Pancreatic Insulinoma: Zizindikiro ndi Chithandizo

Insulinoma ndi chotupa chachilendo kuchokera kwa β-cell a kapamba, wobisirana insulin yambiri.

Kuzindikira kumakhala ndi kuyesa ndi kusala kwa maola 48- kapena 72 ndi miyeso ya glucose ndi insulin komanso zotsatira za endoscopic ultrasound. Chithandizo chimachitidwa opaleshoni (ngati zingatheke).

Pakati pa milandu yonse ya insulinomas, 80% imakhala ndi node imodzi ndipo, ngati ikapezeka, kuchira kumatheka. 10% insulini imayipa. Insulinomas imapanga ndi pafupipafupi 1 / 250,000. Insulinomas yokhala ndi mtundu wa I MEN nthawi zambiri.

Kutenga insulinoma ya exogenous kumapangitsa magawo a hypoglycemia, ngati chithunzi cha insulinoma.

Pancreatic Insulinoma Prevalence

Kutalika kwathunthu kwa insulin kumakhala kochepa - milandu ya 1-2 pa anthu 1 miliyoni pachaka, koma amapanga pafupifupi 80% ya ma pancreatic neoplasms onse odziwika. Amatha kukhala onse osakwatirana (omwe nthawi zambiri amakhala ochepa), komanso angapo (omwe nthawi zambiri amatenga cholowa), zomwe zimapangitsa kuti azindikire zovuta asanachitidwe opaleshoni. Insulinomas amapangidwira pancreas, koma mu 1-2% ya milandu amatha kupanga kuchokera ku minofu ya ectopic ndikukhala ndi kutulutsa kwapadera.

Insulinoma ndimapangidwe apawiri a MEN syndrome mtundu I, womwe umaphatikizanso zotupa za parathyroid, adenohypophysis, ndi zotupa za adrenal cortex (zomwe zimakonda kugwira ntchito kwambiri m'thupi).

Odwala ambiri, insulinoma imakhala yochepa, mu 10-20% ili ndi zizindikiro za kukula koopsa. Insulinomas yokhala ndi masentimita oposa 2-3 nthawi zambiri imakhala yoyipa.

Pancreatic Insulinoma Gulu

Mu ICD-10, mitu yotsatirayi ikufanana ndi insulinoma.

• C25.4 Neoplasm yolakwika yamasamba apancreatic.
• D13.7 Benign neoplasm of pancreatic islet cell.

Insulinoma ndiyomwe imapangitsa kwambiri organic hyperinsulinism syndrome, yomwe imadziwika ndi HS yayikulu, makamaka usiku komanso pamimba yopanda kanthu, i.e. pambuyo kusala kokwanira kokwanira. Hyperinsulinism ndi endo native hyperproduction ya insulin, yomwe imapangitsa kuwonjezeka kwa kuchuluka kwake m'magazi (hyperinsulinemia) ndi mwayi waukulu wokhala ndi vuto la hypoglycemia. Organic hyperinsulinism imapangidwa pamaziko a zomangidwe zachilengedwe zomwe zimatulutsa insulin yambiri. Kuphatikiza pa insulinomas, zifukwa zosowa kwambiri za organic hyperinsulinism ndi adenomatosis ndi islet-cell element hyperplasia - non-idioblastosis.

Pazifukwa zowoneka bwino, mawonekedwe a hyperinsulinism amasiyanitsidwa, nthawi zambiri amakhala ndi maphunziro osavuta komanso mapangidwe a matendawa (Table 3.21).

Amayambitsa ndi pathogenesis ya pancreatic insulinoma

Mikhalidwe ya hyperinsulinemia, mapangidwe ndi kusintha kwa glycogen m'chiwindi ndipo minofu imakulanso. Kusakwanira kwa ubongo ndi mphamvu yayikulu ya gawo lapansi kumayendetsedwa ndimatenda amitsempha, kenako ndikusintha kosasintha kwa machitidwe amkati mwa dongosolo lamitsempha ndikupanga ubongo wa asthenia ndi kuchepa kwa luntha.

Pakalibe chakudya chapanthawi yake, matenda a hypoglycemia amakula mosiyanasiyana, amawonetsedwa ndi adrenergic ndi cholinergic zizindikiro ndi zizindikiro za neuroglycopenia. Zotsatira za kuchepa kwa mphamvu yayitali kwa maselo a ziwongo zam'mimba ndi edema yawo komanso kukula kwa vuto la hypoglycemic.

Zomwe zimayambitsa chidwi cha hyperinsulinism mwa akulu

Zizindikiro ndi pancreatic insulinoma

Hypoglycemia ndi insulinoma imayamba pamimba yopanda kanthu. Zizindikiro zimatha kufufutidwa ndipo nthawi zina zimatsata zovuta zingapo zamaganizidwe ndi mitsempha. Zizindikiro zakuchuluka kwacifundo zimawonekera kawirikawiri (kufooka kwathunthu, kunjenjemera, palpitations, thukuta, njala, kusakwiya).

Kusowa kwa zodziwikiratu ndi zina mwazifukwa zazikulu zomwe zimapangitsa kuti insuloma ichitike mochedwa. Poterepa, mbiri ya matendawa imatha kuwerengetsa zaka. Mwa mitundu yosiyanasiyana ya mawonetseredwe azachipatala, zizindikiro za neuropsychiatric ndizodziwika bwino - magawo a chisokonezo, malankhulidwe ndi kuwonongeka kwa magalimoto, mawonekedwe achilendo, kuchepa kwa malingaliro a kukumbukira ndi kukumbukira, kutayika kwa luso la akatswiri, amnesia, ndi zina. Zizindikiro zina zambiri (kuphatikizapo mtima ndi m'mimba) ndizowonetsera kwa pachimake. neuroglycopenia ndi kudziyimira payekha.

Nthawi zambiri, odwala amadzuka ndi zovuta, amasokonezeka nthawi yayitali, amayankha mwachidule mafunso osavuta kapena samakumana ndi ena. Kusokonezeka kapena kusalankhula, mtundu womwewo wamawu ndi mawu osinthika, mayendedwe osafunikira amakopa chidwi. Wodwalayo amatha kusokonezeka ndi mutu komanso chizungulire, kupweteka kwa milomo, diplopia, thukuta, kumverera kwa kunjenjemera mkati kapena kuzizira. Pakhoza kukhala magawo a psychomotor mukubwadamuka ndi khunyu. Zizindikiro monga kumva kuti muli ndi njala komanso kusowa tulo m'mimba zimakhudzana ndi zomwe zimachitika m'matumbo.

Momwe ma pathological amathandizira, kusunthika, kugwedezeka kwa manja, kupindika kwa minofu, kukokana, kumachitika. Chifukwa chakuyambiranso amnesia, monga lamulo, odwala sangathe kudziwa za kuukira.

Chifukwa chofuna kudya pafupipafupi, odwala amakonda kunenepa kwambiri.

Ndi kuwonjezeka kwa nthawi yayitali ya matendawa, mkhalidwe wa odwala omwe ali munthawi yolimbana ndi masinthidwe amasintha kwambiri chifukwa cha kuphwanya zochitika zapamwamba zamkati: kusintha kwamalingaliro ndi malingaliro kumakhazikika, kukumbukira kumakulirakulira, mphamvu zamaganizo pantchito zimachepa, luso laukadaulo limatha pang'onopang'ono, kusasamala komanso kukwiya. munthu.

Kuzindikira kwa pancreatic insulinoma

Ndi kukula kwa zizindikiro, ndikofunikira kuyesa kuchuluka kwa shuga mu seramu yamagazi. Pamaso pa hypoglycemia, ndikofunikira kuyesa kuchuluka kwa insulin panthawi yomweyo yotengedwa ndi magazi. Hyperinsulinemia> 6 mcU / ml ikuwonetsa kupezeka kwa insulin-mediated hypoglycemia.

Insulin imasungidwa mwanjira ya proinsulin, yopangidwa ndi unyolo wa α ndi unyolo wa β wolumikizidwa ndi C peptide. Chifukwa insulin yamafakitale imangokhala ndi β-unyolo; makonzedwe achinsinsi a insulin angadziwike poyesa milingo ya C-peptide ndi proinsulin. Ndi chinsinsi chogwiritsira ntchito kukonzekera kwa insulin, kuchuluka kwa izi ndizowoneka bwino kapena kuchepetsedwa.

Popeza odwala ambiri alibe zizindikiro pa nthawi yoyeserera (ndipo chifukwa chake palibe hypoglycemia), kuthandizidwa kuchipatala kuti ayesedwe ndi kusala kudya kwa maola 48-72 kukuwonetsedwa kuti akutsimikizira matendawa. kufa ndi njala kumakulitsa mawonetseredwe azachipatala, mu 70-80% mkati mwa maola 24. Udindo wa hypoglycemia kumayambiriro kwa zizindikiro umatsimikiziridwa ndi Whipple triad:

1. Zizindikiro zimawoneka pamimba yopanda kanthu
2. Zizindikiro zimawoneka ndi hypoglycemia,
3. kudya kudya kwa carbohydrate kumachepetsa zizindikiro.

Ngati zigawo za Whipple triad sizinayang'anitsidwe pambuyo pa kusala kudya, ndipo kuchuluka kwa shuga m'magazi pambuyo poti asala kudya usiku> 50 mg / dl, kuyesa kwa C-peptide kungapangike. Ndi kulowetsedwa kwa insulin kwa odwala omwe ali ndi insulinoma, palibe kuchepa pazomwe C-peptide imakhala yokhazikika.

Endoscopic ultrasound imakhala ndi chidwi cha> 90% pozindikira chotupa. Pachifukwa ichi, PET imagwiritsidwanso ntchito. CT ilibe chitsimikiziro chotsimikizika, monga lamulo, palibe kufunika kwa arteriography kapena kusankha catheterization a portal ndi splenic mitsempha.

Ngakhale chithunzithunzi chowoneka bwino, chokhala ndi organic hyperinsulinism, chodziwika ngati ngozi ya cerebrovascular, diencephalic syndrome, khunyu, ndi kuledzera nthawi zambiri chimakhazikitsidwa.

Ngati kuthamanga kwa shuga m'magazi ndizoposa 3.8 mmol / L ndipo palibe umboni wotsimikiza wa HS, kupezeka kwa insulinoma kungathetsedwe. Ndikusala kudya glycemia wa 2.8-3.8 mmol / L, komanso oposa 3.8 mmol / L kuphatikiza ndi hypoglycemia, mbiri yofulumira imachitidwa, womwe ndi njira yodzetsitsira Whipple triad. Kuyesedwa kumawoneka bwino ngati kusintha kwa labotale ndi zizindikiro zamankhwala za hypoglycemia zikuwonekera, zomwe zimayimitsidwa ndi kukhazikika kwa njira yothetsera shuga. Odwala ambiri, Whipple triad amakwiya kale patadutsa maola ochepa kuchokera poyambira. Ndi organic hyperinsulinism, kuchuluka kwa insulin ndi C-peptide kumachulukirachulukira ndipo sikuchepa pakusala kudya, mosiyana ndi anthu athanzi komanso odwala omwe ali ndi hyperinsulinism yogwira ntchito.

Pankhani yoyesedwa ndi njala, kuwunika kwa zotupa pakumachitika pakumenyetseka pogwiritsa ntchito ma ultrasound (kuphatikiza endoscopic m'mimba mwa ultrasound ndikuwona ma kapamba), MRI, CT, kusankha angiography, transcinpatic catheterization ya nthambi za mitsempha ya portal, pancreaticoscopy yokhala ndi biopsy.

Ma receptors a Somatostatin ali ndi insulin yokwanira 90%. Scintigraphy ya somatostatin receptors ogwiritsa ntchito radioactive kupanga somatostatin - pentetreotide imalola kuti apezeke matenda a zotupa ndi ma metastases, komanso postoperative kuwunika kwakukulu kwa opereshoni.

Njira yofunikira yodziwitsira matenda ndikuwunikiranso kwa kapamba ndi chiwindi, komwe kumathandizira kuzindikira ma neoplasm ndi metastases omwe sakanadziwika pamaso pa opareshoni.

Kusiyanitsa mitundu

Ngati pambuyo zasayansi kutsimikizira organic hyperinsulinism insulin sanawoneke, percutaneous kapena laparoscopic diagnostic puncture biopsy wa kapamba amachita. Kafukufuku wotsatira wa morphological amatilola kukhazikitsa zifukwa zina za organic hyperinsulinism - nezidioblastosis, pancreatic microadenomatosis. Panthawi yosiyanitsa mitundu, matenda ndi machitidwe angapo omwe amaphatikizidwa ndi chitukuko cha hypoglycemia ayenera kusiyidwa: kufa ndi njala, kuphwanya kwambiri chiwindi, impso, sepsis (chifukwa cha kuchepa kwa gluconeogeneis kapena kuchepa kwa kagayidwe ka mankhwala amkati mwa insulin, zotupa zazikulu za mesenchymal zomwe zimagwiritsa ntchito glucose, kuvutikira kwa kuderera kwa thupi, kuvutikira kwa kuderera kwa thupi, kuvutikira kwa kuderera kwa thupi, kuvutikira kwa kuderera kwa thupi. kukhazikitsa owonjezera insulin pa matenda a shuga, kumwa kwambiri kuchuluka kwa mowa ndi waukulu Mlingo wa mankhwala ena, nnye chakhungu shuga kagayidwe (gluconeogenesis zopindika michere), chitetezo kwa insulin.

Chithandizo cha Pancreatic Insulinoma

• Kuyambiranso maphunziro.
• Diazoxide ndipo nthawi zina octreotide kukonza kukonza kwa hypoglycemia.

Pafupipafupi mankhwala ochiritsira opaleshoni ukufika 90%. Insulinoma imodzi yaying'ono pamtunda kapena yopanda kuchokera pansi pa kapamba imatha kuchotsedwa ndi enucleation. Ndi adenoma imodzi yayikulu kapena yakuya, yokhala ndi mawonekedwe angapo a thupi ndi / kapena mchira, kapena ngati insulini singadziwike (iyi siyowoneka kawirikawiri), distal subtotal pancreatectomy imachitika. Osakwana 1% ya milandu, insulinoma imakhala ndi ectopic malo apafupi ndi kapamba - khoma la duodenum, dera la periduodenal ndipo imatha kupezeka ndi kuwunika kokwanira. Pancreatoduodenectomy (ntchito ya Whipple) imapangidwira insulinomas yamatenda a proximal pancreas. Cancreatectomy yonse imachitidwa pazochitika zapambuyo pancreatectomy yam'mbuyomu.

Ndi hypoglycemia womwe umapitirira kwa nthawi yayitali, diazoxide imatha kutumikiridwa limodzi ndi natriuretic. An somatostatin analog octreotide ali ndi kusintha kosiyanasiyana, angagwiritsidwe ntchito mwa odwala omwe ali ndi hypoglycemia osakhalitsa omwe sayankha chithandizo cha diazoxide. Poyerekeza ndi momwe octreotide amagwiritsidwira ntchito, zingakhale zofunikira kutenga kukonzekera kwapancreatin, chifukwa kuponderezana ndi katulutsidwe katemera kumachitika. Mankhwala ena omwe ali ndi malire komanso osintha mochulukirapo pakumata kwa insulin amaphatikiza ndi verapamil, diltiazem, ndi phenytoin.

Ngati Zizindikiro zake ndizosalamulirika, mutha kumwa mankhwala ochulukitsa, koma mphamvu zake ndizochepa. Ndi kuikika kwa streptozocin, kuthekera kwa kukwaniritsa izi ndi 30-40%, kuphatikiza ndi 5-fluorouracil - 60% (kuchotsedwa kwazaka mpaka zaka 2). Njira zina zochizira ndi doxorubicin, chlorozotocin, interferon.

Njira yokhazikika kwambiri yolandirira ndi njira yodutsira chotupa pakukokoloka kapena pang'ono pancreatic resection. Ndi insulinoma yoyipa, resection ya pancreatic imaphatikizidwa ndi lymphadenectomy ndikuchotsa metastases yowoneka (nthawi zambiri m'chiwindi).

Ngati ndizosatheka kuchotsa chotupacho ndipo ngati opaleshoniyo satha, opaleshoni yothandizira imagwiridwa ndi cholinga chopewa (pafupipafupi kudya zakudya zamagulu, diazoxide) ndi mpumulo wa HS.

Ngati pakuwunika zotsatira zabwino za scan ndi octreotide zapezeka, ndiye kuti maupanga a somatostatin amalembedwa - octreotide ndi mitundu yake yotulutsidwa ya octreotide (octreotide-depot), lanreotide, yomwe imakhala ndi antiproliferative ntchito komanso imaletsa osati chinsinsi cha kukula kwa mahomoni, komanso insulin, seroton gastrin, glucagon, secretin, motilin, vaso-matumbo polypeptide, pancreatic polypeptide.

Potsimikizira mtundu wankhanza wa insulinomas, chemotherapy yokhala ndi streptozotocin imasonyezedwa, zomwe zimapangitsa kuwonongedwa kwa maselo a pancreatic R.

Zambiri

Insulinoma ndi chosaopsa (mu 85-90% ya milandu) kapena chodwala (mu 10-15% ya milandu) chotupa chochokera ku maselo a of maselo a Langerhans, okhala ndi zochita za maholidi ndipo zimayambitsa hyperinsulinism.Kubisirana mosasamala kwa insulin kumayendera limodzi ndi kukula kwa hypoglycemic syndrome - mawonekedwe a adrenergic ndi neuroglycopenic mawonetseredwe.

Pakati pa zotupa zogwira pancreatic ya mahomoni, insulinomas imakhala 70-75%, pafupifupi 10% ya milandu yomwe ndi gawo la mtundu wa I 1 endocrine adenomatosis (limodzi ndi gastrinoma, zotupa za pituitary, parathyroid adenoma, etc.). Insulinomas nthawi zambiri imapezeka mwa anthu azaka 40-60, mwa ana ndi osowa. Insulinoma imatha kukhala mu gawo lililonse la kapamba (mutu, thupi, mchira), m'malo ena amapezeka kunja - khoma lam'mimba kapena duodenum, omentum, chipata cha ndulu, chiwindi ndi madera ena. Nthawi zambiri, kukula kwa insulinomas ndi 1.5 - 2 cm.

The pathogenesis ya hypoglycemia yokhala ndi insulinoma

Kukula kwa hypoglycemia mu insulinoma kumachitika chifukwa cha kuchuluka kwambiri, kosabisalira kwa insulin ndi chotupa b-cell. Nthawi zambiri, kuchuluka kwa glucose m'magazi kukagwa, kumachepa kupanga insulin ndi kulowa kwake m'magazi. M'maselo a chotupa, njira ya kayendetsedwe ka insulin imasokonekera: ndi kuchepa kwa glucose, kutsika kwake sikumaponderezedwa, zomwe zimapangitsa kuti pakhale matenda a hypoglycemic.

Omwe amamva kwambiri hypoglycemia ndi maselo aubongo, pomwe glucose ndiye gawo lalikulu lamphamvu. Pankhani imeneyi, neuroglycopenia imawonedwa ndi insulinoma, ndipo kusintha kwa dystrophic mu chapakati kwamanjenje kumayamba ndi hypoglycemia. Mkhalidwe wa hypoglycemic umapangitsa kuti amasulidwe akhale m'magazi a mahomoni opatsirana (norepinephrine, glucagon, cortisol, mahomoni okula), omwe amayambitsa zizindikiro za adrenergic.

Zizindikiro za Insulinomas

Pa nthawi ya insulinoma, magawo omwe amakhala ndi thanzi amasiyanitsidwa, omwe nthawi zina amasinthidwa ndi matenda owonetsa hypoglycemia ndi hyperadrenalinemia. Mu nyengo yakumapeto, mawonetseredwe okha a insulinoma amatha kukhala onenepa kwambiri komanso kukulitsa chilimbikitso.

Kuopsa kwa hypoglycemic kwachitika chifukwa chakuwonongeka kwa kusintha kwazinthu zamkati mwa dongosolo lamanjenje ndi zotsutsana nazo. Kuukira kumayamba m'mimba yopanda kanthu, pambuyo pakupuma kwakudya kwambiri, nthawi zambiri m'mawa. Pakuwukira, glucose wamagazi amatsika pansi pa 2,5 mmol / L.

Zizindikiro za neuroglycopenic za insulinomas zimatha kufanana ndi zovuta zamitsempha zambiri komanso zamisala. Odwala amatha kupweteka mutu, kufooka kwa minofu, ataxia, ndi chisokonezo. Nthawi zina, kuukira kwa hypoglycemic kwa odwala omwe ali ndi insulinoma kumayendera limodzi ndi mkhalidwe wa psychomotor mukubwadamuka: kuyerekezera zinthu zina, kulira mokweza, nkhawa zamagalimoto, mkwiyo wosagwedezeka, euphoria.

Zomwe zimachitika mwanjira yomvera chisoni-adrenal kwambiri hypoglycemia ndi mawonekedwe a kunjenjemera, thukuta lozizira, tachycardia, mantha, paresthesias. Ndi kupitirira kwa kuukira, kugwidwa, khunyu, kuzindikira, ndi kupsa mtima kumatha. Nthawi zambiri kuukira kumayimitsidwa ndi kulowetsedwa kwa shuga mkati, komabe, atachira, odwala samakumbukira zomwe zinachitika. Pakadutsa matenda a hypoglycemic, kuphwanya magazi m'mitsempha kumayamba chifukwa cha kuperewera msana kwa minyewa yamtima, Zizindikiro zakuwonongeka kwakanthawi kwamanjenje (hemiplegia, aphasia), yomwe ingakhale yolakwika chifukwa cha stroko.

Aakulu hypoglycemia odwala ndi insulinoma, kugwira ntchito kwa chapakati ndi zotumphukira mantha dongosolo kusokonezeka, zomwe zimakhudza gawo la gawo bwino. Munthawi yopatsirana, kuchepa kwa minyewa yam'mimba, kuchepa kwa mawonekedwe, myalgia, kuchepa kwa kukumbukira ndi luso la malingaliro, komanso kusayanjika kumachitika. Ngakhale atachotsa insulinomas, kuchepa kwa luntha ndi encephalopathy nthawi zambiri kumapitilira, zomwe zimapangitsa kuti luso la akatswiri komanso moyo wam'mbuyomu lithere. Mwa amuna, ndipo nthawi zambiri amakumana ndi vuto la hypoglycemia, kusowa mphamvu kumayamba.

Kufufuza kwamitsempha kwa odwala omwe ali ndi insulinoma kumawonetsa asymmetry ya m'mbuyo ndi mawonekedwe a tendon, kusakhazikika kapena kuchepa kwa m'mimba, kuzungulira kwa Rossolimo, Babinsky, Marinescu-Radovic, nystagmus, paresis wa kuyang'ana kokulirapo, etc. Chifukwa cha polymorphism ndikuwoneka kowoneka bwino kwa odwala. matenda olakwika a khunyu, chotupa mu ubongo, vegetovascular dystonia, sitiroko, diencephalic syndrome, pachimake psychosis, neurasthenia, zotsalira sizothandiza matenda opatsirana, etc.

Kuzindikira kwa insulinoma

Mu 65-80% ya odwala atachotsedwa opaleshoni ya insulinoma, kuchira kwamankhwala kumachitika. Kuzindikira koyambirira ndi chithandizo chamankhwala cha insulinomas cha panthawi yake kumayambitsa kusintha kwamkati mwa dongosolo la zamanjenje molingana ndi deta ya EEG.

Imfa ya postoperative ndi 5-10%. Kubwezeretsanso kwa insulinoma kumayamba mu 3% ya milandu. Zomwe zimachitika kuti insulinomas yoyipa ndiyabwino - kupulumuka kwa zaka ziwiri sikupitirira 60%. Odwala omwe ali ndi mbiri ya insulinoma amalembetsa ku endocrinologist ndi neurologist.

Zizindikiro ndi matendawa

Kupezeka kwa insulinoma kumapangitsa kuti pakhale insulin yambiri. Madokotala amazindikira chotupa champhamvu chokhala ndi chodetsa nkhawa, chomwe chimakhala ndi mphamvu yodziyimira payokha. Nthawi zambiri, chotupa cha pancreatic chimayimiridwa ndi zazing'ono zazilumba zazilumba. Kukopa kwake kumapangitsa kuti chiwonetsero cha insulin chiwonjezeke, ndipo izi zimawopseza wodwalayo chifukwa cha mawonekedwe a dziko la hypoglycemic.

Zizindikiro za neoplasm zimawonekera kuchokera kukopa kwa zinthu zingapo.

1. Kuchuluka kwa insulin komwe kumatulutsa.
2. Miyeso ya maphunziro.
3. Zambiri.
4. Zolemba za thupi.

Zizindikiro zoyambira zomwe zimapezeka mu pancreatic insulinoma ndi:

• Nthawi zambiri chimachitika kuchitika kwa hypoglycemia - maola atatu mutadya,
• kuchuluka kwa shuga muamu seramu ndi 50 mg,
• Kuchotsa kwa matenda matendawa potenga shuga.

Ngati vuto la hypoglycemia limachitika pafupipafupi, izi zimabweretsa kusintha pakuyenda kwamanjenje. Chifukwa chake, pakati pa kuukiridwa, munthu amakhala ndi zisonyezo:

• maonekedwe a neuropsychic,
• mphwayi
• myalgia
• kuchepa kwa kukumbukira, luso la malingaliro.

Ambiri mwa kupatuka kumatsalira pambuyo pakuchotsedwa kwa opaleshoni ya pancreatic gland insulinoma, yomwe imayambitsa chitukuko cha kutayika kwa ukadaulo ndikuchita bwino m'magulu.

Mwa amuna, matendawa amakula pafupipafupi, izi zimatsogolera ku kusabala.

Pancreatic insulinoma ikayamba, Zizindikiro zimagawika mikhalidwe:

• chifukwa cha pachimake
• Zizindikiro zopyola kung'anima.

Hypoglycemia yokhala ndi insulinoma, yomwe imayamba pachimake, imawoneka chifukwa cha zizindikilo zotsutsana ndi kusintha kwamachitidwe amkati amanjenje. Nthawi zambiri kuukira kumachitika m'mimba yopanda kanthu, kapena pakudya nthawi yayitali pakudya.

1. Mutu woopsa umayamba mwadzidzidzi.
2. Kuphatikiza pa nthawi yoyenda kumasweka.
3. Acuity owoneka amachepa.
4. Kuwona.
5. Kuda nkhawa
6. Mantha ndi zipolowe zimasinthanso.
7. Miyendo Yanjenjemera.
8. Kuthamanga mtima.

Kukhalapo kwa zizindikiro kwa odwala omwe ali ndi pancreatic insulinoma popanda kukokomeza ndizovuta kuzindikira. Zizindikiro zimachepa kapena palibe.

1. Kukulitsa kudya, kukana chakudya kwathunthu.
2. Kufa ziwalo.
3. Ululu, kusapeza bwino mukamasuntha.
4. Kusintha kwa kukumbukira.
5. Kuwonongeka kwamankhwala kumaso.
6. Kuchepa kwa ntchito zamaganizidwe.

Kuzindikira matendawa

Pancreatic insulini ndizovuta kudziwa. Pa mawonekedwe oyamba a wodwalayo, amayikidwa kuti alandire chithandizo. Kwa nthawi yoyamba, masiku 1-2, wodwalayo ayenera kufa ndi njala moyang'aniridwa ndi madokotala.

Kuzindikira matendawa, njira zotsatirazi zimagwiritsidwa ntchito:

• kuyezetsa magazi - kudziwa chizindikiro cha insulin ndi shuga m'magazi,
• CT, MRI, ultrasound - chifukwa cha data, kukhazikitsidwa komwe maphunziro kumatsimikiziridwa,
• laparoscopy, laparotomy.

Kuchiza matenda

Pambuyo pazomwe zimadziwika, zizindikirazo zimatengedwa, chithandizo pambuyo podziwikiratu chidzakhala opareshoni. Kukula kwa njira yomwe ikubwerayi kudzatsimikiziridwa ndi kutanthauzira kwake ndi kukula kwa mapangidwe a kutulutsa timuyo. Tumor Excision imatha kuchitidwa m'njira zosiyanasiyana.

Conservative Therapy ikuchitika, monga:

• kugwiritsa ntchito mankhwala omwe amachulukitsa glycemia,
• kukhazikitsidwa kwa shuga m'mitsempha,
• njira chemotherapy.

Gawo lalikulu la chithandizo chamankhwala ndi zakudya, zomwe zimatenga shuga wambiri, kuchuluka kwa chakudya chambiri pang'onopang'ono.

Matenda obwera ndi matenda

Pambuyo pakuchita opaleshoni, pali kuchepa kwa shuga, shuga m'magazi amakwera.

Ngati chotupa cha pancreatic chapezeka ndikuchotseka pa nthawi, ndiye kuti 96% ya odwala amachira.

Zotsatira zake zimawonedwa pochiza matenda ang'onoang'ono a koopsa. Ndi matenda oopsa, kugwiritsa ntchito bwino kwake kwa mankhwalawa kumangokhala mu 65% ya milandu. Kupezeka kwa kubwereranso kulembedwa mu 10% ya odwala.

Ngati matenda a shuga a mellitus 2 sangakwanitse kulimbikitsa thupi, izi zimabweretsa zovuta zina. Zomwe zili zowopsa pamenepa ndi matenda - hypoglycemia, nephropathy, trophic zilonda zam'mimba, ketoacidosis. Mavuto amayambitsa kufa kwa anthu 2 miliyoni pachaka.

Pamaso pa dongosolo la hypoglycemic, ziyenera kukumbukiridwa kuti zizindikiro ndi chithandizo cha odwala ndizosiyana, chifukwa chake musadziyese, koma dokotala.

Zoyambitsa Insulinoma

Zomwe zimayambitsa pancreatic insulinoma chitukuko sizikudziwika mpaka pano.

Zikondwerero zokhala ndi thanzi labwino zimapanga mahomoni omwe amayambitsa shuga m'magazi, kupanga asidi am'mimba ndi ena. Kafukufuku wasonyeza kuti inshuwaransi ya insulin itachepa, kuchuluka kwa shuga kumatsika. Izi zimabweretsa ma neoplasms osiyanasiyana mu kapamba.

Popeza ubongo ulibe golide, komwe ndi chakudya, thupi limakakamizidwa kulipirira chofooka ndi zinthu zina.

Kutsika kwamphamvu kwa shuga kungayambitse zinthu izi:

• kuchepa kwa ntchito ya insulin chifukwa cha kuchepa kwa kukula kwa mahomoni:
• matenda a adrenal gland
• Matenda a Addison
• kuchuluka kwa shuga mumahomoni ena,
• kutsirizika kwathupi lathupi,
• Zakudya, kusala,
• matenda am'mimba
• kuyambitsa poizoni ndi chiwindi matenda ena aimpso.
• kukomoka
• mitsempha, matenda amisala,
• opaleshoni yam'mimba,
• kusowa kwazinthu zodziyimira pawokha.

Kupezeka kwa insulinomas kumangotengera kuchuluka kwa insulini kokha, komanso kuntchito yowonjezera ya mahomoni a pancreatic.

Insulinoma ili ndi zizindikiro zomwe zimanenedwa ngati:

• mkhalidwe
• thupi limatopa, lofooka popanda chifukwa chodziwikiratu
• kugunda kwamtima, kugwedezeka kwamphamvu,
• ntchito yogwira thukuta,
• kuzindikira kowopsa
• kumangokhalira kumva njala.

Wodwala akangomaliza kudya, zizindikilo zonse zimachoka. Mlingo wapamwamba kwambiri wamatenda amayamba kuyambira pomwe mtundu wa hypoglycemia sukumveka ndi munthuyo. Kuyiwala kuwongolera mkhalidwe wanu. Sangadye panthawi yake ndikulipiritsa.

Mafuta a m'magazi akatsika pang'ono, mkhalidwe wa wodwalayo umakulirakulira. Amatha kuwona bwino zithunzi za hallucinogenic. Kuphatikiza apo, malovu, thukuta ndi kawiri m'maso. Wodwalayo amatha kuchita moyenera ndi ena pazakudya. Ngati shuga sawonjezereka, ndiye kuti minyewa yake imayamba kugwidwa ndipo khunyu lidzayamba. Pamodzi ndi izi, kuthamanga kwa magazi kumakwera ndipo kuthamanga kwa mtima kumawonjezeka.

Chifukwa chosowa thandizo la wodwala panthawi yake, chikomokere chimatha. Zimaphatikizidwa ndi pafupifupi zonse mwazizindikiro. Chifukwa cha kukomoka kwa hypoglycemic, kumayambitsa khungu kumapangidwa.

Kuchotsa chotupacho sikutsimikizira kuyambiranso kwamphamvu zonse zathupi ndi malingaliro.

Odwala omwe ali ndi shuga wosasinthika wamagazi nthawi zina amapezeka insulin edema.

Nthawi zambiri mapazi, mafupa a ankolo amavutika, nthawi zambiri samayandikira oblium. Komabe, ngakhale mawonekedwe amphamvu samakhudza kugwira ntchito kwa ziwalo zina zamkati. Insulin edema safuna chithandizo. Nthawi zina, okodzetsa amalembedwa kuti athetse madzi owonjezera.

Chifukwa chakuti zambiri mwazizindikiro sizinafotokozedwe, odwala angapezeke molakwika.

Mitundu ndi magawo a chitukuko

Mu ICD-10, insuloma ya pancreatic imagawidwa kukhala: orthoendocrine ndi paraendocrine zotupa. Poyambirira, mahomoni omwe amapanga mapangidwe a thupi (insulinoma ndi glucagonoma) amabisika. Paraendocrine neoplasms imaphatikizapo zotupa zomwe zimapanga mahomoni achilendo kwa islet ntchito.

Komanso chotupa cha pancreatic chikhoza kukhala:

• chidziwitso
• insulinoma woipa,
• malire.

Mokulira, insulinoma imayambitsa kupanga insulin yowonjezera, yomwe imadziwika ndi hyperinsulinism, makamaka usiku pamimba yopanda kanthu. Izi zikuchitika chifukwa cha njala yayitali. Matenda ena amathanso kuyambitsa hyperinsulinism: adenomatosis, hyperplasia.

Komanso, insulomas zimatengera magawo omwe mahomoni amayambira kupita mthupi. Chotupa chimodzi chimatha kukhala ndi mawonekedwe osiyanasiyana m'magawo ake osiyanasiyana:

• mtundu wodziwika bwino wa insulinoma ndi glucagon ndi trabecular. Amasiyanitsidwa ndi kapangidwe ka trabeculae ndi zombo,
• mtundu wa alveolar umachitika ndi gastrinomas. Mtunduwu umapangidwa kuchokera ku minyewa inayake ya zotupa m'magazi ndi m'mitsempha yamagazi.

Kutengera mawonekedwe a stroma, pancreatic insuloma imachitika:

• mtundu wa parenchymal,
• Mitundu yamafinya,
• malingaliro osakanikirana.

Mwa chiyambi, potengera mahomoni omwe amagwira ntchito, insuloma imagawidwa:

• glucagonomas. Amapangidwa kuchokera ku mbali ya maselo a endocrine dongosolo la kapamba. Ma cell apulogalamu alpha amawonjezera maphunziro awo,
• insulinomas otchedwa beta-cell kochokera. Dzina lawo limadzilankhulira lokha. Chotupacho chimapangidwa kuchokera ku maselo a beta. Zimayambitsa kupanga insulini m'magazi, zomwe zimalepheretsa shuga. Kukula kwamtundu wamtunduwu kumawonedwa nthawi zambiri. Chotupa ndichabwino,
• somatostatinomas amapangidwa kuchokera ku maselo a islet Pachikawa. Amatchedwa delta cell neoplasms. Chotupa chamtunduwu chimapangitsa somatostatin. Amalepheretsa mahomoni angapo, kuphatikizapo insulin ndi glucagon,
• PP- (F) -cellular neoplasms. Amapangidwa kuchokera ku maselo a pancreatic islets ndikuyambitsa pancreatic polypeptide.

Kupewa

Kupewa kwa HS kumakhala ndi zakudya zomwe zimasankhidwa payekhapayekha. Kudyetsa pang'ono zakudya zamatumbo kumatha kupangitsa kuti ntchito ya matenda iziyenda bwino.

Pofuna kusiyitsa kuthekera kuti mubwererenso, wodwalayo ayenera kuonedwa pachaka ndi dokotala wa opaleshoni, endocrinologist ndipo, ngati pakufunika, ndi oncologist, tsatirani malangizowo. Wodwalayo amakhala ndi miyeso ya mahomoni, kuyezetsa magazi kwa chiwindi, mwina MRI ya m'mimba.

Popeza insulinoma ndi chotupa chokwanira mu 80%, kuchira kwathunthu kumachitika pambuyo pa opaleshoni.

Pakusintha kwakhalidwe koyenera kuchokera ku dongosolo lalikulu lamanjenje, kuzindikira koyambirira kwa matendawa ndikofunikira. Popeza ntchito zaubongo ndi matenda zimataya mphamvu.

Ndikosatheka kupatula zotsatira zoyipa ndikuyambiranso.Izi zikugwiranso ntchito neoplasms yoyipa. Kupulumuka kumafikira odwala 60%.

Limagwirira chitukuko ndi zizindikiro za insulinoma

Zomwe zimawoneka ngati insulin sizikudziwikabe. Sizikudziwika bwinobwino zomwe zimayambitsa kupangika kwa chotupachi. Mtundu umodzi ndi masinthidwe amtundu wa pancreatic cell.

Mwa munthu wathanzi, kuchuluka kwa insulin kumachepa poyankha ndi njala. Ndi insulinoma, kupanga kwambiri kwa insulin ndi chotupa kumatchedwa - hyperinsulinism - njira yomwe sikudalira kudya kwambiri. Zimayambitsa kutsika kwa shuga wamagazi. Chiwerengerochi chikatsika pansi 3 mmol / L, amalankhula za hypoglycemia.

Hypoglycemia ndi mkhalidwe wamavuto omwe amayamba chifukwa cha kuchepa kwa shuga m'magazi. Poterepa, ma cell aubongo samakhala ndi gwero lamphamvu, glucose, zomwe zimabweretsa zovuta zina zamagetsi. Hypoglycemia imachititsanso machitidwe onse ndi ziwalo, kuwakakamiza kuti apange mahomoni omwe amalimbikitsa shuga.

Zizindikiro zokhudzana ndi kuchuluka kwa adrenaline:

• nkhawa
• thukuta kwambiri
• kunjenjemera m'thupi
• kumva kwamphamvu njala
• thukuta lozizira
• zokonda mtima
• kufooka koopsa.

Zizindikiro zokhudzana ndi kufera kwa ubongo:

• kusokonekera kwa mawu
• chisokonezo,
• mutu
• masomphenya apawiri
• Kuchepetsa kukumbukira ndi luntha,
• kukokana
• kuyerekezera
• kwamikodzo komanso kuwonongeka kwa fecal
• chikomokere.

Nthawi zambiri, kuukira kumawonekera m'mawa kwambiri, kapena kumayambitsa nkhawa, kulimbitsa thupi, kudya chakudya chamafuta kwambiri. Wodwalayo amadzuka mwadzidzidzi, ngati kuti “mwa iye”. Itha kukhala yotseketsa kwambiri, osamvetsetsa komwe ili ndi zomwe zikuchitika. Kapenanso, mosangalatsa, mokondwa kwambiri, mwamphamvu, mwamwano.

Matenda ofanana ndi khunyu ndi otheka. Milandu yayikulu, kusazindikira kumachitika, mpaka kukomoka kwa hypoglycemic ndi kufa kwa munthu. Myocardial infarction ndi sitiroko ndizotheka.

Kukhumudwitsidwa mobwerezabwereza, makamaka kukokana kapena chikomokere, kumabweretsa zotsatira zosasinthika mbali yamanjenje - kuchepa kwa luntha ndi kukumbukira, manja akunjenjemera, kusokonekera pagulu.

Nthawi zambiri munthu amene ali ndi insulinoma amayamba kulemera. Izi ndichifukwa choti wodwala wotere amadziwa kale zam'mawa zake ndipo amamva momwe akumayendera masana. Amayesa kulanda gawo loterolo ndi china chake chokoma, nthawi zina kudya michere yambiri.

Kuyesa kwa masiku atatu

Ngati mumakayikira insulini, munthu amayamba amayesa kudya kwa masiku atatu. Iyenera kuchitika kuchipatala, chifukwa pamakhala chiopsezo chambiri chakutha kwa chikumbumtima.

Njala imayamba chakudya chatha. Mukamayesedwa, simungadye chilichonse, muzimwa madzi okha. Pambuyo maola 6, kenako maola atatu aliwonse, magazi amakokedwa ndi glucose. Kumayambiriro kwa kuyesedwa, ndipo kuchuluka kwa glucose kutsikira kufika ku 2.8 mmol / L, kuchuluka kwa insulin ndi C-peptide kumatsimikizidwanso (C-peptide ndiye molekyu yomwe insulin imamangidwa panthawi yosungirako kapamba).

Nthawi zambiri, maola 12-18 atayamba kusala kudya, kuukira kwa hypoglycemia kumayamba. Ngati kuchuluka kwa glucose m'magazi kutsika ndi 2,5 mmol / L ndipo zizindikiro zikuwoneka, mayesowo amatengedwa kuti ndi abwino ndikuima. Ngati chiwopsezo sichikupezeka mkati mwa maola makumi awiri ndi limodzi ndipo shuga alibe kugwa pansi 2.8 mmol / l, muyeso umawoneka kuti ndi wopanda pake.

Panthawi yoyesa, mawonekedwe a Whipple Triad akuyembekezeredwa, kuphatikiza:

• kusala kudya kwa hypoglycemia ndi zizindikiro za neuropsychic,
• kutsika kwa glucose pakuwukira pansipa 2.5 mmol / l,
• kuukira kumachitika pambuyo mtsempha wa magazi a shuga.

Kuyesedwa kwa magazi kwa insulin panthawi ya hypoglycemia

Ngati kuchuluka kwa insulini kutsimikizika mu gawo la hypoglycemia motsutsana ndi mseru wochepetsetsa wamagazi m'magazi, ichi ndi chitsimikiziro chinanso cha insulinoma. Nthawi zambiri, mulingo wa C-peptide umatsimikizika pamodzi ndi insulin. Popeza amapangidwa kuchokera molekyu imodzi, kuchuluka kwa insulini kuyenera kufanana ndi kuchuluka kwa C-peptide.

Pali nthawi zina pomwe odwala, pazifukwa zina, amanamizira kuti ali ndi insulin, adadzibaya okha ndi insulin kuchokera kunja monga mawonekedwe a jakisoni. Muzochitika zotere, mulingo wabwinobwino wa C-peptide wapezeka, womwe umathandizira kumvetsetsa kwake.

Mlozera wa NOMA amawerengeredwanso - uku ndi chiwerengerero cha insulini kumagulu a shuga. Kuwonjezeka kwa index ya NOMA kumawonetsa hyperinsulinism ndipo imagwiritsidwa ntchito ngati chizindikiritso chowonjezera.

Njira Zofufuzira

Zikaonekeratu kuti munthu akudwala insulinoma, ndikofunikira kuzindikira chotupacho ndikuchichotsa, chifukwa ndizopulumutsa moyo, ndipo pang'onopang'ono pazochitika zake zimakhala zovulaza. Njira zowonera zimathandizira kuchita izi:

1. Kuunika kwa Ultrasound ndi njira yosavuta kwambiri komanso yotsika mtengo, komabe, sikuti imakhala yothandiza nthawi zonse. Chifukwa cha kukula kwa insuloma komanso malo a kapamba, chotupacho chimavuta kudziwa.

Odalirika kwambiri a ultrasound kudzera pa khoma la chimbudzi, kapena kuchitidwa opareshoni.

Pancreatic chotupa

1. CT ndi MRI - kulingalira koyerekeza ndi maginito. Njira zabwino kwambiri. Insulinoma imadziwika kwambiri ngati ikupezeka pamalo wamba. Komanso, njirazi zimagwiritsidwa ntchito posaka insulin.
2. Hagiography. Nthawi zina, ndimatha kutenga magazi kuchokera m'mitsempha kuchokera ku kapamba. Izi zimachitika pophunzira mitsempha yamagazi ndi wothandizira kusiyanitsa - angiography. Chifukwa chake onetsetsani kuti chotupacho chili mu kapamba, osati ziwalo zina.
3. Pancreatic scintigraphy ndi njira yofufuzira pamene ma radioot isotopes amaperekedwa kwa munthu. Isotopes imasankhidwa ndi chotupacho, ndipo imawonekera pazenera.
4. PET - positron emission tomography - komanso njira imodzi yodziwitsira za radionuclide, yapamwamba kwambiri masiku ano.

Angapo Endocrine Neoplasia Syndrome

Ngati insulinomas yapezeka, wodwalayo amafunika kumuwunika, chifukwa mu 10% ya nthendayi ndi mbali ya mtundu wa I endocrine neoplasia syndrome (MEN). Type I MEN syndrome ndi kuphatikiza zingapo za endocrine syndromes ndi zotupa - zotupa za parathyroid, zotupa za pituitary, zotupa za pancreatic, zotupa za adrenal gland, mwina zotupa za ziwalo zina.

Zizindikiro za matendawa

Madokotala amachitcha chotupa chovulaza kapena chowononga chokhala ndi zochita zaokha zamafuta. Nthawi zambiri imakhala ndi mawonekedwe azinthu zazing'ono (Island). Zotsatira zake zimabweretsa kuwonjezeka kwakukulu pakupanga kwa insulin yambiri, ndipo izi zimawopseza wodwalayo poyambanso kwa zizindikiro za hypoglycemic syndrome.

Zizindikiro za insulinomas nthawi zambiri zimapezeka mwa anthu azaka 40 mpaka 60. Mu ana, matendawa samachitika. Chotupacho chimapezeka mu kapamba, ndipo ma neoplasm amatha kuwoneka mu gawo lililonse la chiwalo. Nthawi zina insulinoma imayamba kukhoma kwa m'mimba, omentum kapena duodenum. Nthawi zina, neoplasm imawonekera pazitseko za ndulu kapena imagwira chiwindi. Nthawi zambiri, kukula kwa chotupa sikupitirira 15-20 mm. Nthawi zambiri, anthu amakhala ndi chosaopsa (80% ya milandu). Kuchokera pamitundu yoyipa ya neoplasms, kuyambira 5 mpaka 10% sagwiritsidwa ntchito, zomwe zimayambitsa imfa kwa wodwalayo. Madokotala amatha kutalikitsa moyo wake kwa zaka 1 mpaka 1.5 mothandizidwa ndi mankhwala, koma wodwalayo amamwalirabe.

Kupezeka kwa dokotala panthawi yoyenera matendawa, wodwalayo amatha kukonza bwino thanzi lake.

Zinthu zomwe zimatsogolera matendawa

Zomwe zimayambitsa kukula kwa matendawa zimachitika chifukwa cha mawonekedwe a hypoglycemia chifukwa cha kusakhazikika kwa kuphatikiza kwa insulini b ndi maselo.

Ngati munthu ali wathanzi, ndiye kuti dontho lililonse la glucose m'magazi limayambitsa kuchepa kwa kapangidwe ka insulin komanso kuletsa kwake kupezeka kwa magazi. Neoplasm ikachitika pamaziko a ma cellular ma cell, kayendetsedwe kazinthu zimasokonekera, komwe kumayambitsa kukula kwa hypoglycemic syndrome.

Zomwe zimakhudzidwa kwambiri ndi njirayi ndi maselo aubongo, chifukwa amalandila mphamvu pakutha kwa glucose. Chifukwa chake, mawonekedwe a chotupa amatha kukhala cholimbikitsira kupezeka kwa glycopenia mu mitsempha ya muubongo. Ngati vutoli limatha kwa nthawi yayitali, ndiye kuti kusintha kwa dystrophic kumayamba m'magawo osiyanasiyana am'magazi amkati mwa munthu.

Zomwe zimapangitsa kuti wodwala azikhala woipa nthawi imeneyi ndizotulutsidwa m'magazi a mahomoni monga cortisone, norepinephrine ndi zinthu zina. Zomwe zili pamwambapa zimayambitsa kupangirana kwa matendawa. Amawonetsedwa bwino mwa odwala omwe ali ndi chotupa choyipa.

Pakakhala vuto, munthu akhoza kuyamba kulowetsedwa. Izi zimachitika chifukwa cha kusokonezeka kwa magazi kozungulira m'misempha ya mtima. Nthawi zina munthu amayamba zotupa zamanjenje (mwachitsanzo, aphasia, hemiplegia), zomwe madokotala amayambira kupeza ngati ali ndi stroke.

Zizindikiro za chotupa

Zizindikiro zazikulu za matendawa ndi izi:

1. Maonekedwe osinthika magawo abwinobwino amunthu komanso matenda, amatanthauzira glycemia kapena kuchuluka kwa adrenaline m'magazi.
2. Kuthamanga kwamphamvu kwa wodwala ndikukulitsa kudya.

Mtundu wowopsa wa vuto la hypoglycemic umayamba chifukwa cha mawonekedwe ambiri a insulin, omwe samachotsedwa m'thupi. Poterepa, chotupa chimafalikira ku ma cell aubongo. Zizindikiro za izi ndi motere:

1. Kuukira kumadziwonekera m'mawa, pamene munthu alibe nthawi yakudya.
2. Kugundika kumatha kuchitika popewa kudya nthawi yayitali, pomwe kuchuluka kwa glucose m'magazi a wodwalayo kumatsika kwambiri.

Ngati matendawa amakhudza ma neurons a ubongo, ndiye kuti zizindikiro zake ndi izi:

1. Wodwala ali ndi matenda osiyanasiyana amisala kapena mitsempha.
2. Munthu amadandaula kuti wapweteka mutu.
3. Wodwalayo amatha kusokonezeka.
4. Zizindikiro za ataxia kapena kufooka kwa minofu ndizotheka.

Nthawi zina ndi insulinoma, nthenda ya hypoglycemic imayamba kutsutsana ndi zomwe zili zotsatirazi:

1. Mkhalidwe wosangalatsa wa psychomotor ntchito.
2. Angapo kuyerekezera zinthu zosiyanasiyana.
3. Kuyankhula zopanda pake, kufuula.
4. Ukali kapena kukondwerera.
5. Thukuta thukuta lozizira, ndikunjenjemera ndi mantha.
6. Nthawi zina khunyu imakhazikika, wodwalayo amatha kukumbukira, amagwa.
7. Pambuyo pochotsa chiwopsezo ndi kulowetsedwa kwa shuga, wodwalayo sakumbukira chilichonse.

Ngati matendawa ndi osachiritsika mwachilengedwe, ndiye kuti magwiridwe antchito a maselo aubongo amasokonezeka mwa munthu, ndipo gawo lakumapeto kwa mitsempha imakhudzidwa. Potere, magawo a boma wamba amafupikitsidwa.

Pakadutsa masiku angapo, madokotala amaika magazi m'thupi mwa wodwala, amayamba kuona, amatha kuiwalako, komanso amakhala ndi chidwi. Pambuyo pakuchita opaleshoni, wodwalayo amatha kuchepa kwa luntha, amatha kukhala ndi chidwi cha m'mimba, ndipo izi zimapangitsa kutaya luso la akatswiri ndikuwonjezera mbiri ya munthu. Ngati bambo akudwala, ndiye kuti atha kukhala ndi zofooka.

Njira zodziwira matendawa

Kuyesa kwa wodwala, kukhazikitsa zomwe zimayambitsa matendawa, kusiyanitsa matendawa kumatenda ena kumachitika ndi mayeso a labotale. Kugwiritsa ntchito njira zowunikira, kutenga zitsanzo zogwira ntchito.

Kuyesedwa kosala kumagwiritsidwa ntchito nthawi zambiri, komwe kumayambitsa kuwukira kwa hypoglycemia wodwala. Izi zimapangitsa kuchepa kwakukulu kwa kuchuluka kwa shuga m'magazi, mawonekedwe osiyanasiyana a neuropsychic amakula. Madokotala amasokoneza izi mwa kuthira shuga m'magazi a wodwalayo kapena kumukakamiza kuti adye zakudya zotsekemera (chidutswa cha shuga, maswiti, ndi zina).

Exo native insulin imaperekedwa kwa wodwala kuti ayambe kuwukira. M'mawu am'magazi odwala wodwalayo ali pamunsi kwambiri, koma zomwe zili mu C-peptides zimawonjezeka. Nthawi yomweyo, kuchuluka kwa insulin ya insulin kumakwera kwambiri, momwe umapitilira gawo limodzi m'magazi a munthu wathanzi. Zikatero, chiŵerengero cha insulin ndi shuga mwa wodwala chimatha kupitirira 0,4, zomwe zikusonyeza kukhalapo kwa matenda.

Ngati mayesowa olimbikitsa atapereka zotsatira zabwino, ndiye kuti amatumizidwa molakwika kuti atulutsidwe m'mimba ndi kapamba. MRI ya ziwalozi imachitidwa. Nthawi zina mumayenera kusankha njira yoyenera kuti mutenge magazi kuchokera kumitsempha ya portal. Kuti mumvetse bwino za matendawa, kupezeka kwa laparoscopic kwa kapamba kumatheka. M'malo ena azachipatala, ma intraoperative ultrasonography amachitidwa, omwe amakupatsani mwayi kuti muwone bwino komwe neoplasm ili.

Madokotala azitha kusiyanitsa matenda omwe afotokozedwayi kuchokera ku chidakwa kapena mankhwala osokoneza bongo a hypoglycemia, kusakwanira kwa khansa kapena khansa yamakonzedwe a adrenal ndi zina zina zofanana. Kuzindikira kuyenera kuchitika ndi akatswiri odziwa ntchito.

Therapy ndi Zoneneratu

Pambuyo pozindikira moyenera, opareshoni imalembedwa, popeza pakadali pano chitukuko cha mankhwala, kulandira chithandizo ndi njira zina ndikosayenera. Kukula kwa ntchito yomwe ikubwera kumadalira komwe kuli neoplasm komanso kukula kwake. Chotupacho chimatha kuchotsedwa pogwiritsa ntchito njira zosiyanasiyana.

Mphamvu ya neoplasm imagwiritsidwa ntchito nthawi zambiri, kapena madokotala amagwiritsa ntchito njira zosiyanasiyana kuphatikizanso magawo a kapamba. Ngati afunika, chiwalo chonse chimachotsedwa. Nthawi ya opaleshoni, mphamvu ya zochita za madokotala a opaleshoni imayang'aniridwa pogwiritsa ntchito zida zoyezera kukula kwa magazi m'magazi a wodwala.

Ngati chotupa chiri chachikulu, ndipo sichingatheke kugwira ntchito ndi munthu, ndiye kuti wodwalayo amasamutsidwa kuti athe kukhalabe wokhutira mothandizidwa ndi mankhwala osiyanasiyana. Kugwiritsa ntchito mankhwala okhala ndi adrenaline, glucocorticoids, glucagon ndi mankhwala ena omwe ali ndi vuto lofananalo ndi mankhwala.

Ngati vuto la vuto la neoplasm likhazikitsidwa panthawi ya kupezeka kwa mankhwalawa, ndiye kuti mankhwala a chemotherapy angagwiritsidwe ntchito. Pakukhazikitsa kwake, 5-fluorouracil, streptozotocin ndi mankhwala ena amagwiritsidwa ntchito.

Pambuyo pa opareshoni, zovuta zingapo zimatha kuchitika. Nthawi zambiri, wodwalayo amakhala ndi kapamba, maonekedwe a fistulas pazinthu zomwe zimayendetsedwa ndizotheka. Pambuyo pakuchita opaleshoni, anthu ena amakhala ndi chifuwa pamimba kapena peritonitis imayamba. Necrosis yotheka ya kapamba palokha.

Wodwala akafika kuchipatala panthawi yake, ndiye kuti mankhwalawo ndi othandizika, ndipo munthuyo amachira pambuyo pochita opareshoni. Malinga ndi ziwerengero, kuchokera 65 mpaka 79% ya odwala amachira. Ndi matenda oyamba ndi opaleshoni yotsatira, ndikotheka kuyimitsa kusinthika kwa maselo aubongo, kubwezeretsa munthu ku moyo wabwinobwino.

Zotsatira zoyipa nthawi yopanga opaleshoni ndi pafupifupi 10%, popeza njira zolimbana ndi zotupa zoyipa sizinapezekebe. Anthu omwe ali ndi vuto lotere la opaleshoni atachitidwa opareshoni amakhala osaposa zaka 4-5, ndipo kupulumuka kwa zaka ziwiri atatha maphunziro a sayansi sikupitirira 58%.

Kubwezeretsanso kwamatenda kumadziwonekeranso mu 4% yonse ya chithandizo cha matenda. Ngati munthu ali ndi mbiri yodwala, ndiye kuti amalembetsa ndi katswiri wamitsempha ndi endocrinologist.