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(.. )
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: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21
(
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(.. , .. )
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43
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47
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50
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54
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59
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62
65
67
68
69
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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
(.. , .. , .. , .. , .. )
. . . . . . . . . . . 75
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
. . . . . . . . . . . . . . . . . . . . . . . . . . .89
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94
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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .104
. . . . . . . . . . . . . . . . . . . . . . . .105
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .105
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .107
. . . . . . . . . . .108
. . . . . . . . . . . . . . . . . . . . . . .108
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .108
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .111
. . . . . . . . .115
(.. , .. , .. , .. )
. . . . . . . . . . . . . . . . . . . . . . . . . . .117
. . . . . . . . . . . . . . . . . . . . .118
. . . . . . . . . . . . . . . . . .120
. . . . . . . . . . . . . . . . . . . . . . . . . .121
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .122
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .126
<
( )
,
126
128
128
129
130
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .130
130
131
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .137
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .138
. . . . . . . .143
. . . . . . . . . . . . . . . . . . . .147
. . . . .149
< <
150
151
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .151
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .153
153
155
159
163
165
168
. . . . . . . . . . . . . . . . . . . . . . . .171
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .174
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(.. , .. , .. , .. , .. )
, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .181
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .182
. . . . . . . . . . . . . . . . . . . . . . . . . . . . .186
186
193
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .199
199
203
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .215
. . . . . . . . . . . . . . . . . . . . . . .219
(.. , .. , .. , .. )
, , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .221
. . . . . . . . . . . . . . . . . .224
. . . . . . . . . . . . . . . . . .227
<
227
227
229
229
231
232
232
233
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .236
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .243
243
250
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .251
. . . . . . . . . . . . . . . . . . .257
(.. , .. )
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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .259
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .260
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .262
263
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .264
270
. . . . . . . . . . . . . . . . . . . . . . . . .271
() . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .272
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .272
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .273
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .275
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .276
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .280
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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .284
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .286
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .286
. . . . . . . . . . . . . . . . . . .288
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .288
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .288
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .289
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .289
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .289
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .289
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .290
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .290
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .291
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .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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. . . . . . . . .373
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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .375
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .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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,
,
.
. ,
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, .
20
. ..
,
, ,
,
, ,
,
.
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.
.
.
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,
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, ,
9
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Page 10
.
,
.
,
, ,
.
, ,
.
,
,
, , ,
.
10
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..
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I.
.
Jecur aqua repletum (
).
1872 , (. Bruns)
.
(Eschner) 1886 ,
(Loretta) 1888 , 1896
.
1889 .. .
,
.
, ..
.. 1894 ,
. , ,
.
, ,
, .
.
,
.
, 1913
.. ,
.
,
.
.
.
.. . ..
(1924)
.
,
13
Hepato_2003_Last_With_Index.qxd
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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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Page 15
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
Hepato_2003_Last_With_Index.qxd
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Page 16
, , ,
.
,
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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18:38
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
Hepato_2003_Last_With_Index.qxd
10.02.2003
18:38
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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18:38
Page 20
Hepato_2003_Last_With_Index.qxd
10.02.2003
18:38
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.
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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18:38
Page 23
II
(
..
..
Hepato_2003_Last_With_Index.qxd
10.02.2003
18:38
Page 24
Hepato_2003_Last_With_Index.qxd
10.02.2003
18:38
Page 25
II.
.
,
,
. 4
, 5
. 10
.
.
1200 1800 ,
1500 .
. ,
34 ,
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. 1
,
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.
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,
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100000 2 2 .
25
Hepato_2003_Last_With_Index.qxd
10.02.2003
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.
. 5
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26
Hepato_2003_Last_With_Index.qxd
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18:38
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)
.
,
.
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,
.
.
.
,
27
Hepato_2003_Last_With_Index.qxd
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18:38
Page 28
,
.
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I II ).
, ,
,
. ,
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.
, .
.
.
, .
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() (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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18:38
Page 29
II.
6
: 3 3
(. 2.1).
, . :
;
1
7
2
8
3
9
7
4
8
6
5
10
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() () .
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; 3 ; 4
; 5 ; 6
; 7 ; 8 ; 9 ; 10
29
Hepato_2003_Last_With_Index.qxd
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18:38
Page 30
( ) ;
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.
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,
.
, [Couinaud C.,
1957].
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.
,
,
[Rex ., 1888], [Cantlie J., 1898].
, .
,
30
Hepato_2003_Last_With_Index.qxd
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18:38
Page 31
II.
. 2.2 ,
.
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, ,
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()
31
Hepato_2003_Last_With_Index.qxd
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18:38
Page 32
. 2.4 Couinaud
, ,
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32
Hepato_2003_Last_With_Index.qxd
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18:38
Page 33
II.
,
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33
Hepato_2003_Last_With_Index.qxd
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. 1330
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70%
. 2.6 ().
,
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( .. .. , 1989)
34
Hepato_2003_Last_With_Index.qxd
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II.
.
. (Pit),
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Hepato_2003_Last_With_Index.qxd
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.
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36
Hepato_2003_Last_With_Index.qxd
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18:38
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II.
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37
Hepato_2003_Last_With_Index.qxd
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,
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38
Hepato_2003_Last_With_Index.qxd
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II.
. (. . 2.7),
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39
Hepato_2003_Last_With_Index.qxd
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, III . ,
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40
Hepato_2003_Last_With_Index.qxd
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II.
.
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).
41
Hepato_2003_Last_With_Index.qxd
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Page 42
.
.
, ( 4080%)
.
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(a. hepatica communis), (truncus celia
cus).
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.
,
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, VI VII .
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III .
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).
,
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.
,
,
.
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42
Hepato_2003_Last_With_Index.qxd
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Page 43
II.
( 50%),
.
,
.
(515%)
(13%).
.
(1219%).
,
.
.
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.
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.)
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.. (1974) .
,
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.
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, ,
.
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43
Hepato_2003_Last_With_Index.qxd
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Page 44
,
, .
,
, (v. mesenterica superior),
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,
.
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.
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.
.
.
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, , 80%
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,
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,
VI VII .
(I ), II .
III IV . III IV
( )
.
44
Hepato_2003_Last_With_Index.qxd
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18:38
Page 45
II.
.
.
,
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.
(25%). ,
.
,
,
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( 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 . .
,
. ,
, ,
,
.
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.
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,
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v. rectalis inferior),
( ).
.
(v. umbilicalis), ,
,
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.
(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 .
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).
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, ,
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47
Hepato_2003_Last_With_Index.qxd
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Page 48
0,51,0 2 .
.
.
,
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, (ligamentum v. cavae),
.
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.
.
,
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(ductus thoracicus).
,
,
48
Hepato_2003_Last_With_Index.qxd
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Page 49
II.
,
(cisterna chyli).
.
.
.
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,
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.
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.
.
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,
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.
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49
Hepato_2003_Last_With_Index.qxd
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Page 50
.
(ductus hepaticus commu
nis). (duc
tus cysticus) (ductus choledochus).
.
,
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.
,
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.
.
,
.
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.
5%
, ..
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.
20%
.
III IV ,
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.
50
Hepato_2003_Last_With_Index.qxd
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Page 51
II.
( 2%),
,
. 2 ,
.
V ,
, ,
.
,
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.
.
,
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.
, 1130%
.
. ,
.
,
.
.
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,
[Mirizzi P.,1940]. ,
.
.
51
Hepato_2003_Last_With_Index.qxd
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Page 52
,
(papilla duodeni major, seu papilla Vateri)
(ductus pancreaticus). ,
.
, ,
2 12 .
, , .
57 . 58
1 .
( ) 3 .
,
, .
. ,
. , ..
.. (1986) 911
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, 1215 95,2%,
, , 8
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( 3 ); 4)
()
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,
(ampulla hepatopancreati
ca) 39 ,
(porus papillae).
, ,
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34
52
Hepato_2003_Last_With_Index.qxd
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Page 53
II.
.
,
,
.
.
.
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,
.
,
.
.
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.
, , .
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.
,
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53
Hepato_2003_Last_With_Index.qxd
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Page 54
(633%).
(46%),
(46%).
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,
.
,
(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 .
.
,
.
, ,
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[Oddi R., 1887],
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,
.
.
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.
.
,
, .
.
: ,
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55
Hepato_2003_Last_With_Index.qxd
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Page 56
,
.
. ,
, ,
, ,
,
.
.
(vesica fellea)
,
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sa vesicae felleae).
,
,
.
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,
.
:
1 ;
2 ;
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3 ;
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4
. (1,52 ),
;
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6
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56
Hepato_2003_Last_With_Index.qxd
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Page 57
II.
: , .
(fundus vesicae felleae)
, .
. (corpus vesicae felleae) ,
.
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,
.
.
,
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leae) , ,
.
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.
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57
Hepato_2003_Last_With_Index.qxd
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Page 58
.
.
,
.
.
, .
, [Heister L., 1717].
, , .
, ,
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1909], ,
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, .
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.
,
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. .
.
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, .
.
58
Hepato_2003_Last_With_Index.qxd
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Page 59
II.
,
,
.
,
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,
.
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59
Hepato_2003_Last_With_Index.qxd
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Page 60
.
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60
Hepato_2003_Last_With_Index.qxd
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Page 61
II.
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61
Hepato_2003_Last_With_Index.qxd
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,
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62
Hepato_2003_Last_With_Index.qxd
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II.
.
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Hepato_2003_Last_With_Index.qxd
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64
Hepato_2003_Last_With_Index.qxd
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65
Hepato_2003_Last_With_Index.qxd
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Page 66
10 1 . ,
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66
Hepato_2003_Last_With_Index.qxd
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Page 67
II.
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. (1982) 12
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14.
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20.
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. .: , 1975. 266 .
28.
.., .., .. .
// . . 1982. 3. . 3441.
29.
.., .., ..
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IV
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..
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120
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121
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1849 .
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2 6 . (1985)
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127
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128
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,
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130
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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].
,
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.
.
.
,
, [ ..,
1984; .., 1988; .., .., 1990; Ac
kery D., Smith F.W., 1985].
(),
,
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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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IV.
Hepato_2003_Last_With_Index.qxd
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18:39
Page 134
[Scherer U. et al.,
1978].
( ).
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.
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.
2
.
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[Bahr P., 1984]. , ,
134
Hepato_2003_Last_With_Index.qxd
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IV.
, ,
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135
Hepato_2003_Last_With_Index.qxd
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.
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II, III, V IV
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100 .
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136
Hepato_2003_Last_With_Index.qxd
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,
, .
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[ .., 1981; .., 1992; .., 2002;
Wakabayashi H. et al., 2002].
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40% .
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,
. , .. . (1992),
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137
Hepato_2003_Last_With_Index.qxd
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18:39
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( ) 715 [
.., 1996; .., 1998].
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[
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[ .., 1967; .., 1983; .., 1986; ..,
.., 1995].
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:
1.
1.1
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2.2 ,
3.
138
Hepato_2003_Last_With_Index.qxd
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18:39
Page 139
IV.
3.1
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[ .. ., 2002].
M. Refferscheid (1957).
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139
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/
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140
Hepato_2003_Last_With_Index.qxd
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.
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.
[ .. ., 1986, 1987].
.
141
Hepato_2003_Last_With_Index.qxd
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18:39
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.
1952 . I. LortatJacob . Robert ,
.
,
.. (1967), W. Longmire (1961),
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.
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. ,
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()
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142
Hepato_2003_Last_With_Index.qxd
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IV.
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. ..
(1970)
3540 . ,
143
Hepato_2003_Last_With_Index.qxd
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60
. ,
2030 .
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,
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o,
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1984].
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.
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144
Hepato_2003_Last_With_Index.qxd
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18:39
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IV.
.
,
,
. 10 . .,
.
.
Biopump ()
.
70 .
F. ChahezPeon . (1970), S. Franke, . Urban (1979)
,
.
.
.
.. .. (1980, 1981)
,
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,
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.
1993 .
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5 , .
3 .
.
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145
Hepato_2003_Last_With_Index.qxd
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.
,
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.
,
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.
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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].
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,
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,
.
. ,
, [Kinoshita H., 1986].
. ,
1999 .
300 , 2001 .
100 ,
3000 .
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( 2001 ., , ).
147
Hepato_2003_Last_With_Index.qxd
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Page 148
, .
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,
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[ .. ., 2002].
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[ .., 2001, 2002; Yamanaka N. et al., 1993; Elias D., 1999].
.
.
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. .. . (2002)
, , ,
.
.
, 96%
, , , , .
, .
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148
Hepato_2003_Last_With_Index.qxd
10.02.2003
18:39
Page 149
IV.
,
3050%
.
.
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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
,
, ,
.
,
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.
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).
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.
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150
Hepato_2003_Last_With_Index.qxd
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18:39
Page 151
IV.
.
. F.P. Gall 1987 .
110 CUSA
, 5
03 32% [Gall F.P., 1987].
,
.
/ /
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.
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,
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.
,
.
,
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9,5%
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, 50%
, [ ..,
.., .. ., 2002].
,
151
Hepato_2003_Last_With_Index.qxd
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Page 152
2030 , 5 2045% [
.., 1993; .., 1996].
2
:
,
.
,
[ .., 1998].
( 3 )
( 3 ), (
)
(
). .
.
,
, (
),
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,
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Silen W., 1989].
,
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.
,
.
,
.
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, 16,1 34,9 , 2
47% 72%, 3 30,6% 57,5%, 5
20% 47%.
152
Hepato_2003_Last_With_Index.qxd
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18:39
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%),
,
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.
.
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.
,
, (
)
,
. :
; ,
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.
:
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.
155
Hepato_2003_Last_With_Index.qxd
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4 :
1. .
2. .
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4.
( ).
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.
,
.
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156
Hepato_2003_Last_With_Index.qxd
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Page 157
IV.
12 ,
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710
.
7 , ,
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,
1520
, .
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.
.
.
. ,
157
Hepato_2003_Last_With_Index.qxd
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Page 158
.
.
.
,
50% ,
.
.
, ,
, . ,
.
.
, ,
.
.
.
, ,
23 .
30%
. 13
[Chuang V.P. et al., 1982].
( 10 )
,
.
.
158
Hepato_2003_Last_With_Index.qxd
10.02.2003
18:39
Page 159
IV.
,
,
, ,
11,5 [Chuang V.P.,
1982; Delcour C.P. et al., 1988].
. 612
.
.. , .. (1990)
.
, [Fortner J.G., 1984; et al.,
1994]. S. Saitoh (1994),
.
,
.
,
,
.
,
.
60 . .
.
, .
7580% 2025%
,
[Breedis C., Young G., 1954].
159
Hepato_2003_Last_With_Index.qxd
10.02.2003
18:39
Page 160
. U. Tylen (1982),
, .
,
,
.
5, 52, ,
. .
8 90% [ .., 1990;
Schroder R., 1985; Schlag P., 1990; Shciba . et al., 1993].
5 (1020 / 24
), (2030 /2 ),
(0,2 / ) [Ballet F.. et al., 1983; Saffi F., 1988].
, , 14,5 .
.
, ,
[ .., .., 1990].
npenapa . , K. Nakakuma . (1983)
16
.
,
, .
, .
,
3446%
, 53,5%
[Kanematzu, 1984; Katagini Y. et 1., 1989; Shibata J. et 1., 1989].
,
, , 4 12 ,
,
160
Hepato_2003_Last_With_Index.qxd
10.02.2003
18:39
Page 161
IV.
.
[Katagini Y. et 1.,
1989; Martin J.K. et al., 1990; Schlag P. et al., 1990; Pentecost M.J., 1993].
,
,
.
. ,
.
,
,
.
.
,
( 5070% ),
10 (. 4.2. , , ).
, ,
.
, , ,
,
,
. , , 4
. ,
.
4%.
.
. M.Y. Pentecost .
(1993) ,
.
.
161
Hepato_2003_Last_With_Index.qxd
10.02.2003
18:39
Page 162
,
,
.
[Teng G.J. et al., 1993].
N. LeVeen . (1984),
,
.
,
, . J.M. Ariel
. (1970)
90Y .
,
, 26 .
,
,
. 4.2.
. .
.
, VII VI
.
. .
.
VII VI
.
.
. VII VI
.
162
Hepato_2003_Last_With_Index.qxd
10.02.2003
18:39
Page 163
IV.
. ,
,
,
.
, .
.
.
.
.. .. 1967 .
.. , .. (1986)
,
.
.
,
.
:
;
;
.
[ .., .., 1986].
,
, 1964 . .. .
163
Hepato_2003_Last_With_Index.qxd
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Page 164
,
,
.
,
.
.
.
.
,
,
.
,
.
.
. ,
,
,
.
,
.
.
,
,
.
50109/ 65%
.
, .
.
164
Hepato_2003_Last_With_Index.qxd
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18:39
Page 165
IV.
,
.
,
.
,
.
.
910
,
.
.
(5,5%) (1,3%)
.
. 2,7%
, . 5,5%
, 8,3%
, .
.
,
[ .. ., 1980].
.
.
,
165
Hepato_2003_Last_With_Index.qxd
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Page 166
.
.
,
.
,
.
.
.
,
.
.
.
(. 4.3 , ).
,
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. 4.3 .
,
.
.
166
Hepato_2003_Last_With_Index.qxd
10.02.2003
18:39
Page 167
IV.
.
.
1,52,0 ,
,
1520
.
,
.
,
.
.
10001500 . .,
.
,
1,5 , 200 5%
.
( 23 ).
: 500 10%
, 12
, 20 5%
,
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.. . : , 1983. 352 .
2.
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//
. 1998. . 44. 5. . 662666.
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, 1986. 214 .
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20.
.. //
. .. . 1990. 2. . 148150.
21.
.., .. //
. .. . 1975. 10. . 137142.
174
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22.
..
. .: ., 1988. 240 .
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24.
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26.
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. . /.../ . . , 1969. 23 .
27.
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.: , 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.
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.. . .: ,1967.
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.. ,
.. ,
.. ,
.. ,
..
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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).
(,
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,
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,
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, .
, , ,
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181
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:
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.., .., 1995].
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[ .. ., 1989].
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),
.
5 ,
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129 .
92 (71,3%) 37 (28,7%)
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33 (26,4%) ( 9 (7,2%)
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.
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182
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.
, ,
45 .
.
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. (
, , , , )
. 40% [
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,
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2,5 ( 12 8 ), 8
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71 (55%)
35
36 .
,
.
,
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zalez E.M. et al., 1988].
,
.
183
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,
. 60
80% [ .. ., 1980; Aseni P. et al., 1987].
,
[ ..,
.., 1984].
[TranMinh V.A. et al., 1991].
[ .. ., 1983;
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,
[ .., .., 1984; .. ., 1985;
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,
,
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1990 . 56
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184
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19.03.98 . . V:VI :
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.
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.
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186
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187
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5 (11,9%)
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.
188
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V.
.
.
[Numata K. et al., 1993].
C. Reinhold . (1995)
198 .
, .
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, (0,530,75 ) .
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.
,
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) [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%).
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,
.
189
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, .
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., 1989; Honda H. et al., 1992].
28%
.
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.
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.
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.
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]. ,
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.
.
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.
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,
191
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.
.
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. Krause T. . (1993)
(52%),
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(95%).
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.
192
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,
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.
. ,
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[Gonzalez E.M. et al., 1988].
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.
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193
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.. . (1990) ,
,
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, ,
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,
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berg B. et al., 1987].
76 .
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. .
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194
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V.
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, XII
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.
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.
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.
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.
,
, [Sood A.
et al., 1996]. ,
[Contor R.L., Longmire W.P., 1988]. ..
. (1997)
32 .
195
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42,8%
.
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, ,
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.
196
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.
.
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18:39
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V.
J. Pfannenstiel 1898 .
,
. ,
, .
R. De Blassio . (1996) , 10%
.
, ,
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1990. 6. . 135139.
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22.
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// :
/ , 1999. . 111.
24.
25.
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. ., 1980.
27.
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// . 1997. 4.
. 1114.
28.
.. : .
. . . . , 1997. 23 .
29.
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// . 1992. . 28. 7. . 161163.
30.
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// . . 1986. 8. . 5961.
31.
32.
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// . 1989. 2. . 3844.
33.
.., .., .. .
//
. 2002. . 7. 1. . 713.
34.
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// . . 1990. . 36. 5. . 583585.
35.
.. // . 1986. 2. . 37.
36.
.., .. //
.... 1981. 9. . 4347.
37.
.., .., ..
// . 1991. 2. . 6669.
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VI
.. ,
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, ,
. ,
0,8% [Kummerle F., Ehlert C., 1967],
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, ,
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,
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[Fernandez M.
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.
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. ,
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224
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VI.
, [Lotz G.W.,
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[ .., 1972].
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.
. , 12
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1984], [Roemer C.E. et al.,
1981].
[
.., 1984]. , ,
,
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, , [Martelli H. et
al., 1982; Schulz F. et al., 1984; .. ., 1985; Edwards J.D.
et al., 1987; Lotz G.W., Stahlschmidt M., 1987; Pichlmayr R., Guberna
tis G., 1987]. 5% .
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40 .
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.
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225
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58 (92%)
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.
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,
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226
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VI.
, 13% , 5% 1 %
.
35% ; 3%;
9,5%; 4%
.
, ,
,
(, , , , ),
.
,
, ,
,
[ .. ., 1981; .. .,
1986; Starzl T.E. et al., 1982].
[ .., .., 1982;
.., .., 1987; Schulz F. et al., 1984].
E. Austin . (1981)
.
,
,
[ .. ., 1989; Swobodnik W.,
1986; Rini G.B. et al., 1987].
1/3
[Davis . et al., 1981].
227
Hepato_2003_Last_With_Index.qxd
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(12 ) ;
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, ; 2)
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,
. J. Edwards . (1987)
.
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.
,
.
.
[ .., 1986;
Rohner A., 1986; Swobodnik W., 1986].
,
,
, [
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60 . 16,7%
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.
5 10 .
,
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.
228
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VI.
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, .
,
,
,
[ .. ., 1981; Marchese E. et al.,
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42.
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.. // . 1986. 2.
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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
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.
.
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7.
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9.
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. 7175.
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292
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VII.
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// . . 1987. 2. . 37.
20.
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21.
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. 1986. 5. . 1820.
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23.
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3234.
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. : , 1976. 537 .
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., 1976. 310 .
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. 7376.
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29.
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) // . . 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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Hepato_2003_Last_With_Index.qxd
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Page 295
VIII
.. ,
..
Hepato_2003_Last_With_Index.qxd
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Hepato_2003_Last_With_Index.qxd
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. :
.
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,
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. ,
.
7,
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.
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1976]. 35%
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.
.
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.
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297
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..
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:
.
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.
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II. :
1.
2.
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.
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(Bacteroides fragilis, Bacteroides spp., Peptostreptococci,
Cl. perfringens) [ .. ., 1999,
Huang C.J., 1996].
41,8% [ .. ., 1988].
.
Candida albicans [ ., 2000].
:
;
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298
Hepato_2003_Last_With_Index.qxd
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299
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, ,
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:
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300
Hepato_2003_Last_With_Index.qxd
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VIII.
:
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,
[ .., .., 1972].
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,
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302
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.
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.
,
.
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.
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.
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.
.
, 67 .
.
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.
,
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.
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.
, , .
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.., 1972].
303
Hepato_2003_Last_With_Index.qxd
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,
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.
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304
Hepato_2003_Last_With_Index.qxd
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VIII.
[ .. .,1983].
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.
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.
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.
.
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305
Hepato_2003_Last_With_Index.qxd
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, .
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.
.
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.
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.
306
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VIII.
.
,
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.
.
,
.
. 8.1 [Sanford J.P.
.,1996].
.
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,
Enterobacteriacae,
bacteroides,
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+
+
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307
Hepato_2003_Last_With_Index.qxd
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,
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. // . 1990. 8. . 122124.
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3.
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. // . . . . . 1995. 20 .
4.
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. // . 1999. . 4. 2. . 8586.
5.
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. // . 1988. 9. . 9194.
6.
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// . 1999. 10. . 2428.
7.
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. .: , 1982. 240 .
8.
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, 1967. 314 .
9.
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. :
. . , , 1997. . 211.
10.
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. : . , 2000. 688 .
11.
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. , 1983. 288 .
308
Hepato_2003_Last_With_Index.qxd
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VIII.
12.
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. ./ . . .. . .: , 2000. 360 .
13.
.., .., .. . //
. 1999. . 4. 2. . 118.
14.
. . , 1974. 301 .
15.
16.
17.
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// . 1999. . 4. 2. . 134.
18.
., ., ., .
. : , 1976. 537 .
19.
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20.
21.
22.
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.
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.
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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.
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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
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IX
.. ,
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, ,
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313
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,
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326
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