 ) 
 
, 
( ).


,

.
189

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, . 
8590%, 
9598% [ ..
., 1989; Honda H. et al., 1992].
28%
. 
,
. 

.
, 
78,1% . 9,4%


.
5 .
9,4% , .

. 

5 (. 5.1 ). 97%
1
4,55 . 
5
61,5% , 15,4%
, 23,1%
.

85,7% . 
. 

.
,
, , 87,5%,
91,7% 5 ,
92,3% 5 85,7%
. 


190

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V.

. : 91,7%
5 , 61,5% 5 85,7% 
( 78,1%).

/ , 
 
.  
,

.
1,0 . 

[McFarland E.G. et al., 1994;
Siewert B. et al., 1994; Powers C. et al., 1994; Semelka R.C. et al., 1994;
Moteki T. et al., 1995; Berger J.F. et al., 1996]. , 
100%. , 

, 
, ,
.



, .


, 99m, 
.
.
, , 

.
,
[
.., 1991].

(198Au
131J) [ .., .., 1986].


,
191

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. 

.

, 99m
. Krause T. . (1993) 
(52%),
(68%) 
(95%). 
1,0; 0,9 0,5 . 
,  
, 100%. 
. ,
 
,
, 
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,

, .

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,
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5 

.

. ,
5 
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Tc99m
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5 73,3% 80,0%
.
192

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, 
Tc99m
, .
1 ,

, 
.
, 99m


.


. ,
, .
.. . (1990) 
:
;
; 


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[Gonzalez E.M. et al., 1988]. 

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,
[ .. ., 1990].
.

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.. . (1990) ,
, 
, 
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, .
, , 

. , 



,
, 

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berg B. et al., 1987].


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. .
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194

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, 
, XII 
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.

.
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.

, 
, [Sood A.
et al., 1996]. , 

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. (1997) 
32 . 
195

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, , 
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67 /. , 2 :
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196

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198

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Hepato_2003_Last_With_Index.qxd

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V.




J. Pfannenstiel 1898 .
, 

. ,
, .
R. De Blassio . (1996) , 10% 
. 
, , 
[
.., .., 1981; .., .., 1984;
.., 1986; .. ., 1991; Contor R.L., Longmire W.,
1988]. 
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(1989) 
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, 
. , 
, 
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. ,

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, 
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., 1983; .., 1986; .., 1986; .., 1990;
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.. (1986) 18 (70%) 26 
. , 
, 
, 
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80% . .. 
. (1992), 7
,


.
, ,
.

. , 
. 
[Gonzalez E.M.
et al., 1988].
H. Demizyurek . (1997) , 
,
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.
,
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roce E. . (1994) 4
, 
.
,
, 
, [ ..
., 1990]. 
,
.
.
.. . (1998) 
,
.

14 . 4 48 56 10
20 60 .
7
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II III 1
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203

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[ .. ., 1989; 
.., 1990]. 
,
, 
.
S.I. Schwartz, W.C. Husser (1987) 
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, 
, 
.
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204

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, . :
.
21.04.98 : 2025 ,
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.
,
, . . 28.04.98: b 76 /, :
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206

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2%, 56 /; 24,7 /, 0,68 /.,


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207

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,
.

, , .

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. 

7 

, 15
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,
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, 
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[
.., 1990].

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ley P.T. et al., 1983; Soyer P., Levesque M., 1995].
.. . (1993)


. 
.. (1997), 
,
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, 
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208

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, 6 ( . . 4 
) 1 
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.
209

Hepato_2003_Last_With_Index.qxd

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. 
.
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210

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211

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10473 ( 14.08.97
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213

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.
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214

Hepato_2003_Last_With_Index.qxd

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Page 215

V.


1.

.. // .
1990. 6. . 135139.

2.

.. . :  , 1983. 352 .

3.

.., .. // 
. .. . 1989. 9. . 4748.

4.

.., .., .. 
// .... 1983. 9. . 6465.

5.

.., .. . , 1984. . 331332.

6.

.., .., .. . .
.:  , 2000. 144 .

7.

.., .. //.
. , 1999. . 34.

8.

.., ..
// . 1984. 7. . 6164.

9.

.., ,. . : , 1999. 176 .

10.

.., .., .. 
// . 1992. 1. . 101109.

11.

.. . :  
, 1986. 214 .

12.

.. // 
.... 1990. 2. . 148150.

13.

.. // ....
1985. 7. . 27.

14.

.., .. //
.... 1992. 3. . 314315.

15.

.., .., .., .. .




// . 1989. 12. . 2328.

16.

.., .., .. . , 1985.

17.

..  
:: . . . . .,
1987. 31 .

18.

.. 
. .: ., 1987. 400 .

19.

.. . ., 1980. 516 .

20.

.., .., .. . 
// . .
1990. . 4. . 126.

21.

( . .., ..).: 
, 1991. 224 .

215

Hepato_2003_Last_With_Index.qxd

10.02.2003

18:39

Page 216

22.

.., .., .., .. 


// . 1988. . 3.
3. . 308309.

23.

.., .., .. 
// : 
/ , 1999. . 111.

24.

.., .., .., . 


// . 1991. 6.
.2529.

25.

.. . .: ., 1972. 352 .

26.

.., .., ..
. ., 1980.

27.

.., .., .. .
// . 1997. 4.
. 1114.

28.

.. : .
. . . . , 1997. 23 .

29.

.., ..
// . 1992. . 28. 7. . 161163.

30.

.., ..
// . . 1986. 8. . 5961.

31.

. . // Acta chir. plast. 1982. V.


24. 4. P. 200205.

32.

.., .., .. 
// . 1989. 2. . 3844.

33.

.., .., .. . 
// 
. 2002. . 7. 1. . 713.

34.

.., .., ..
// . . 1990. . 36. 5. . 583585.

35.

.. // . 1986. 2. . 37.

36.

.., .. // 
.... 1981. 9. . 4347.

37.

.., .., ..
// . 1991. 2. . 6669.

38.

Althaus S., Ashdovn B., Coldwell D. et al. Transcateter arterial embolisation of two sym
ptomatic giant cavernous hemangiomas of the liver // Cardiovascular and Interventional
Radiol. 1996. V. 19. N 5. P. 364367.

39.

Aseni P., Riolo F., Cerrari F. et al. Gliemangiomi epatici: Criteri di scelta per una terapia
chirurgica // Minerva chir. 1987. V. 42. N 6. P. 469473.

40.

Berger J.F., Laissy J.P., Limot O. et al. Differentiation between multiple liver hemangio
mas and liver metastases of gastrinomas: value of enhanced MRI // J. Computer Assisted
Tomography. 1996. V. 20. N 3. P. 349355.

41.

Bruce S., Downe L., Devonald K., Ellwood D. Noninvasive investigation of onfantile he
patic hemangioma: a case study // Pediatric. 1995. V. 95. N 4. P. 595597.

216

Hepato_2003_Last_With_Index.qxd

10.02.2003

18:39

Page 217

V.

42.

Contor R.L., Longmire W.P. Reccurent hepatic hemangiomas. Possible association with
estrogen therapy // Ann. Surg. 1988. V. 207. N 2. P. 115119.

43.

De Blasio R., Avallone U., Donisi M. et al. Emangioma epatico. Diagnosi e trattamento
// Ann. Surg. 1996. V. 67. N 2. P. 233237.

44.

Fujimoto M., Moriyasu F., Noshikawa K. et al. Color Doppler Sonography of hepatic tu
mors with a galactosebased contrast agent correlation with angiographic findings //
Amer. J. Roengenol. 1994. V. 163. N 5. P. 10991104.

45.

Gonzalez E.M., Garcia I.L., Kempin J.C. et al. Indikationen und Resultate der chirurgische
Behandlung von cavernosen Hemangioma der Leber // Chirurg. 1988. Bd. 59. N 5. S. 338342.

46.

Honda H., Matsuura Y., Onitsuka H. et al. Differential diagnosis of hepatic tumors (he
patoma, hemangioma and metastasis) with CT: value of twophase incremental imaging
// Amer. J. Roentgenol. 1992. V. 159. N 4. P. 735740.

47.

Itai G., Ohtomo K., Furui S. et al. Noninvasive diagnosis of small cavernous hemangio
ma of the liver // Amer. J. Roentgenol. 1985. V. 145. P. 11951199.

48.

Itai Y., Ohtomo K., Araki T. et al. Computed tomography and sonography of cavernous he
mangiomas of the liver // Amer. J. Roentgenol. 1983. V. 141. P. 315320.

49.

Johnson C.M., Sheedy P.F., Stanson A.W. et al. Computed tomography and angiography
of cavernous hemangiomas of the liver // Radiol. 1981. V. 138. P. 115121.

50.

Kawarada I., Mizumoto R. Surgical treatment of giant hemangioma of the liver // Amer.
J. Surg. 1984. V. 148. P. 287291.

51.

Libutti S.K., Starker P.M. Laparoscopic resection of a nonparasitic liver cyst. //


Surg.Endosc. 1994. V. 8. P. 11051107.

52.

Limberg B., Hopker W., Kommerell B. Histologic differential diagnosis of local liver les
ions by ultrasonically guidid fine needle biopsy // Gut. 1987. V. 28. N 3. P. 237241.

53.

Maresca G., Barbaro B., Summaria V. et al. Color Doppler ultrasonography in the diffe
rential diagnosis of focal hepatic lesions. The SH U 508 A (Levevist) experience //
Radiol. Med. 1994. V. 85. N 5. P. 4149.

54.

McFarland E.G., MayuoSmith W.W., Saini S. et al. Hepatic hemangiomas and malig
nant tumors: improved differentiation with heavily T2weighted conventional spinecho
MR imaging // Radiol. 1994. V. 193. N 1. P. 4347.

55.

Moteki T., Ishisaka H., Horikoshi H., Matsumoto M. Differentiation on between hemangio
mas and hepatocellular carcinomas with the apparent diffusion coefficient calculated from
turboFLASH MR images // J. Magnetic Resonance Imaging. 1995. V. 5. N? 2. P. 187191.

56.

Nischida O., Saton N., Alam A., Uchino J. The effect of hepatic artery ligsation for irres
ectable cavernous hemangioma of the liver // Amer. Surg. 1988. V. 54. N 6. P. 483486.

57.

Numata K., Tanaka K., Matsui K., Morimoto M et al. Flow characteristics of hepatic tu
mors at color Doppler sonography: correlation with arteriographic findings // Amer. J.
Roentgenol. 1993. V. 160. N 3. P. 515521.

58.

Panis Y., Fagniez P.L., Cherqui D. et al. Successful arterial embolisation of giant liver ha
emangioma. Report of a case with fiveyear computed tomography followup // Surgery.
1993. V. 7. N 2. P. 141146.

59.

Powers C., Ros P.R., Stoupis C. et al. Primary liver neoplasms: MR imaging with patho
logic correlation // Radiographics. 1994. V. 14. N 3. P. 459482.

60.

Schwartz S.I., Husser W.C. Cavernous hemangioma of the liver. A single institution re
port of 16 resections // Ann. Surg. 1987. V. 205. N 5. P. 456465.

217

Hepato_2003_Last_With_Index.qxd

10.02.2003

18:39

Page 218

61.

Semelka R.C., Brown F.D., Ascher S.M. et al. Hepatic hemangiomas: a multiinstitutio
nal study of appearance on T2weighted and serial gadoliniumenhanced gradientecho
MR images // Radiol. 1994. V. 192. N 2. P. 401406.

62.

Siewert B., Muller M.F., Foley M. et al. Fast MR imaging of the liver: quantitative com
parison of techniques // Radiol. 1994. V. 193. N 1. P. 3742.

63.

Sood A., Sandhu P., Sood N. et al. Giant cavernous hemangoimas of liver mimicking ma
tastasis // J. Association Physic. India. 1996. V. 44N 11. P. 784785.

64.

Soyer P., Levesque M. Haemoperitoneum due to spontaneous rupture of hepatic hae


mangiomatosis: treatment by superselective arterial embolisation and partial hepatecto
my // Austral. Radiology. 1995. V. 39. N 1. P. 9092.

65.

Stanley P., Grinnell V.S., Stanton R.E. et al. Therapeatic Embolization of Infantile Hepatic
Hemangioma with Polyvinyl Alcohol // Amer. J. Rontgen. 1983. V. 141. N 5. P. 10471051.

66.

TranMinh V.A., Gindre T., Pracros J.P. et al. Vol vulvus of a pedunculated hemangioma
of the liver // Am. J. Roentgenol. 1991. V. 156. N 4. P. 866867.

67.

Veltri A., Capello S., Faissola B. et al. Dynamic contrastenhanced ultrasound with car
bon dioxide microbubbles as adjunct to arteriography of liver tumors // Cardiovascular
and Interventional Radiol. 1994. V. 17. N 3. P. 133137.

218

Hepato_2003_Last_With_Index.qxd

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VI

.. ,
.. ,
.. ,
..

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, , 
. ,
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, ,
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, ,
.

, ,
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. , 
,
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,
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. 
,
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. 
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224

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.., 1984]. , ,
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al., 1982; Schulz F. et al., 1984; .. ., 1985; Edwards J.D.
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225

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58 (92%) 
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.

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, 
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228

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, 

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,

229

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. 

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).

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230

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.
, 99m


.


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.


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., 1991]. P.Brady . (1987)
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10
. 
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231

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, 
,
,
.
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.
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, 

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232

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6%
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233

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 ;
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, [ .., 1986;
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, . .
, ,
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236

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, 

,

, ,
,
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,

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. 
, 

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237

Hepato_2003_Last_With_Index.qxd

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, , 
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. 

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et al., 1984]. Suraci V. . (1984) 

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,
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238

Hepato_2003_Last_With_Index.qxd

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. , 

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.

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. 
, , 
,
, , 
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[Libutti S.K., Starker P.M., 1994; Tate J.J. et al., 1994; Watson D.I.,
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[Ooi L.L., 1994] [ ..,
1998; .. ., 1999; Ker C.G. et al., 1997].

, , 
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3. .
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, 
.
, 38% 
. 
,
, , 
. 
, 
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[Klingler P.J. et al., 1997].


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, [ .., .., 1983; .,
1997; Cala Z. et al., 1996].

.
. 


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246

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248

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6 :
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al., 1981].
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250

Hepato_2003_Last_With_Index.qxd

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VI.

. .. . (1999), .. 
. (1999) 
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40 ,
1 3 . 
 .
. 
, ,
, ,
,
[Edwards J.D. et al., 1987; Rifkin M.D. et al., 1987].

: 
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. (1999), 102
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.


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2.

.., ..
// . .. . 1990. 6. . 1721.

251

Hepato_2003_Last_With_Index.qxd

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Page 252

3.

.., .. . , 1984. . 331332.

4.

.., .., .. . .
.:  , 2000. 144 .

5.

.., .., .. 
. , 1981.

6.

..  . :
, 1983. 144 .

7.

.., ..
. : . 1987. 336 .

8.

.., .. 
// . .. . 1994. 56. . 4650.

9.

.., .., .. //
. 1988. 9. . 142143.

10.

.. . :  
, 1986. 214 .

11.

.. 
: . . . . , 1998. 309 .

12.

.., .., .. . , 1985.

13.

.. // ....
1989. 10. . 4648.

14.

.. 
. .: ., 1987. 400 .

15.

.., .., .. .
// . .. .
1986. . 36. 1. . 3640.

16.

.., .., .., .., ..


// . 5.
1996. . 1620.

17.

.., .., .. .
// : 
/ , 1999. . 89.

18.

.., .., .. // 
. .. . .. , 1999. .92.

19.

.. .., .. .  

// : /
, 1999. . 94.

20.

.., ..
// . 1983. 9. . 57.

21.

.., .., .., .. 


// . 11. 1994. . 15.

22.

.., .., ..
// . 1973. 3. . 6974.

23.

.., .. ( )
// . 1982. 1. . 108114.

252

Hepato_2003_Last_With_Index.qxd

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Page 253

VI.

24.

.., .., .. .
// . 1992. 78. . 2933.

25.

.., .., .. 
// : 
/ , 1999. . 111.

26.

.., .., .., . 


// . 1991. 6.
.2529.

27.

.. 
: . . . . ,
1986.

28.

.. // . 1978. 1. . 120.

29.

.. . .: ., 1972. 352 .

30.

.. . . .: ., 1993. 544 .

31.

. ., .., .. . 
// . 1996. . 1. . 242.

32.

.., .., .. 
// . 1992. 1. . 9899.

33.

.., .., .. //
. 1976. 1. . 128.

34.

.., .. // 
.... 1989. 7. . 6061.

35.

.., .., ..
// . 1996. . 1. . 258.

36.

.., .., .. . .,
1987. . 111112.

37.

.., .., .. 
// . . 1989. 4.
. 9093.

38.

.., .. //
. .. . 1989. 3. . 5253.

39.

.. :
. . . . , 1997.

40.

.., .., .. , 
// . . 1986. 9. . 67.

41.

.., .., .., ..


. i: i, 1993. 512 .

42.

.., .., ..
// . 1977. 6. . 29.

43.

.. // . 1986. 2.
. 37.

44.

Angelescu N., Jitea N., Dimitriu C. et al. Chisturi serous seroase neparazitare ale ficatu
lui // Chirurgia.1994. V. 43. N 2: P. 13.

45.

Austin .H., Mitchell G.E., Oliphant M. et al. Solitary hepatic cyst and benign bile duct
polip: a heretofore unheralded association // Surgery. 1981. V. 89. N 3. P. 359363.

253

Hepato_2003_Last_With_Index.qxd

10.02.2003

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Page 254

46.

Belcher M.Y., Hull H.C. Nonparasitic cysts of the liver: report of three cases // Surgery.
1969. V. 65. N 3. P. 427431.

47.

Bismuth H., Castaing D., Kunstlinger F. Peroperative echography in hepatobiliary surge


ry // Presse med. 1984. V. 13. N 30. P. 18191822.

48.

Bourgeois N., Kinneart P., Vereerstraeten P. et al. Infection of hepatic cysts following kid
ney transplantation in polycystic disease // Wld J. Surg. 1983. Vol. 7. P. 629631.

49.

Bourgeon R., Guntz M, Mouiel J et al. Hepatic resections in relation to hydatid cyst //
Chirurgie. 1982. V. 108. N 7. P. 585587.

50.

Brady P.G., Goldschmid S., Chappel G. et al. A comparison of biopsy techniques in su
spected focal liver disease // Gastrointest. Endoscop. 1987. V. 33. N 4.P. 289292.

51.

Brendel A., Leccia F., Drouillard J. et al. Single photon emission computed tomography
(SPECT), planar scintigraphy, and transmission computed tomography: a comparison of
accuracy in diagnosing focal hepatic disease // Radiology. 1984. V. 153. N 2. P. 527532.

52.

Burdine J.A., Murphy P.H., DePuey E.G. Radonuclide computed tomography of the bo
dy using routine radiophamaceuticals. 11 Clinical applications // J. of Nucl. Med. 1979.
V. 20. P. 108114.

53.

Cala Z., Cvitanavijc B., Perko Z., Velnijc D., Rasic Z. Laparoscopic treatment of nonpa
rasitic cysts of spleen and liver // J.Laparoendosc Surg. 1996. V. 387. P. 91.

54.

Chuang J.H., Huang S.C. Posttraumatic hepatic cyst an unusual seguella of liver in
jury in the era of imaging // J. Pediatr. Surg. 1996. V. 31: P. 272274.

55.

Davis C.K., Schoffstall R.O., Glass T.F. Fatal complication of hepatic cystic disease // J.
South. Med. 1981. V. 74. P. 14091411.

56.

Edwards J.D., Eckhauser F.E., Knol J. A et al. Optimizing surgical management of sym
ptomatic solitary hepatic cysts // Amer. Surg. 1987. V. 53. P. 510514.

57.

Emmermann A., Zornig C., L Toyd D.M. et al. Laparoscopic treatment of nonparasitic
cysts of the with omentol transposition flop // Surg. Endosc. 1997. V. 11. P.734736.

58.

Farsi M., Alessio F., Martelli S. et al. Cisti congenite del fegato. Diagnosi strumentale e in
dicazioni al trattamento chirurgico // Minerva Chirurgica. 1992. V. 47. N19. P.15131520.

59.

Fernandez M., Cacioppo J.C., Davis R.P., Nora P.F. Management of solitary nonparasitic
liver cyst // Ibid. 1984. V. 50. P. 205208.

60.

Fiori E., Galati G., Gazzanelli S. et al. Attuali orientamenti sul trattamento delle cisti non
parassitarie giganti del fegato // Giornale di Chirurgia. 1994. V. 15. N 10. P. 450454.

61.

Gigot J.F., Legrand M., Hubens G. et al. Laparoscopic treatment of nonparasitic liver
cysts: adeguate selection of patients and surgical teehnigue // World J. Surg. V. 20.
P. 556561.

62.

Goebel N., Enzler P., Binkert D. Cystic liver with duodenal compression // Fortschr.
Rontgenstr, 1984. Bd. 140. S. 352353.

63.

HenneBruns D., Klomp HJ., Kremer B. Nonparasitic liver cysts and polycystic liver dis
ease: results of surgical treatment // HepatoGastroenterology. 1993. V. 40. N 1. P. 15.

64.

Huguet C., Nordlinger B., Baron J.C. et al. Congenital cysts and benign tumors of the li
ver in adults. What are the surgical indications? Apropos of 47 cases // Ann.Chir. 1986.
V. 40. ? 4. P. 231235.

65.

Jeng KS., Yang FS., Kao CR., Huang SH. Management of symptomatic polycystic liver
disease: laparoscopy adjuvant with alcohol sclerotherapy // Journal of Gastroenterology
& Hepatology. 1995. V. 10. N 3. P. 359362.

254

Hepato_2003_Last_With_Index.qxd

10.02.2003

18:39

Page 255

VI.

66.

Ker C.G., Kai K.K., Chen J.S., Lee K.T., Sheen P.C. Laparoscopic fenestration for giant
liver cyst // Kao Hsiung I Hsuehko Hsueh Tea Chih. 1997. V. 13. N 9. P. 572577.

67.

Klingler P.J., Gadenstater M., Schmid T. et al. Treatment of hepatic cysts in the era of la
paroscopic surgery // Br. J. Surg. 1997. V. 84. P. 468.

68.

Kummerle F., Ehlert C.P. On the surgery of nonparasitic liver cysts // Med. Clin. 1967.
Bd. 62. S. 471.

69.

Libutti S.K., Starker P.M. Laparoscopic resection of a nonparasitic liver cyst. //


Surg.Endosc. 1994. V. 8. P. 11051107.

70.

Lin T.Y. Treatment of nonparasitic cystic disease of the liver: a new approach to therapy
with polycystic liver // Ann. Surg. 1968. V. 168. P. 921922.

71.

Lotz G.W., Stahlschmidt M. Nonparasitic parenchymatous liver cysts // Dtsch.med.


Wschr. 1987. Bd. 112. N 43. S. 16661668.

72.

Marchese E., Ambrosini A., Verrenti D., Lannutti F. Cystic disease of the liver. Report of
a case of a solitary giant cyst // Minerva chir. 1987. V. 42. P. 12331237.

73.

Maresca G., Barbaro B., Summaria V. et al. Color Doppler ultrasonography in the diffe
rential

74.

Martelli H. et al. Discovery of benign hepatic lesions during investigation for hepatic me
tastases. // Nouv. Presse med. 1982. Vol. 11. P. 28332836.

75.

Marvik R., Myrvold HE., Johnsen G., Roysland P. Laparoscopic ultrasonography and tre
atment of hepatic cysts // Surgical Laparoscopy & Endoscopy. V. 3. N 3. P. 172174.

76.

Morino M., Garrone C., Festa V., Miglietta C. Laparoscopic treatment of nonparasitic li
ver cysts // Am. Chir. V. 50. P. 419430.

77.

Ooi LL. Cheong LH., Mack PO. Laparoscopic marsupialization of liver cysts // Austra
lian & New Zealand Journal of Surgery. V. 64. N 4. P. 262263.

78.

Pichlmayr R., Gubernatis G. Preventive surgical indications in liver and bile duct surgery
// Chirurg. 1987. Bd. 58. S. 316323.

79.

Pul N., Pul M. Congenital solitary nonparasitic cyst of the liver in infancy and childhood
// J. Pediatz Gastroenteral Nutz. V. 21. P. 461462.

80.

Ramesh J., Walrond ER., Prussia PR., Williams K., St.John MA. Congenital solitary non
parasitic cyst of the liver // West Indian Medical Journal. V. 44. N 1. P.36367.

81.

Rifkin M.D., Rosato F.E., Branch H.M. et al. Intraoperative ultrasound of the liver. An im
portant adjunctive tool for decision making in the operating room // Ann. Surg. 1987.
V. 205. N 5. P. 466472.

82.

Rini G.B., Scardavi M., Renda G. Echography and clinical aspects in the differential di
agnosis of hepatic cysts // G.Clin. med. 1987. V. 68. N 3. P. 169171.

83.

Robinson D.A. et al. Magnetic resonance imaging of the solitary hepatic mass: direct correla
tion with pathology and computed tomography // Clin. Radiol. 1987. V. 38. N 6. P. 559568.

84.

Roemer C.E., Ferrucci J.T., Mueller P.R. et al. Hepatic cysts: diagnosis and therapy by so
nographic needle aspiration // Amer. J. Roentgenol. 1981. V. 136. P. 10651071.

85.

Rohner A. Treatment of benign tumors of the liver // Schweiz. Med. Wschr. 1986.
Bd. 116. N 3132. S. 10441050.

86.

Romien C., Brunschwig A. Etude experimentale de la flore hepatique chez l,homme //


Lyon. Chir. 1952. N 47. P. 11.

87.

Sancher H., Gagner M., Jenkins P.L. et al. Surgical management of nonparasitic cystic
liver disease // Am. J. Surg. 1991. V. 161. P. 113118.

255

Hepato_2003_Last_With_Index.qxd

10.02.2003

18:39

Page 256

88.

Schulz F., Fugger R., Contreras F., Funovics Y. Clinical aspects and therapy of congeni
tal cystic livers // Chirurg. 1984. Bd. 55. S. 813816.

89.

Schutter F.W., Nier H., Klein M. et al. Die chirurgische Problematik der intrarteriellen Zi
tostaticaPerfusion der Leber // Aktuel. Chir. 1985. V. 20. N 6. S. 241244.

90.

Sianesi M., Farinon A.M., Sacco M. Symptomatic nonparasitic congenital cysts of the
liver // Int. Surg. 1982. V. 67. N 4. P. 453455.

91.

Starzl T.E., Demetris A.J. Liver transplantation. Year book medical publishers inc., 1990.

92.

Suraci V., Fianchini A., Mambelli V. et al. Nonparasitic cysts of the liver // Czir. Ital.
1984. V. 36. N 6. P. 947960.

93.

Swobodnik W. Sonographic diagnosis of focal lesions of the live // Leber, Magen, Darm.
1986. Bd. 3. N 3. S. 153168.

94.

Tate J.J., Lau W.Y., Li A.K. Transhepatic fenestration of liver cyst: a further application of
laparoscopic surgery // Australian & New Zealand Journal of Surgery. 1994. V. 64. N 4.
P. 264265.

95.

Turnage R.H., Eckhauser F.E., Knol J.A., Thompson N.W. Therapeutic dilemmas in pati
ents with symptomatic polycystic liver disease // Amer. Surg. 1988. V. 54. N 6.
P. 365372.

96.

Watson D.I., Jamieson G.G. Laparoscopic fenestration of giant posterolateral liver cyst //
Journal of Laparoendoscopic Surgery. V. 5. N 4. P. 255257.

97.

Wolff H., Sperling P., Lippert H., Arbi O. Surgical treatment of benign liver tumors // Zbl.
Chir. 1986. Bd. 111. N 19. S. 11531165.

256

Hepato_2003_Last_With_Index.qxd

10.02.2003

18:39

Page 257

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3.

.. . .: , 1972.

4.

.. . :  , 1983. 352 .

5.

.., .., .. 
// .... 1967. 4. . 54.

6.

.. // . 1980. 6. . 78.

7.

..
// . 1993. 4. . 7074.

8.

.., .., .. 
// . .. . .. ,
1999. . 43.

9.

.. . .: , 1989. 208 .

10.

.. / ,: ., 1968. 373 .

11.

.. // . 1980. 6.
. 7175.

12.

.. , 
.  , 1992. 206 .

13.

.. : .
. /.../  . , 1962.

14.

.., .., .., .. 


// . .. . .. ,
1999. . 76.

15.

.., .. 
. . .
, 1995. . 118120 .

16.

.., ..
// . . 1986. 5. . 8285.

17.

.., .., .. . // .. 1977. 4.


. 480484.

18.

.., .., .. . 
// . 2002. . 7.
1. . 1822.

292

Hepato_2003_Last_With_Index.qxd

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Page 293

VII.

19.

.., .., .. 
// . . 1987. 2. . 37.

20.

.., .. 
// . 1980. 6. . 6871.

21.

.., .. // . 
. 1986. 5. . 1820.

22.

.., .. . .: ., 1985.

23.

.. , 
// . . 1987. 2. .
3234.

24.

.., .., .., .. 



// . . 1981. 5. . 1118.

25.

.,  ., ., . 
. :  , 1976. 537 .

26.

/ . .. , .. . .:
., 1976. 310 .

27.

.. // . . 1987. 2.
. 7376.

28.

.., .., .., ..


. i: i, 1993. 512 .

29.

.. (
) // . . 1986. 5. . 5760.

30.

GillGrande L.A., Rodviguez  Caabeivo F., Prieto J.G. et al. Randomized controlled teri
al of effecacy of albendazole in intraabdominal hydatid disease // Lancet. 1993. V. 342.
P. 1269.

293

Hepato_2003_Last_With_Index.qxd

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Page 294

Hepato_2003_Last_With_Index.qxd

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Page 295

VIII

.. ,
..

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. :
. 
, 

,
, . . .

. ,
.
7, 
, 
.

0,451,47% [ . .,
1976]. 35%
[Ochsner O., 1938]. 

, 0,0070,015%
[ .., 2000].


.

. 
(
, , , .), 
, , ,
.
,
, 
[ .., 1983].
297

Hepato_2003_Last_With_Index.qxd

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..
.. (1972) 
:
.
1.
2.
3.
.
I. :
1.
2. , 

II. :
1.
2.
 , 

,
. 
(Escherichia coli, Klebsiella pneumo
nia, Proteus, Enterococcus faecalis, Enterobacter spp., Pseudomonas spp.),
(Bacteroides fragilis, Bacteroides spp., Peptostreptococci,
Cl. perfringens) [ .. ., 1999,
Huang C.J., 1996].
41,8% [ .. ., 1988]. 

. 
Candida albicans [ ., 2000].
:
 ;
 ;
 ;
 
;
 ( )
( ).

(
298

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, ,  
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.), , , . 

, 
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,
.
.
, ,
. 

, 
.

, , 
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, 
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. 
, ,
.

. 

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, .).
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. ,
,
. 
, 
, 
, 
.

.
299

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, ,
, .
30%
50% [Seeto R.K., 1996]. ,
.


, 
IVV . 
, 
 ( ), 
. .. .
(1993), , 
, 
.

.
, , 
. 
, 
, . . , 
.

, 
. (
)
40% [Seeto R.K., 1996].
,
. , , ,
, ,
, , .
.
, .
153 ,
C.J. Huang (1996):
:

52%

48%

300

Hepato_2003_Last_With_Index.qxd

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VIII.

:

22%

63%

14%
80%
, 
[ .., .., 1972].



, 
, , . . ,
. 

. 
, 
.
. 
, .
. 
. 
, 
.
, 
. ,
. , 
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, , .
, , ,
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. 
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.
301

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,
, 
. 
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, 
, .


, .
, 

. 
.

 
, . 
. ,
.. . (1993)
65,2% , .

, , 
, ,
.


. 

, 
. 

 , . 

.

. 
.
, 

302

Hepato_2003_Last_With_Index.qxd

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VIII.

. 

.

[ .. ., 1987]. 


.
, 
.
,
. 

,
.
. 

, 
, 
.
.

, 67 . 
.
() ,
.
,
. 
. 

[ .. .,1987].

.


, , .
3040 2530% [ .., 
.., 1972]. 
303

Hepato_2003_Last_With_Index.qxd

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,
.

.
, 
, .
, .
, ,
 , (. 8.1).

, .

.


, , . . 
, : , 
(, , 
), , .

. 8.1

304

Hepato_2003_Last_With_Index.qxd

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VIII.




[ .. .,1983].

. 

.


, . 
.
.

.
,
NaCl.
 . 
, 
, ,
.
.

812 F (2,74 ). 
, 
.
.

. ,
, 
, .

,

.

, , 
,
. 
,
305

Hepato_2003_Last_With_Index.qxd

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, .

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3 . 

.

,
, 
.
( ), 
. 
.
, , 
XII .
,
,
, 
.. . 

.
, 
, ( Ochsner Graves),
. 
. 

. 
.

[ .. .,1990].
, 
, 
, , 
. 

[ .. ., 1993].

.
306

Hepato_2003_Last_With_Index.qxd

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VIII.


.
, 
, 
,
, 
[Huang C.J., 1996]. 
,
.
, 
, 
: 
, , 
.
.

( ) , 
II .

, , 
,
.

.
, 
. 
. 8.1 [Sanford J.P.
.,1996]. 
.
8.1
,

Enterobacteriacae,
bacteroides,
enterococci

+

+

1. ()

2. III +
3. /
4. ,
307

Hepato_2003_Last_With_Index.qxd

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,

, , 
. ,
.
,
, ,
.
, 

. 

.

.
,
.


1.

.., .. 
. // . 1990. 8. . 122124.

2.

.. ( ). :  . , 1983. 352 .

3.

..
. // . . . . . 1995. 20 .

4.

.., .. 
. // . 1999. . 4. 2. . 8586.

5.

.., .., .. 
. // . 1988. 9. . 9194.

6.

.., .. : .
// . 1999. 10. . 2428.

7.

.., .., .. 
. .: , 1982. 240 .

8.

. . : .  .
, 1967. 314 .

9.

.. 
. : 
. . , , 1997. . 211.

10.

.. 
. : . , 2000. 688 .

11.

..  . :  
. , 1983. 288 .

308

Hepato_2003_Last_With_Index.qxd

10.02.2003

18:39

Page 309

VIII.

12.

.., .. : :
. ./ . . .. . .: , 2000. 360 .

13.

.., .., .. . // 
. 1999. . 4. 2. . 118.

14.

.  . , 1974. 301 .

15.

.., .., .., .. 


. // . 1983. 9. . 5155.

16.

.., .., .., .. 


. .: 
, 1987. 280 .

17.

.., .., .. . .
// . 1999. . 4. 2. . 134.

18.

.,  ., ., . 
. :  , 1976. 537 .

19.

.. . : , 1981. 155 .

20.

.., .., .., ..


. // .
1999. . 4. 2. . 139.

21.

.., .., .., ..


. //
. 1999. . 4. 2. . 139140.

22.

.., .., .., ..


. i: i, 1993. 512 .

23.

Branum G.D., Tyson G.S., Branum M.A., et al. Hepatic abscess. Changes in etiology, di
agnosis, and management. // Ann. Surg., 1990. V.212. P.655660.

24.

Cainzos M., Sayek I., Wacha et al. H.Septic Complications after Biliary Tract Stone Sur
gery: A Review and Report of the European Prospective Study. // HepatoGastroentero
logy. 1997. V. 44. P. 959967.

25.

Goor H. The Treatment of Severe Intraabdominal Infection. // HepatoGastroenterolo


gy. 1997. V. 44. P. 975981.

26.

Huang C.J. Pyogenic hepatic abscess. Changing trends over 42 years.// Ann. Surg.
1996. Vol. 223, N. 5. P. 600607.

27.

Hippocrates. The Genuine Works of Hippocrates. Translated from the Greek with a prelimi
nary discourse and annotations by Adams, F. Vols. I and II. New York, William Wood & Co.,
1886, pp. 5758, 266267.

28.

MacDonald A.P., Howard R.J. Pyogenic Liver abscess. // World J. Surg. 1980. Vol. 4.
P. 369380.

29.

Ochsner A, De Bakey M, Murray S. Pyogenic abscess of the liver. II. An analysis of for
tyseven cases with review of the literature.// Am. J. Surg. 1938. Vol. 40. P. 292319.

30.

Rubin R.H., Swartz M.N., Malt R. Hepatic abscesses. // Amer. J. Med. 1974. Vol. 57.
P. 601610.

31.

Seeto R.K. Pyogenic liver abscess. Changes in etiology, management, and outcome.//
Medicine (Baltimore). 1996. Vol. 75, N. 2. P. 99113.

32.

Shah P.M. Therapie haufiger Infektionen in der taglichen Praxis. Frankfurt am Main,
1997.

309

Hepato_2003_Last_With_Index.qxd

10.02.2003

18:39

Page 310

33.

Sanford J.P., Gilbert D.N., Sande M.A. Guide to antimicrobial therapy. 26th Edition. An
timicrobial therapy Inc., Dallas, USA, 1996.

34.

Lever abscess. In book: Lever and Biliary Deseases (Edr. Neil Kaplowitz, 2 Edition), Fhi
ladelphia, 1996. P. 463468.

310

Hepato_2003_Last_With_Index.qxd

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Page 311

IX

.. ,
..

Hepato_2003_Last_With_Index.qxd

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Page 312

Hepato_2003_Last_With_Index.qxd

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Page 313



 
. , 500 
. , 

,
, [
.., 1981; .. ., 1991; .. ., 1992].
, 
2570% 
[ .., 1995], 3040%
[ .. .., 1988; ..
.., 1989].

, ( 5060%).
, ,
, ,

[ .. .., 1990].

[Cox E.F. et al., 1988]. 
, ,
, 5070% 
, , [ ..,
1989; .. ., 1991; .. ., 1992; Giuliano F. et al., 1987].
. 
, 
, , 
, ,
. 
. 
2027% [ .. ..,
1977].
313

Hepato_2003_Last_With_Index.qxd

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8,536% , 
.

, 
, , 
.
, 

. 
.. (1955) 
, 
, . , 
.


[ .. .., 1977].

(3050%), , 
, , 
. ,
1,712%,
, 
1829% , 
.
,
, , 
. 
.

, 
,
.

35:1. 
2040 [ .. ..,
1977; .. ., 1986].
, 
, , /
. 
( 
), ( )
314

Hepato_2003_Last_With_Index.qxd

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IX.

( 
). ,

(, , 
), .

. 

, ,
, . 
: , 
.
(
), (
) , (
),
.
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, 
.
.
(, 
), 
.

. 

, ,
. 
, 
, ,

,
. 

45 . , 
, , 
,
.
315

Hepato_2003_Last_With_Index.qxd

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, ,
, , .
,
, . 

,
, 
.

.
 
.
.

. 
.
, ,
( ),
,

.
, 
,
, 
, .
.
, 
,
,
.
, ,
( , , )
(Cupet P. et al., 1984).


.
1. . 
, .
316

Hepato_2003_Last_With_Index.qxd

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IX.

2. . 

, .

. 

, ,

.
3. . , ,
,

, , .

, 
( , , .)
, 
,
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, 
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, . 
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.

, ,
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.

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. 

317

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 ,
.

.
. 

. .
,
, , 23 .

, . . , 

.
,
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.

.
,


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. 
:
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. 
, . 

, , .
, 
. 
, 
.
, 
.
, .
, 
,
. 
318

Hepato_2003_Last_With_Index.qxd

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IX.

, 
.
, 
.
. 
() ,
. ,
. 
810 
.
.
.

. ,
. 
, 

.
, 
, 

, ,
.
, 70 
, , . 

. ,
.. .. (1993)
4,4%, 7,1% 
233 .
,
.
,
, 
. 
, 
.

, .. .. (1977):

319

Hepato_2003_Last_With_Index.qxd

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1. .
. :
( 
);
;
, ;
.
. :
I. 2 ;
II. 23 ;
III.
;
IV.
.
.
.
.
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: , , .
 .
3. .
,

, , 
 .

.
,

.
.

, 
.

, .
,

320

Hepato_2003_Last_With_Index.qxd

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Page 321

IX.

. .. (1983),

, 
, 
. 
,
.

,
37% [ .., 1979; Muin A.,
Leong Y.P., 1992; Kruuna O.F. et al., 1994].

75% .

1335%,
823%, 1218%,
2530%, 1012%, 
2530%, 338%,
412%, 1638%,
2,54%, 23% . 1825% 

, 1226% , . 
 
. 6080% 
,
1012% [ .., ..,
1980; .., .., 1988; .., .., 1989; 
.., .., 1993; .., 1995; Donovan P. et al., 1968,
1973; Kovis M. et al., 1981; Buckhan R.F. et al., 1988; Cox E.F. et al., 1988].



, 

. ,
. ,
.

. , ,
321

Hepato_2003_Last_With_Index.qxd

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. 
, , .
(
), (

). 
( 
). 
 ( , ).
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, ), 
, .

, , 
, .
, , 
. .. (1955), 
, 
. 
,
. ,

,
. 
,

.

: , 
,
, , , ,
.
.
,
. , 
, ,
.
 . 


.
322

Hepato_2003_Last_With_Index.qxd

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IX.

,
,
. 
,

, .

, . 

( 1 ). 
, 
11,5 , ..
. 
, 

.
,
, , 
, . 
, 
,
.

.
,

. 
, ,
,
, XII [Madding G.,
Kennedy P., 1965]. 
, ,
.
,
, 
. 
, 

[ .., .., 1977].
,
, .
323

Hepato_2003_Last_With_Index.qxd

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. 
, ,
.
,

.
,
, .

. 
, 
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.
, 
, , 
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.
.. (1977),
34 .
, 
, .
, 

, , , .

.
, 
. 
, 
( ).
,
, .
324

Hepato_2003_Last_With_Index.qxd

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IX.


. 
,
.
,
,
, .

, .
, , 
,
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. .
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, 
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,
.

, 

.
:
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. 
, 
,
. 

, 
. 
,
325

Hepato_2003_Last_With_Index.qxd

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,
.

.
(
), 
, .
. 
. 
4045%.
,
.

, , 
, .
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, .

. 
, 
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, ,

. ,
.


. 
, 
, , ().

. , 
, , .

. 
, 23 .
, ,
.
326

Hepato_2003_Last_With_Index.qxd

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IX.


, 
. 

[ .., 1982; Stain S.C.
et al., 1988].

2030 , 
, 
. 
, . 
, ,
.
(10109/
15109/ ) .

. 
 
, ,
.



. , 
, , 
, , 
.

.


. 

. 
, 
. , 
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,
327

Hepato_2003_Last_With_Index.qxd

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, , ,

.
, 
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.

.

, 
, .


. .
()
, 100150 .

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. 

1520 
. 
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.


. 
, 

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,
.

, 

328

Hepato_2003_Last_With_Index.qxd

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IX.

9698%.
. 

, . . ,

.

,
. 
 
. 

, .
,
. , 
. , 
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, .

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.
. 

.
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329

Hepato_2003_Last_With_Index.qxd

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. 
/ 
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. 

.


.

(. 9.19.3).
, ,
,
. 
, 
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. 9.1. ., 31 .
, .

, ,
VI .

330

Hepato_2003_Last_With_Index.qxd

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IX.

. 9.2. .
.

.

. 9.3. ., 31 . .
. .
.

6 . .
. .

331

Hepato_2003_Last_With_Index.qxd

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, . . ,
. 

,
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,
.
810
40 
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.


.
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50 , , 
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.

.
, ,
.

() 
,

. 
, ,
., . 
90%.

. 
, . 

.
332

Hepato_2003_Last_With_Index.qxd

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IX.


,
,
. 

. 
,
.
,
,
500800 , 
, .

.

.

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, .

, 
, 
, . 
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., ,
.

.


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II VII . 

.
333

Hepato_2003_Last_With_Index.qxd

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1214 . .

. 

. , 

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.

, :

, ;
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;

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.

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. 
, 

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, 
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. 
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,
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, 

334

Hepato_2003_Last_With_Index.qxd

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IX.

. 

. 
.




. 
. 
,
, .
, ,
. 

,
. 
, 
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.
,
( ). 
, .. .. (1977) :
, 
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. 

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. 

.
335

Hepato_2003_Last_With_Index.qxd

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(, 
) 
, . 

. 
, 

, ,
. 

.


. 
, 

, , 
[Delius R.E. et al., 1989; Croce M.A. et al., 1995;
Reihner E., Brismar B., 1995].
. 
, [Me
ger A.A. et al., 1985]. . , 

24% [Carrillo E.H. et al., 1999].
, , ,
.

, 

, 
 ,
. , 
, 

. 
.

.
,
. 
, . 
336

Hepato_2003_Last_With_Index.qxd

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Page 337

IX.

I, II 
(
.. .. , 1977). 

. 
.


. 
, , 
.
, , ,
 .

.
,

. , 
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II IV .
, ,
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, 
.

,

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, 
337

Hepato_2003_Last_With_Index.qxd

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.
, , , 
IV, V, VI VIII . 

78 ( ,
).

(VIIVIII ),
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, 8
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. 6 7
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,

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. ()
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, 
. 
. 
 .


.

5 (
, , .).

, 
338

Hepato_2003_Last_With_Index.qxd

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Page 339

IX.

. 
VIVII , ,

.
( !) ,
. (3045)
.


, .
, 
, 
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.


. 
, 
.
. , ,
, , , 
.

, , 
. 

. ,
. 
.
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.
,

, .

1520 [
.., 1971]. ,

339

Hepato_2003_Last_With_Index.qxd

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Page 340

, , 
.
, 
, , 

, .

.
,
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. 
, ,
,
. .. .. (1993),

23 .,

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35 . .
, 
, (15) 
, 

3040 . [ . .., 1977].
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, 
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.
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.

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63.

Balasegaram M., Joichy S.K. Hepatic resection. The logical approach to surgical manage
ment of major trauma to the liver. Am. J. Surg. 1981. Vol. 142 . . 580593.

369

Hepato_2003_Last_With_Index.qxd

10.02.2003

18:39

Page 370

64.

Becker H., Markus P.M. Bile duct lesions in liver trauma. //Chirurg. 1994. Vol. 65, N 9.
. 766774.

65.

Bourgeon R. La resection hepatique "a la demande" dons les traumatismes du foie. //J.
Chir. 1984. t.121, N 10. . 605609.

66.

Buckhan R.F., Piono G., Dunhams C. Major bowel and diaphragmatic injuries associated
with blunt spleen or liver rupture. //J.Trauma. 1988. Vol. 28, N 9. . 13171321.

67.

Buechter H., Zeppa R., Gone Z. The use of segmental anatomy for on operative classifi
cation of liver injuries. //Ann. Surg. 1990. Vol. 211, N6. .699675.

68.

Bynoe P. Complications of nonoperative management of blunt hepatic injuries. //J. Trau


ma. 1992. 32. P. 308315.

69.

Cappiung J., Schaub G., Hosh D.V. Control of massive hemorrhage from vena cava and
liver injuries. //Arch. Surg. 1972. Vol. 104 . 104106.

70.

Carrillo E.H., Spain D.A., Wohltmann C.D. et al. Interventional techniques are useful ad
juncts in nonoperative management of hepatic injuries // J.Trauma. 1999. Vol. 46, N 4.
P. 619622.

71.

Chen R.J., Fang J.F., Lin B.C. et al. Selective application of laparoscopy and fibrin glue in
the failure of nonoperative management of blunt hepatic trauma // J.Trauma. 1998,
Vol. 44, 4. P. 691695.

72.

Chiskalm T., Leni O.P. Traumatic injuries of the portal vein. //Am. J. Surg. 1972. Vol. 124.
P. 770773.

73.

Cochran W., Sabot W.S. Open versus closed diagnostic peritoneal lavage. //Ann. Surg.
1984. Vol. 200, N 1. P. 2428.

74.

Couinaud C. Controlled hepatectomies and exposure of the intrahepatic bile ducts. Paris,
1981. 112 p.

75.

Cox E.F., Flancbaum L., Dauterive A.N., Paulson R.L. Blunt trauma to the liver. Analysis
of management and mortality in 323 consecutive patients. //Ann.Surg. 1988. Vol. 207,
N 2. P. 126134.

76.

Cox E.F., Flancbaum L., Paulson R. Blunt trauma to the liver. //Ann.Surg. 1988. Vol. 206,
N 1. P. 126134.

77.

Croce M.A., Fabian T.C., Menke P.G., et al. Nonoperative management of blunt hepatic
trauma is the treatment of choice for hemodynamically stable patients: results of a pro
spective trial // Ann. Surg. 1995. Vol. 221. P. 744.

78.

Cupet P., Baumer R., Roche A. Hepatic hemobilia of traumatic or iatrogenic origin: recept
advances in diagnosis and therapy. Review of the literature from 1976 to 1981. //World
J. Surg. 1984. Vol. 8, N 1. P. 28.

79.

Delius R.E., Erankel. W., Coran A.G. A comparison between operative and nonoperative
management of blunt injuries to the liver and spleen in adult and pediatric patients.
//Surgery. 1989. Vol.106, N 4.

80.

Donovan A., Michaelion M., Yellin A. Anatomical hepatic lobectomy in trauma to the li
ver. //Surgery. 1973. Vol. 73. P. 883847.

81.

Donovan A., Turrill F., Facey F. Hepatic trauma. //Surg. clin. N. Am. 1968. Vol. 48.
P. 13131335.

82.

Farnell M.B., Spenser M.P., Thompson E., et. al. Nonoperative management of blunt he
patic trauma in adults. //Surgery. 1988. Vol. 104, N 4. P. 748756.

370

Hepato_2003_Last_With_Index.qxd

10.02.2003

18:39

Page 371

IX.

83.

Feliciano D.V., Jordan G.L., Bitondo C.D., et. al. Management of 1000 consecutive cas
es of hepatic trauma.( 19791984). //Ann. Surg. 1986. Vol. 204, N 4. P. 438443.

84.

Fifer Th., Obeid F.N., Sorensen V.J., et. al. Comparative accuracy of diagnostic periton
eal lavage, liverspleen scientigraphy, and visceral angiography in blunt abdominal trau
ma. //Amer. Surg. 1989. Vol. 55, N 10. P. 612615.

85.

Giuliano F., Haas O., Barry P. Les traumatismes olu foie. //J.Chir. 1987. Vol. 124, N 2.
P. 103107.

86.

Hollands M.F., Litle J.M. Perihepatic packing: its role in the management of liver trau
ma. // Aus. N. Z. J. Surg. 1989. Vol. 59, N 1. P. 2124.

87.

Jacobson L. The use an absorbable mesh wrap in the management of major liver injuries.
// Surgery. 1992. 111. P. 455461.

88.

Kovis M., Princis J., Pehan V. Liver injuries. //World J. Surg. 1981. Vol. 5. P. 765772.

89.

Kralik J., Vojacek P. Posttraumatic hemobilia and successful direct treatment of the arte
riobiliary fistula. //Zentralblatt fur Chirurgie. Vol. 117, N 10. P. 560563.

90.

Kruuna O.J., Haapiainen R.K., Kivilaokso E.O. Penetrating liver laceration with comple
te transection of hilas structures presenting with minimal clinical signs. //Ann. Chir. et
Gynec. 1994. Vol. 83, N 1. P. 7375.

91.

Lim P., Knudson J, Stule M. Liver trauma. Current method of management. //Arch.
1972. Vol. 124. P. 1015.

92.

Litl J.M., Fernandes A., Tait N. Liver trauma. //Aus. N. Z. J. Surg. 1986. Vol. 56, N 8.
P. 613619.

93.

Longmire W. Manual of liver surgery. N. Y., 1981. 320 p.

94.

Madding G., Kennedy P. Trauma to the liver. Philadelphia & London, 1965. 134 p.

95.

Meger A.A., Cross R.A., Lim R.S. Selective nonoperative management of blunt liver in
juries using computed tomography. //Arch.Surg. 1985. Vol. 20, N 5. . 550554.

96.

Mentha G., Pretre R., Huber O. Traumatismes Hepatiques. //Ann.chir. 1992. T. 38, N. 3
. 291296.

97.

Muin A., Leong Y.P., Laceration of the common hepatic duct bifurcation in blunt abdomi
nal trauma. //Injury. 1992. Vol. 23, N6. . 422423.

98.

Nielsen M.L., Mygini T. Selective arterial embolization in traumatic hemobilia. //World


J.Surg. 1980. Vol. 4, N 3. P. 357359.

99.

Noyes L.D., Doyle D.I., Meswain N.E. Septic complications associated with the use of
peritoneal drains in liver trauma. //J Trauma. 1988. Vol. 28, N 3. P. 337345.

100. Ochsner M.G., ManiscalcoTheberge M.E., Champion H.R. Fibrin glue as a gemostatic
agent in hepatic and splenic trauma // J. Trauma. 1990. Vol. 30. P. 884.
101. Orcalli F., Elio A., Veronese E. Conservative laparoscopy in the treatment of posttrauma
tic spleen laceration using microfiber hemostatic collagen // Surg. Laparosc. Endosc.
1998. Vol. 8, N 6. P. 445448.
102. Pretre R., Mentha G., Huber O., et. al. Hepatic trauma: Risk Factors influencing outco
me. // Brit. J. Surg. 1988. Vol. 0775, N 6. P. 520524.
103. Reihner E., Brismar B. Management of splenic trauma changing concepts // Eur. J.
Emerg. Med. 1995. Vol. 2, N 1. P. 4751.
104. Rubin B.E., Katzen B.T. Selective hepatic artery embolization to control massive hepatic
hemorrhage after trauma. //Amer. J. Roent. 1977. Vol. 129, N 2. P. 253256.

371

Hepato_2003_Last_With_Index.qxd

10.02.2003

18:39

Page 372

105. Sandblom P.H., Solgesser F., Mircovich V. Hepatic hemobilia hemorrhage from the in
trahepatic biliary tract. A00 review. //World J.Surg. 1984. Vol. 8, N 1. P. 4150.
106. Stain S.C., Yellin A.E., Donovan A.J. Hepatic trauma. //Arch. Surg. 1988. Vol. 123, N 10.
P. 12511255.
107. Taylor S.A., Dauson J.L. The treatment of hemobilia. //Brit. J. Surg. 1978. Vol. 65 , N 4.
P. 252253.

372

Hepato_2003_Last_With_Index.qxd

10.02.2003

18:39

Page 373

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Hepato_2003_Last_With_Index.qxd

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.

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.

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.

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1.

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.. . .: . , 2002. 416 .

2.

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3.

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. /.../ . . ., ., 1985., 34 .

4.

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5.

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// . ,
2000. 222 .

6.

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, 2001. 128 .

7.

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IV ., ., ., 1988., . 4950.

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Hepato_2003_Last_With_Index.qxd

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18:39

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8.

.   
,
. . . /.../ ... ,1983. .12,19.

9.

.. . ., , 1974. 407 .

10.

..  
. . . /.../ ...
,1974. . 5, 13.

11.

.. 
,
. . /.../ . . , 2000.

12.

.. , ,

. . . /.../ . . ., 1986.

13.

Benoit J.N., Zimmerman B., Premeu A.J., et al. Role of glucagon in splanchnic hypere
mia of chronic portal hypertension // Am. J. Physiol. 1986. V. 251. P. 674677.

14.

Burnett D.A., Rikkers L.F. Nonoperative emergency treatment of variceal hemorrhage //


The Surgical Clinics of North America. 1990. Vol. 70, N 2, P. 291306.

15.

Burroughs A.K., Alexandrino P., Cales P. et.al. In: De Franchis R. (ed.) Portal hyperten
sion, proceedings of the second Baveno Internaional Consensus Workshop on definitions,
methodology and therapeutic strategies // London, Blackwell Science, 1995. P. 1017.

16.

Cello J.P., Ring E.J., Olkott E.W. et. al. Endoscopic sclerotherapy compared with percu
taneous transjugular intrahepatic portosystemic shunt after initial sclerotherapy in pati
ents with acute variceal hemorrhage // Ann. Intern. Med. 1997. Vol. 126. P. 858865.

17.

Child C.G., Turcotte J.G. Surgery and portal hypertention // The liver and portal hyper
tention. Philadelphia: W.B. Saunders Co., 1964. P.50.

18.

Fleig W.E. Osophagusvarizen. In: Hahn E.G., Riemann J.F. (eds.). Klinische Gastroen
terologie. Stuttgart: Georg Thieme Verlag, 1996 S. 17131734.

19.

Gurakar A., Fagiuoli S., Gavaler J.S. . The use of granulocytemacrophage colo
nystimulating factor to enhance hematologic parameters of patients with cirrhosis and
hypersplenism // J. Hepatol. 1994. Vol. 21. P. 582586.

20.

Harry R.,Wendon J. Management of variceal bleeding // Current option in critical care.


2002. Vol. 8. P. 164170.

21.

Hwang S.J., Lin H.H., Chang C.F. . Randomized controlled trial comparing octre
otide and vasopressin in the control of acute esophageal variceal bleeding // J. Hepatol.
1992. Vol. 16. P. 320325.

22.

Imperiale T, Chalasani N: A metaanalysis of endoscopic variceal ligation for primary


prophylaxis of esophageal variceal bleeding // Hepatology. 2001. Vol. 33. P. 802807.

23.

Jalan R, Redhead DN, Allan PL, Hayes PC. Prospective evaluation of haematological al
terations following the transjugular intrahepatic portosystemic stentshunt (TIPS) //
Eur. J. Gastroenterol. Hepatol. 1996. Vol. 8. P. 381385.

24.

Jenkins S.A., Shields R., Davies M. . A multicenter randomised trial comparing


octreotide and injection sclerotherapy in the management and outcome of acute variceal
haemorrhage // Gut. 1997. Vol. 41. P. 526533.

25.

Kaplowitz N. Liver and biliary diseases. Williams & Wilkins. 1996. 769 C.

26.

Kelty R.H., Baggenstoss A.H., Butt H.R. The relation of the regenerated liver nodule to
the vascular bed in cirrhosis// Gastroenterology. 1950. V.15. P.285295.

462

Hepato_2003_Last_With_Index.qxd

10.02.2003

18:39

Page 463

X.

27.

Korula J. Ascites: Pathogenesis, characteristics, complication and treatment in: Liver and
biliary diseases. Wlliams & Wilkins. 1996. P. 589602.

28.

Levacher S., Letoumelin P., Pateron D. . Early administration of terlipressin plus


glyceryl trinitrate to control active upper gastrointestinal bleeding in cirrhotic patients //
Lancet. 1995. Vol. 346. P. 865868.

29.

MacDougall B.R.D. Williams R. A controlled clinical trial of cimetidine in recurrence of


variceal hemorrhage: Implicatins about pathogenesis of hemorrhage // Hepatology.
1983. Vol. 3. P. 6973.

30.

Madden J.L.Ligation of the hepatic and splenic arteries is the treatment of cirrhosis of the
liver.// Arch.Path.1953 v.96. N5 p.594598.

31.

Maddison F.E. Embolic therapy of hypersplenism.//Invas. Radiol.1973. V. 8. N 2.


P. 280283.

32.

Mahl T.C., Groszmann R.J. Pathophysiology of portal hypertension and variceal bleeding
// The Surgical Clinics of North America. 1990. Vol. 70., N 2, P. 251266.

33.

Mutchnick M.G., Lerner E., Conn H.O. Effect of portacaval anastomosis on hypersple
nism // Dig. Dis. Sci. 1980. Vol . 25. P. 929938.

34.

Nolte W., Hartmann H., Ramadori G. Portale Hypertension Pathophysiologie und


Therapieansatze // Ztsch. fur Gastroenterologie. 1994. 32. S. 447459.

35.

Paquet KJ. Portal hypertension state of the art // In 3rd postgraduate course in he
patobiliary surgery. 1995. P. 311333.

36.

Paquet K. J., Lazar A. Zum Stellenwert von Kollateralisations und Venensperroperationen


bei der akuten Osophagusvaricenblutung des Lebercirrhotikers // Der Chirurg. 1995.
Bd. 66. S.582 587.

37.

PeckRadosavljevic M. Hypersplenism Eur. J. Gastroenterology & Hepatology. 2001.


Vol. 13. P. 317323.

38.

Pugh R.N.H., MurrayLyon I.M., Dawson J.L. et al. // Brit. J. Surg. 1973. Vol. 60, N 8.
P. 646648.

39.

Pursnani K.G., Sillin L.F., Kaplan D.S. Effect of transjugular intrahepatic portosystemic
shunt on secondary hypersplenism // Am. J. Surg. 1997. Vol. 173. P. 169173.

40.

Richter G. M., Roeren Th., Brado M. Portale Hypertension und percutan transjugular an
gelegte portosystemische StentShunts (TIPSS) // Der Chirurg. 1996. 66. S. 555565.

41.

Rossle M. Der transjugulare intrahepatische portosystemische Shunt (TIPS)  Indika


tionen und Ergebnisse // Ztsch. fur Gastroenterologie. 1997. 35. S. 505515.

42.

Rossle M. Deibert P., Haag G. et.al. Randomized trial of transjugular intrahepatic porto
systemic shunt versus endoscopy plus propranolol for prevention of variceal rebleeding //
Lancet. 1997. Vol. 349. P. 10431049.

43.

Richter G. M., Roeren Th., Brado M. Portale Hypertension und percutan transjugular an
gelegte portosystemische StentShunts (TIPSS) // Der Chirurg. 1995. Bd. 66.
S. 555565.

44.

Sauer P., Theilmann L., Benz C. TIPS vs. endoskopische Sklerosierung+Propranolol zur
Pravention der Rezidivblutung aus Osophagusvarizen: Eine randomisierte Studie //
Ztsch. fur Gastroenterologie. 1997. Bd. 35. S. 426.

45.

Sauerbruch T., Wotzka R., Kopcke W. Prophylactic sclerotherapy before the first episode
of variceal hemorrhage in patients with cirrhosis // New Engl. J. Med. 1988. Vol. 319.
P. 815.

463

Hepato_2003_Last_With_Index.qxd

10.02.2003

18:39

Page 464

46.

Sauerbruch T. Osophagusvaricen  endoskopische Therapie // Der Chirurg. 1995.


Bd. 66. S. 549554.

47.

Sauerbruch T., Schiedermaier P. Medikamentose Behandlung der intestinalen Blutung


bei portaler Hypertension // Dtsch. med. Wschr. 1998. Bd. 123. S. 633636.

48.

Schrier R.W., Arroyo V., Bernardi M. . Peripheral arterial vasodilatation hypothe


sis: a proposal for the initiation of renal and sodium and water retention in cirrhosis // He
patology . 1988. Vol. 8. P. 11511157.

49.

Sikuler E., Kravetz D., Croszmann R.J. Evolution of portal hypertension and mechanism
involved in its maintenance in a rat model // Am. Physiol. 1985. V. 248. P. I825.

50.

Soehendra N., Binmoeller K., Seifert H., Schreiber H. W. Praxis der therapeutischen En
doskopie. Stuttgart; New York: Thime, 1997. 214 S.

51.

Sung J.J, Chung S.C.S., Lai C.W. . Octreotide infusion or emergency sclerothe
rapy for variceal haemorrhage. // Lancet. 1993. Vol. 342. P. 637641.

52.

Vlavianos P., Westaby D. Management of acute variceal haemorrhage // European jour


nal of gastroenterology & hepatology. 2001. Vol. 13. P. 335342.

53.

Yamamoto M., Susuki H. Endoscopic Treatment for EsophagoGastric Varices // Hepa


togastroenterologie. 1997. Vol. 44. P. 637646.

54.

Zeldis J.B., Mugishima H., Steinberg H.N. . B virus infection of human bone mar
row cells // J. Clin. Invest. 1986. Vol. 78. P. 411417.

464

Hepato_2003_Last_With_Index.qxd

10.02.2003

18:39

Page 465

XI

..

Hepato_2003_Last_With_Index.qxd

10.02.2003

18:39

Page 466

Hepato_2003_Last_With_Index.qxd

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XI.


, . Welch 1955 . 
. Starlz 1963 .
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.

, :
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. 
,
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.
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.


. 
,
,

.

. 
,
. 
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( 10), :
467

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VII.



VIII.




.

(HCV) 40% .
80%. 
,
.
HCV.

. 
.
HBV 
. 
8090% . 

HBV
, 1040%.

HDV.

( , 
469

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) . 5 
90%. 
.

. 
.
.

. 
, IV 
, 
, , 
, , 
, . 
2 60 , 
, (

), (HIV)
, 
,
, , 
, .


, . 

HCV HBV .
:
( ), 
, , 
, 
, .

(United Network for Or
gan Sharing UNOS) ,
.
470

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XI.

7
4
3 ,
2 ,
1


.
 
.

(TIPS). 
, 
, . 
TIPS
(bridge to transplantation). 

, 
. 

(Child A), 
.

: 
,
,  . 
.

,
.
.
, 

.

 . 
23
.
, ,

471

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,
. 
. 

.
,
. 

: , .

 ,
;
 ;
 , 

.

 , ;
 :
(, , 
, , , ),
(, , ), 
Fisher 11,5 (/ N=33,5).

 ;
 , 
;
 ();

;

 
;
 ;
472

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XI.

 ;
 ( 
).


.
3 : , 
(bypass) .


(UWsolution).
UW :
(
), (), 
(),
(, ). UW

( ) 24 .

.

2 /.

, . 

. . Starzl 
,
. R. Calne

.

, .
. . 
.

.
, 
.
473

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. 


.
.
.

. 
, .

. .
4
. 
. ,

, .

( 1 ).
. 
bypass.
.


. 
,
.
:
, ,
. 
. 
pH .
. 

.

.
,

.
474

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XI.

: 
, . 
.

.
. 
: 
,
( ),
.

. 30%
(, )
(G. Otto, C. Herfarth, 1991).

.

.
, 

.


.
, 
. Pyggyback technique.


.


.
.

. ,

. 

. 2 18 ,
10 .
475

Hepato_2003_Last_With_Index.qxd

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.
,
 .

.


, ,
,  .
, , . 
, 
, . 

, , .

,
. , 

. 
.
,
, ,
.

. 
 
.


: , .

,
.
. 

.

. 
476

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XI.


.
,
.
. 2448 

.
.
 .

. 
: , 
.

. 
.

. 
,
.
.

48 .

. 
, . 
.

.


.


. 1979 .

. 
25%, 
7080%.
477

Hepato_2003_Last_With_Index.qxd

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2.
  
, , . 
. , 
, .


.

. 
.

.

.

, 
, , .

. 
. 

.
 .
1984 3,
CD3 , 
 .

3 . 
: 
, , , , , .

.
FK506 () 
. 
2.
FK506 .
 
.
478

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XI.

: , , , 
, , .

. 
.

,

.


.
,
.

, 
.

. 
, , 
, .

.
,
70% . 
, .

, .

.
.
,
.
ABO. 
. . 
.
.
 .
. .
479

Hepato_2003_Last_With_Index.qxd

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. , , 
. 
.

. 
,
.
, , 
, .

5001000 (
) 13 
. 3, 
.

. 
.
. 
220% . 

.

.

. , 
.

.


, .

.
(510%), . 1%.

.

. 
480

Hepato_2003_Last_With_Index.qxd

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XI.

.
.


.

, ,
. 
. 
, .

. : 
, , 
. 
.
. 
. 
.



. 80 

. 
,
, 

. 
,
.

, 
, , 
.
.
 

. 
.

481

Hepato_2003_Last_With_Index.qxd

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18:39

Page 482



.
1035%. : ,
, , ,
.

, ,
, ,
. 
, .

.


70%.
European
Liver Transplant Registry 3 20%,
40% 
.

3040%.
( 60%) ( 50%). 412 

5%, 12 23%.



.
. 
, 

.

482

Hepato_2003_Last_With_Index.qxd

10.02.2003

18:39

Page 483

XI.


1.

Calne R.Y. Immunological tolerance the liver effect // Immunol Rev. 2000. Vol. 174.
P. 280282.

2.

Otto G., Herfarth C. Liver transplantation //Dtsch. Med. Wochenschr. 1991. Vol.116,
N 15. P. 579583.

3.

Starzl T.E. The privileged liver and hepatic tolerogenicity // Liver Transpl. 2001. Vol. 7,
N 10. P. 918920.

4.

Starlz T.E., Demetris A.J. Liver transplantation: a 31year perspective. Chicago: Year Book
Medical Publishers, 1990.

483

Hepato_2003_Last_With_Index.qxd

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Page 484

II. 

(
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .33
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .49

54

56

51

50

59
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .49
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .41

43

42

47
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .48
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35
. . . . . . . . . . . . . . . . . . . . . . .61

62

65

67

69

68
. . . . . . .16
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .71(
72
: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21(
22
 26
25

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .179
. . . . . . . . . . . . .203
. . . . . . . . . . . . . . . . .193

484

Hepato_2003_Last_With_Index.qxd

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Page 485

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .182
. . . . . . . . . . . . . . . . . . . . . . . . . . . . .186
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .199
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .186
215(218
. . . . . . . . . . . . . . . . . . . . . . . . .199
, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .181


. . . . . . . . . . . . . . . . . . .73
, . . . . . . . . . . . . . . . . . . . . . . . . . .130
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .159
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .163
. . . . . . . . . . . . . . . . . . . . . . . . . . .117
. . . . . . . .143
. . . . . . . . . . . . . . . . . . . . . . . . . . . .131

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .150
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .122
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .126

. . .171
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .130
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .137
( ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .129
. . . . . . . . . . . . . . . . . . . . . . . . . .121
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .130

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .103


485

108
104
105
103
107
105
108

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Page 486

II. 

108
. . . . . . . . . . . . . .75

81

87
<
86

79

75
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .128
.151

. . .

153
. . . . . . . . . . . . . . . . . .120
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .153
. . . . . . . . . . . . . . . . . . . .147
  . . . . . . . . . . . .151
 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .128

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .89

89
89
94
.155


. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .165
111(114, 174(178
. . . . .149
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .126
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .138
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .168
. . . . . . . . . . . . . . . . . . . . .118


. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11
. . . . . . . . . . . . . . . . . . . .295
. . . . . . . . . . . . . . . . . . . . . . .219

486

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Page 487


233
229
224
231
232
 232
227
250
229
227
243
251(256
236
243
, , 221
227

257
() 272
289
288
259
262, 275, 283, 289, 290
263
260, 273, 282, 288, 290
286
264, 276, 289
270
282
284
271
259
284, 291
292(293

487

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Page 488

II. 

286
291
280
272, 280, 282, 288, 289

115
302
301
304
303
308(310
297

311
339
316
321
326
357
333
335
327
313
337
359
315
332
341
367(372
349
327
335

465
482
482

488

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Page 489

470
473
470
467
477
470
479
482
480
483

469
476

373

391
454
402
397
408
407
401
389
380
. 403
422, 451, 460
399
 () 433
426
375
383
457
416
424
455

489

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Page 490

II. 

412

424
389

433
416
406
385
397

386
387
383
403
413
403
407
400
398
 402
456
457
397
461(464
 409
456
, 401
433
446
375
454
428
437

490

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