Lamulo Kusamalira Malamulo Oyambirira, Malangizo

- Uwu ndi mtundu wa chotupa chamafuta chomwe chimakhudza ma isanc pancreatic (islets of Langerhans). Zimakhudza maselo a beta, chifukwa chomwe kupangidwa kosalamulirika ndi kulowa kwa insulin m'magazi kumachitika. Neoplasms yotere imatha kukhala yopanda pake (mu 70% ya milandu) kapena kukhala adenocarcinomas. Omaliza amakhala ndi mainchesi 6c kapena kupitirira.

Pali mitundu ina yamatumbo a ma pancreatic (ma insulomas) omwe amapanga ma cell a alpha, delta, ndi PP. Pankhaniyi, mitundu ina imapangidwa: pancreatic polypeptide, gastrin, serotonin, somatostatin kapena adrenocorticotropic timadzi. Insulinoma imakonda kuchitika kwa odwala azaka zapakati pa 35 ndi 60, mu - kwambiri. Amuna amadwala kawiri kawiri kuposa azimayi.

Insulinoma si matenda obadwa nawo, ndi osowa kwambiri. Ziphunzitso zake sizikudziwika bwinobwino. Zimatsimikiziridwa kuti nthawi zambiri zotupa za kapamba zimakwiya ndi shuga wochepa wamagazi, zomwe zimayambitsidwa ndi kuphwanya kwa insulin. Hypoglycemia imatha kupezeka zotsatirazi:

• kusowa kwa mahomoni okula, omwe amayamba chifukwa cha kuchepa kwa magwiridwe antchito a kutsogoloku kwa pituitary gland (izi zimayambitsa kuchepa kwa insulini),
• kusakwanira kwa adrenal cortex (pachimake kapena chovuta), komwe kumapangitsa kutsika kwa glucocorticoids komanso kuchepa kwa shuga m'magazi,
• kutopa kochititsidwa ndi matenda omwe atenga nthawi yayitali kapena kufa ndi njala,
• myxedema, chifukwa cha zochepa za zinthu za chithokomiro zomwe zimakweza shuga.
• ngati chakudya chamafuta sichingatenge thupi,
• matenda a chiwindi oyambitsidwa ndi kuwonongeka kwa poizoni,
• kutopa kwamanjenje (chifukwa cha kusowa kwa chakudya),
• zotupa pamimba,
• enterocolitis.

Pancreatic insuloma nthawi zambiri imakhudza mchira kapena thupi la chiwalo. Sipezeka kawirikawiri kunja kwa gland, kutengera minofu ya ectopic (yowonjezera) ya lunguzi. Mukuwoneka, ndimapangidwe opindika, m'mimba mwake mumasiyana masentimita 0.5 mpaka 8. Mtundu wa chotupacho ndi choyera, imvi kapena bulauni.

Nthawi zambiri, ma insulinomas amodzi amadziwika, pokhapokha ngati alipo ambiri. Chotupa chimadziwika ndi chitukuko pang'onopang'ono, metastases ndizosowa komanso mwa mitundu yoyipa yokha.

Kukula ndi zizindikiro za matendawa

Ndi pancreatic insulinoma, Zizindikirozi zimachitika chifukwa cha kugunda kwa hypoglycemia. Izi zimachitika chifukwa cha kuchuluka kwa insulin ndi chotupa, mosasamala kuchuluka kwa shuga m'magazi. Mwa anthu athanzi, ndi kutsika kwa kuchuluka kwa shuga (mwachitsanzo, ndi), kuchepa kwakukulu kwa kuchuluka kwa insulin kumawonedwa. Ndi insulinoma, makinawa sagwira ntchito, chifukwa amasokonezedwa ndi chotupa cha insulin. Izi zimapangitsa kuti pakhale vuto lodana ndi vuto la hypoglycemic.

Hypoglycemia ndi zovuta kuzinthu zomwe zimachitika chifukwa cha kusalinganika komwe kapangidwe ka shuga m'magazi. Amayamba pomwe shuga achepera mpaka 2,5 mmol / L.

Kwambiri, hypoglycemia imawonetsedwa ndi kukula kwa vuto la neuropsychiatric komanso kuchuluka kwa mahomoni: norepinephrine, cortisol, glucagon. Kuchulukitsa kwa norepinephrine kumapangitsa kuti munthu azisesa thukuta, miyendo ndi kunjenjemera ndi angina pectoris. Zovuta zimangobwera zokha ndipo pakapita nthawi zimakhala mitundu yambiri.

Odwala onse omwe ali ndi insulinoma, Whipple triad alipo, yemwe ali ndi zizindikiro zotsatirazi:

• chiwonetsero cha vuto la neuropsychiatric pa kusala,
• kutsika kwa shuga m'magazi pansi pa 2.7 mmol / l,
• kuthekera kochotsa matenda a hypoglycemic kudzera mwa mtsempha wa magazi kapena mkamwa.

Ubongo umakhudzidwa kwambiri ndi matendawa, chifukwa glucose ndiye gwero lake lalikulu la zakudya. Mu hypoglycemia, kusintha kwa mitsempha m'matumbo amkati kumachitika.

Zizindikiro za Insulinomas

Ndi chitukuko cha hypoglycemia, wodwalayo amamva kufooka modzidzimutsa, kutopa, tachycardia, thukuta, kugwedezeka, komanso kumva kuti ali ndi njala. Kudya kumakupatsani mwayi kuti muchepetse kuwonetsa kumeneku. Ngati wodwala sangathe kukwaniritsa njala yake panthawi kapena sanamve zizindikiro zoyambirira za hypoglycemia munthawi yake, kuchepa kwakukulu kwa ndende yamagazi kumachitika. Izi zimaphatikizidwa ndi kuwonjezeka kwa zizindikiro za chikhalidwe cha neuropsychic ndipo zimawonetsedwa ndi kusakwanira. Zizindikiro monga:

• mayendedwe osamveka bwino,
• nkhanza kwa ena,
• mawu osokoneza, mawu osatanthauza,
• kupulumuka
• maulendo osangalatsa osaneneka,
• chisokonezo,
• kuyerekezera
• mizimu yayikulu
• kuganiza kosamveka
• kusakwanira pakuwunika momwe munthu alili.

Wodwala ngati sanapatsidwe chithandizo chamankhwala panthawi yake, ndiye kuti kuchepa kwamphamvu kwa shuga kumayambitsa khunyu, kenako kukomoka kwa hypoglycemic. Muno, mukutayika kwathunthu, kuchepa kwa kugunda kwa mtima ndi kupuma, kuthamanga kwa magazi kumatsikira kumakhalidwe otsutsa. Zotsatira zake, edema yamatumbo imatha kukula.

Zomwe zimapangitsa insulinoma:

Posakhalitsa atatulukira kwa insulin ndi a Bunting ndi West mu 1921, zizindikiro za kuchuluka kwake kwa mankhwala zinadziwika mu kugwiritsa ntchito mankhwala azamalonda odwala omwe ali ndi matenda a shuga. Izi zidalola Harris kuti apange lingaliro la zokha lokhala ndi vuto lophatikizika chifukwa cha kuchuluka kwa mahomoni awa. Kuyesera kambiri kuti mupeze ndi kuthandizira ndi insulin kunachitika mu 1929, pomwe Graham anali woyamba kuchotsa bwino chotupa cha insulini. Kuyambira pamenepo, pakhala pali lipoti padziko lonse lapansi lonena za odwala pafupifupi 2000 omwe amagwira ntchito ndi beta-cell neoplasms.

Palibe kukayikira kuti zizindikiro za insulinoma zimagwirizanitsidwa ndi ntchito yake ya mahomoni. Hyperinsulinism ndiye njira yayikulu yogwiritsira ntchito pathogenetic momwe mawonekedwe athunthu amtundu amayambira. Kubisalira kosalekeza kwa insulin, osamvera maupangidwe a thupi omwe amayendetsa glucose homeostasis, kumabweretsa kukula kwa hypoglycemia, shuga wamagazi ndikofunikira kuti magwiridwe antchito onse a ziwalo ndi minyewa, makamaka ubongo, omwe cortex yake imagwiritsa ntchito kwambiri kuposa ziwalo zina zonse. Pafupifupi 20% ya glucose onse omwe amalowa mthupi amathera ntchito yaubongo. Kuzindikira kwapadera kwa ubongo kupita ku hypoglycemia ndi chifukwa chakuti, mosiyana ndi pafupifupi thupi lonse, ubongo ulibe malo osungirako mafuta ndipo sungathe kugwiritsa ntchito mafuta ozungulira ngati mafuta gwero lamphamvu. Mkulu akasiya kulowa m'matumbo a cortex kwa mphindi 5-7, kusintha kosasinthika kumachitika m'maselo ake, ndipo zinthu zomwe zimasiyanitsa kwambiri ndi kotekisiyo zimafa.

Ndi kuchepa kwa glucose kuchuluka kwa hypoglycemia, njira zimayatsidwa ndikuyang'ana glycogenolysis, gluconeogeneis, kusakaniza mafuta acids aulere, ndi ketogeneis. Munjira izi, mahomoni anayi makamaka amakhudzidwa - norepinephrine, glucagon, cortisol ndi kukula kwa mahomoni. Zikuwoneka kuti woyamba wa iwo ndi omwe amachititsa mawonetseredwe azachipatala. Ngati zotsatira za hypoglycemia potulutsidwa kwa norepinephrine zimachitika msanga, ndiye kuti wodwalayo amakhala ndi kufooka, thukuta, nkhawa komanso njala, zizindikiro zochokera kumanjenje zapakati zimaphatikizira kupweteka kwa mutu, kuwona kawiri, kusokonezeka kwa thupi, kusazindikira.Hypoglycemia ikayamba pang'onopang'ono, kusintha komwe kumalumikizana ndi dongosolo lamkati la mankhusu kumachitika, ndipo gawo lomwe limagwira (pa norepinephrine) limatha kukhalapo.

Zizindikiro za insulinoma mu gawo lomaliza

Pakadutsa mavuto a insulin, imadziwonekeranso monga mawonekedwe ndi zovuta zina. Ndikofunikira kuti muwadziwe kuti adokotala athe kukupatsani chithandizo choyenera. Mu gawo lomaliza, zizindikiro zotsatirazi zitha kuonekera kwa odwala:

• kufooka kwa minofu kapena matenda ena ammimba otumphera (ataxia),
• mutu
• kusokonekera kwamalingaliro ndi kuchepa kwa malingaliro,
• kuwonongeka kwamawonekedwe
• kusinthasintha
• kusokonezeka kwa mphamvu yosintha ya miyendo,
• nystagmus
• kulakalaka kwambiri komanso kuoneka wonenepa kwambiri,
• mavuto azaku kugonana.

Insulinoma ndi chotupa cha maselo a of-masisumbu a Langerhans, kubisalira insulin yambiri, yomwe imawonetsedwa ndi kuwukira kwa zizindikiro za hypoglycemic. Kwa nthawi yoyamba, munthawi yomweyo komanso popanda kudziimira pawokha, Harris (1924) ndi V. A. Oppel (1924) adalongosola zovuta za chizindikiro cha hyperinsulinism.

Mu 1927, a Wilder et al, atayang'ana zotupa za wodwala wokhala ndi insulinoma, adapeza kuchuluka kwa insulini mwa iwo. Floyd et al. (1964), akuwerenga momwe odwala omwewo adakhudzira tolbutamide, glucagon ndi glucose, adazindikira kuchuluka kwawo kwa insulin.

Mu 1929, opaleshoni yoyamba yopambana (Graham) adachitidwa kuti athetse chotupa chopanga cha insulin. Zinanditengera zaka zambiri pakufufuza molimbika, pomwe chithunzi cha matendawa chimapezeka, njira zodziwira ndi kulandira opaleshoni adapeza zojambula zina. M'mabuku mutha kupeza mawu osiyanasiyana omwe amagwiritsidwa ntchito potchula matenda: insuloma, hypoglycemic matenda, organic hypoglycemia, hypoglycemia, hyperinsulinism, insuloma-secreting insuloma. Mawu akuti "insulinoma" pakali pano amavomerezedwa. Malinga ndi malipoti m'mabuku, kukopeka uku kumachitika ndi pafupipafupi mwa amuna ndi akazi onse. Zambiri kuchokera kwa ofufuza ena zikuwonetsa kuti insulinomas imapezeka pafupifupi kawiri mwa akazi.

Anthu ambiri omwe ali ndi zaka zambiri zogwira ntchito - azaka 26-55, amadwala insulinoma. Ana amadwala insulinoma kawirikawiri.

The pathophysiological maziko azachipatala akuwonetsa zotupa kuchokera ku β-maselo a zisumbu za Langerhans amapeza kufotokoza kwawo mu zochitika za mahomoni a neoplasms iyi. Posagwiritsa ntchito maupangidwe a thupi omwe amawongolera homeostasis pankhani yokhudza kuchuluka kwa shuga, β-cell adenomas imatsogolera pakupanga matenda a hypoglycemia. Popeza chizindikiro cha insulinoma ndi chifukwa cha hyperinsulinemia ndi hypoglycemia, zikuwonekeratu kuti kuwopsa kwawonekera kwamankhwala kumawonetsa matenda kumawonetsa kuti wodwalayo ali ndi chidwi ndi insulin komanso kusowa kwa shuga. Zomwe tidawona zidawonetsa kuti odwala amalola kuperewera kwa glucose m'njira zosiyanasiyana. Zomwe zimapangitsa kuti polymorphism ikhale kwambiri, komanso kuchuluka kwa amodzi mwa iwo mwazovuta zazikulu za matendawa, ndizomveka. Magazi a m'magazi ndi ofunika pa moyo wa ziwalo zonse ndi minofu yathupi, makamaka ubongo. Pafupifupi 20% ya glucose onse omwe amalowa mthupi amathera ntchito yaubongo. Mosiyana ndi ziwalo zina ndi minyewa yathupi, bongo lilibe malo ogulitsa glucose ndipo sagwiritsa ntchito mafuta aulere acids ngati magetsi. Chifukwa chake, pamene cortex ikasiya kulandira shuga kwa mphindi 5-7, kusintha kosasinthika kumachitika m'maselo ake: zinthu zomwe zimasiyanitsidwa kwambiri ndi kotekisi zimafa.

Gittler ndi anzawo adazindikira magulu awiri azomwe amayamba ndi hypoglycemia.Gulu loyamba limaphatikizapo kukomoka, kufooka, kunjenjemera, palpitations, njala, kuwonjezeka. Wolemba amalumikizitsa kukula kwa zizindikiro izi ndi hyperadrenalinemia yotakasika. Zovuta monga mutu, kuwonongeka kwa mawonekedwe, chisokonezo, kufooka kwakanthawi, ataxia, kusazindikira, chikomokere, zimaphatikizidwa m'gulu lachiwiri. Ndi matenda a hypoglycemia omwe akusintha pang'onopang'ono, kusintha komwe kumachitika pakatikati kwamanjenje (CNS), komanso matenda oopsa a hypoglycemia, zizindikiro za kufooka kwa hyperadrenalinemia zimayamba. Kukula kwa pachimake hypoglycemia mwa odwala insulinomas ndi chifukwa cha kuwonongeka kwa contra-insular zimagwirira ndi adapter zimatha chapakati mantha dongosolo.

Olemba ambiri amalingalira za chipatala ndi matenda a insulinoma motsindika kuwonetsa kwa kuwukira kwa hypoglycemia, koma kuwunika kwa zizindikiro zomwe zikuwoneka mu nthawi yopatsirana sikulinso kofunikira kwambiri, chifukwa akuwonetsa kuwonongeka kwa hypoglycemia yodutsa pamkati wamanjenje apakati.

Zizindikiro zodziwika bwino za insulinoma ndi kunenepa kwambiri komanso kuchuluka kwa chilakolako chofuna kudya. O. V. Nikolaev (1962) amagawana zizindikiritso zosiyanasiyana zomwe zimachitika ndi zotupa za insulin za kapamba pazowonetsa nyengo yotsalira komanso kukhala chizindikiro cha nthawi yayitali ya hypoglycemia. Lingaliro ili likuwonetsa magawo azabwino omwe amawoneka mwa odwala, omwe nthawi zina amasinthidwa ndi mawonetsedwe owonekera a hypoglycemia.

Mu 1941, Whipple adalongosola kuchuluka kwa zizindikiro, zomwe zimaphatikizira kwambiri mbali zosiyanasiyana za chiwonetsero cha matenda a insulinoma, ndipo adafalitsa zotsatira za kafukufuku wokhudza kuchuluka kwa shuga panthawi ya kuwukira kwa hypoglycemia.

• The zimachitika mwadzidzidzi hypoglycemia pamimba yopanda kapena 2-3 pambuyo chakudya.
• Mwazi wa magazi umatsikira m'munsi mwa 50 mg% pomenyedwa.
• Kuletsa kuukira ndi mtsempha wamagazi kapena shuga.

Matenda a neuropsychiatric omwe ali ndi hyperinsulinism, komanso insulinoma, amakhala ndi malo otsogola gawo latent. Zizindikiro zamitsempha za matendawa ndizosakwanira kwa VII ndi XII jozi yamitsempha yama cranial yomwe ili pakatikati, asymmetry ya tendon ndi periosteal, unevenness kapena kuchepa kwa Reflex yam'mimba. Nthawi zina zinthu zakale za Babinsky, Rossolimo, Marinescu-Radovic nthawi zambiri zimawonedwa. Odwala ena ali ndi zizindikiro za kuperewera kwa piramidi popanda kuuma kwa pathological. Mwa odwala ena, zovuta zam'maso zidawululidwa, zomwe zimakhudza mawonekedwe a khungu hyperalgesia, C3, D4, D12, L2-5. Madera a Zakharyin-Ged, omwe ali ndi kapamba (D7-9), amawonedwa mwa odwala m'modzi. Kusokonezeka kwa tsinde mu mawonekedwe a nystagmus yopingasa ndi kukwera kwapamwamba kumachitika pafupifupi 15% ya odwala. Kuwunika kwamitsempha kumawonetsa kuti gawo lakumanzere laubongo limayang'ana kwambiri machitidwe a hypoglycemic, omwe amafotokozera kuchuluka kwa zotupa zake poyerekeza ndi kumanja. Milandu yayikulu ya matendawa, zizindikiro za kuphatikizika kwa matenda a hemispheres zonse zinawonedwa. Mwa amuna ena, komanso kuwonjezereka kwa matendawa, kusokonekera kwa erectile, kumawonekera makamaka mwa odwala omwe zochitika za hypoglycemic zimachitika pafupifupi tsiku lililonse. Zambiri pa zovuta zamitsempha munthawi yopikika kwa odwala omwe ali ndi insulinoma zimadziwika ndi polymorphism komanso kusapezeka kwa chilichonse chodziwika ndi matendawa. Kuchulukitsa kwa zotupa izi kumawonetsa chidwi cha munthu m'magazi am'mitsempha yamagazi ndikuwonetsa kukula kwa matendawa.

Kuphwanya kwa ntchito yapamwamba yamwadzidzidzi munthawi yolowera kunawonekera pakuchepa kwa kukumbukira ndi kukhumudwa m'maganizo, kusayang'anira chilengedwe, kutayika kwa maluso aukadaulo, omwe nthawi zambiri amakakamiza odwala kugwira ntchito yovuta kwambiri, ndipo nthawi zina kumabweretsa kulumala. Muzochitika zazikulu, odwala samakumbukira zomwe zidawachitikira, ndipo nthawi zina sangathenso kupereka dzina lawo komanso chaka chobadwa. Kufufuza kwa matendawa kumatanthauza kuti kuopsa kwa matendawa, komanso kuuma kwake, komwe, zimadalira momwe munthu akumvera wodwalayo pakusowa kwa magazi komanso kuopsa kwa njira zoponderezera, ndikofunikira pakukula kwamatenda amisala.

Ma electroencephalogram a odwala omwe adalembedwa panja pa vuto la hypoglycemia (pamimba yopanda kanthu kapena pambuyo pa chakudya cham'mawa) adawonetsa kutulutsa kwamphamvu mafunde a O-mafunde, mafunde akuthwa am'deralo ndi mafunde akuthwa, komanso pakuwukira kwa hypoglycemia, pamodzi ndi kusintha kwa EEG, pang'onopang'ono-pang'onopang'ono kunayamba ntchito yochepa kwambiri. odwala kutalika kwa kuukira adawonetsedwa pojambula.

Chizindikiro chimodzi chosasintha cha insulinoma chimadziwika kuti ndikumva njala. Chifukwa chake, ambiri mwa odwala athu anali ndi chidwi chambiri chokhala ndi njala asanaukidwe. 50% yaiwo anali ndi kuchuluka kwa thupi (kuyambira 10 mpaka 80%) chifukwa chakudya pafupipafupi (makamaka chakudya). Tiyenera kudziwa kuti odwala ena amadya mpaka 1 kg kapena shuga kapena maswiti ambiri patsiku. Mosiyana ndi zomwe awerengazo, odwala ena amanyansidwa ndi chakudya, amafunika chisamaliro chokhazikika komanso kulowetsedwa kwamphamvu kwa glucose ndi protein hydrolysates chifukwa chotopa kwambiri.

Chifukwa chake, kusakhala ndi chidwi chochulukirapo, kapena kumva kuti ndi njala sikungaganizidwe kukhala chizindikiro cha matendawa, ngakhale atha kuonedwa mosiyana. Mwanjira yodziwitsa ena, zomwe wodwala akuwonetsa kuti nthawi zonse amakhala ndi zinthu zabwino ndi iye ndizofunika kwambiri. Ambiri mwa odwala athu nthawi zonse amakhala ndi maswiti, makeke, shuga. Pakapita kanthawi, odwala ena amadana ndi chakudya chamtunduwu, koma sanathe kudya.

Kuperewera kwa chakudya m'thupi pang'onopang'ono kunayambitsa kulemera komanso kunenepa kwambiri. Komabe, si odwala onse omwe anali ndi thupi lolemera mopitirira muyeso; mwa ena a iwo, anali abwinobwino komanso ochepera kuposa abwinobwino. Tidazindikira kuwonda kawirikawiri m'magulu omwe ali ndi chidwi chochepa, komanso odwala omwe amakonda kudya.

Odwala ena, kupweteka kwa minofu kumatha kudziwika, komwe olemba ambiri amagwirizana ndikupanga njira zosiyanasiyana zowonongera minofu minofu ndikusinthidwa ndi minofu yolumikizana.

Kudziwitsa kochepa kwa madotolo za matendawa nthawi zambiri kumapangitsa kuti azindikire zolakwa - ndipo odwala omwe ali ndi insulinoma amakhala aatali komanso osapindulitsa chifukwa cha matenda osiyanasiyana. Kuzindikira koyipa kumachitika mwaoposa theka la odwala.

Matenda a insulinoma

Kuunika kwa odwala oterewa kuchokera ku anamnesis kumavumbula nthawi yakuwukira, ubale wake ndi chakudya. Kukula kwa vuto lodana ndi hypoglycemic m'mawa, komanso kulumphira chakudya chotsatira, kupsinjika kwa thupi ndi kwamaganizidwe, mwa azimayi omwe ali kumapeto kwa msambo akuchitira umboni kuti ali ndi insulinoma. Njira zakufufuzira kwakuthupi popeza insulinomas sizimagwira gawo lalikulu chifukwa cha kukula kwa chotupa.

Chofunika kwambiri pakuwonetsetsa kuti insulinoma imayikidwa mothandizidwa ndi mayeso a zinchito.

Mukafufuza kuchuluka kwa shuga m'magazi musanalandire chithandizo, kuchepa kwapezeka pansi pa 60 mg% mwa ambiri odwala. Tiyenera kudziwa kuti mwa wodwala yemweyo masiku osiyanasiyana, kuchuluka kwa shuga m'magazi kunali kosiyanasiyana.Posankha kuchuluka kwa insulini pakusala magazi seramu yambiri, kuchuluka kwakeko kunazindikiridwa, koma nthawi zina, ndi maphunziro obwereza, zomwe zimachitika mwazomwe zimawonedwa. Kusinthasintha koteroko kusamba kwa magazi ndi kuchuluka kwa insulini, zikuwoneka kuti kumalumikizana ndi kusasintha kwa mahomoni a insulinomas masiku osiyanasiyana, komanso kusokonezeka kwakukulu kwa njira zotsutsana.

Kuwunika mwachidule zotsatira za maphunziro omwe amapezeka kwa odwala omwe ali ndi insulinomas panthawi yoyesa, leucine, tolbutamide ndi glucose, titha kunena kuti mayeso ofunikira kwambiri komanso okwera mtengo a insulinomas ndiye kuyesa kwachangu, komwe mwa onse odwala kumayendera limodzi ndi chitukuko cha matenda a hypoglycemia shuga wamagazi, ngakhale mulingo wa insulini pamayesowa nthawi zambiri umakhala wosasinthika kuyerekeza ndi mtengo wake asanaukire. Kuyesedwa kwa leucine ndi tolbutamide mwa odwala omwe ali ndi insulinomas kumabweretsa kuwonjezeka kwakukulu kwamankhwala a seramu insulin komanso kuchepa kwakukulu kwa misempha ya magazi ndikupanga chiwopsezo cha hypoglycemia, komabe, mayesowa samapereka zotsatira zabwino kwa odwala onse. Kuchuluka kwa glucose kumakhala kochepa poyerekeza kuzindikira, ngakhale kuli ndi phindu linalake ndikakufanizira ndi mayeso ena ogwira ntchito ndi chithunzi cha matenda.

Monga momwe maphunziro athu adawonetsera, osati nthawi zonse pamene kutsimikizika kwa insulinomas kungaganiziridwe kutsimikiziridwa, palinso kuchuluka kwa insulin.

Kafukufuku wazaka zaposachedwa adawonetsa kuti zisonyezo za kubisala kwa proinsulin ndi C-peptide ndizofunika kwambiri pakuwunika insulinoma, ndipo mfundo za insunoreactive insulin (IRI) nthawi zambiri zimawunikidwa nthawi yomweyo ndi kuchuluka kwa glycemia.

Chiwerengero cha insulini ku glucose chatsimikiza. Mwa anthu athanzi, nthawi zonse amakhala pansi pa 0,4, pomwe odwala ambiri omwe ali ndi insulinomas amapitilira chizindikiro ichi ndipo nthawi zambiri amafikira 1.

Posachedwa, kufunikira kwakukulu kwalumikizidwa pa kuyesedwa ndi kuponderezedwa kwa C-peptide. Pakati pa 1 h, wodwalayo amapaka jekeseni wamkati ndi insulin pamtunda wa 0,1 U / kg. Ndi kuchepa kwa C-peptide ndi ochepera 50%, kupezeka kwa insulinomas kungaganiziridwe.

Zambiri zotupa za insulin zomwe zimapanga insulin sizidutsa masentimita 0.5-2, zomwe zimapangitsa kuti zikhale zovuta kudziwa panthawi ya opareshoni. Chifukwa chake, mu 20% ya odwala omwe ali ndi koyamba, ndipo nthawi zina kwachiwiri, komanso kwachitatu, chotupa sichingawoneke.

Ma insulinomas oopsa, omwe ndi gawo limodzi mwa magawo atatu a metastasize, amapezeka mu milandu ya 10-15%. Pazowunika za insulin, njira zitatu amagwiritsidwa ntchito makamaka: angiographic, catheterization ya portal system ndi compact tomography ya kapamba.

Kuzindikira kwa insulin kumachitika chifukwa cha kuchuluka kwa ma neoplasms awa ndi ma metastases awo. Gawo lachiberekero la chotupacho limayimiridwa ndi kukhalapo kwa chotupa chomwe chimadyetsa chotupacho ndi malo ocheperako a ziwiya m'dera la chotupa. Gawo la capillary limadziwika ndi kudzikundikira kwakanthawi kosiyanako mu neoplasm. Gawo loukira limawonekera ndi kukhalapo kwa mitsempha yotupa. Nthawi zambiri, insulinoma imapezeka pa capillary siteji. Njira yofufuzira ya angiographic imapangitsa kuti azindikire chotupa mu 60-90% ya milandu. Mavuto akulu kwambiri amatuluka ndi masing'alu ang'onoang'ono, mpaka 1 cm, komanso kutulutsidwa kwawo pamutu wa kapamba.

Kuvuta kwazomwe zimapangidwira insulin komanso kukula kwawo kocheperako zimapangitsa kuti zikhale zovuta kuzizindikira pogwiritsa ntchito computer tomography. Zotupa zotere, zomwe zimakhala m'makulidwe a kapamba, sizisintha kasinthidwe kake, ndipo mayankho olimbirana a x-ray samasiyana ndi minyewa yabwinobwino ya ndulu, yomwe imawapangitsa kukhala osafunikira.Kudalirika kwa njirayo ndi 50-60%. Nthawi zina, yikani patheterization ya portal system kuti mupeze mulingo wa IRI m'mitsempha yama dipatimenti osiyanasiyana a kapamba. Pakufunika kokwanira kwa IRI, munthu akhoza kuweruza kukhazikika kwa ntchito yopanda pake. Chifukwa cha zovuta zaukadaulo, njirayi nthawi zambiri imagwiritsidwa ntchito pazotsatira zoyipa zomwe zimapezeka pazophunzira zakale.

Sonography pakuzindikiritsa insulini siifalikira chifukwa cha kunenepa kwambiri pazambiri odwala, popeza mafuta osokoneza bongo ndi olepheretsa kwambiri mafunde a ultrasound.

Dziwani kuti kupezeka kwa matenda ogwiritsa ntchito njira zamakono zofufuzira mu 80-95% ya odwala omwe ali ndi insulinomas kumalola kudziwa kutulutsa, kukula, kuchuluka kwake komanso kudziwa zilonda zam'mimba (metastases) ya chotupa musanachite opareshoni.

Kusiyanitsa kwakumveka kwa insulinoma kumachitika ndi zotupa zosagwira pancreatic (zotupa za chiwindi, gren adrenal, ma mesenchymomas osiyanasiyana). Muzochitika zonsezi, hypoglycemia imawonedwa. Zotupa zopanda-pancreatic zimasiyana ndi insulin mu kukula kwawo: monga lamulo, ndizazikulu (1000-2000 g). Makulidwe oterewa ndi zotupa za chiwindi, adrenal cortex ndi ma mesenchymomas osiyanasiyana. Ma Neoplasms ofanana ofanana amawonekera mosavuta ndi njira zakufufuzira kwakuthupi kapena njira zamagetsi zamagetsi.

Mavuto akulu amatuluka pakupezeka kwa insulinoma pogwiritsa ntchito mankhwala obisika a insulin. Umboni waukulu wakugwiritsira ntchito insulin kwina ndi kupezeka kwa ma antibodies m'magazi a wodwala, komanso zochepa za C-peptide yokhala ndi IRI yokwanira. Kutulutsa kwachilengedwe kwa insulin ndi C-peptide nthawi zonse kumakhala koyenera.

A malo apadera mu kusiyanasiyana matenda a insulinomas amatengeka ndi hypoglycemia mwa ana, chifukwa cha kusinthika kwathunthu kwa ductal epithelium ya kapamba mu ma cell a b. Vutoli limatchedwa non-idioblastosis. Izi zitha kukhazikitsidwa morphologic. Clin, imadziwoneka ngati yowopsa, yovuta kukonza hypoglycemia, yomwe imatikakamiza kuchitapo kanthu mwachangu kuti muchepetse kulemera kwa minofu ya pancreatic. Kuchuluka kwovomerezeka kwa opaleshoni ndi resection ya 80-95%.

Chithandizo cha insulinoma

Mankhwala othandizira odwala matenda a insulin amaphatikizapo kupumula ndi kupewa kwa zochitika za hypoglycemic komanso momwe chotupa chikuyambitsirana pogwiritsa ntchito mitundu yambiri ya hyperglycemic, komanso zakudya zambiri zamagulu odwala. Othandizira a chikhalidwe cha hyperglycemic amaphatikizapo adrenaline (epinephrine) ndi norepinephrine, glucagon (glucagen 1 mg hypokit), glucocorticoids. Komabe, zimapereka kanthawi kochepa, ndipo makina a makolo ambiri ambiri amaletsa kugwiritsa ntchito. Chifukwa chake, mphamvu ya hyperglycemic ya glucocorticoids imadziwoneka yokha mukamagwiritsa ntchito Mlingo waukulu wa mankhwala omwe amachititsa chiwonetsero cha cushingoid. Olemba ena amati zabwino pa glycemia ya diphenylhydantoin (diphenin) pa mlingo wa 400 mg / tsiku, komanso diazoxide (hyperstat, proglikem). Mphamvu ya hyperglycemic ya benzothiazide yopanda diuretic iyi imachokera pazomwe zimapangitsa kuti insulin isungidwe. Mankhwala amagwiritsidwa ntchito muyezo wa 100-600 mg / tsiku mu Mlingo wa 3-4. Amapezeka m'mapiritsi a 50 ndi 100 mg. Chifukwa cha kutchulidwa kwa hyperglycemic, mankhwalawa amatha kukhalabe ndi shuga m'magazi pazaka zambiri. Ili ndi chuma chokhala ndi madzi osungidwa m'thupi mwakuchepetsa ma sodium excretion ndipo zimabweretsa chitukuko cha edematous syndrome. Chifukwa chake, kugwiritsa ntchito diazoxide kuyenera kuphatikizidwa ndi diuretics.

Odwala omwe ali ndi zilonda zam'mimba zotsekemera zotupa, mankhwala a chemotherapeutic streptozotocin (L. EBroder, S. K. Carter, 1973). Zochita zake zimatengera kuwononga kosankha kwa ma islet cell a kapamba. 60% ya odwala amakhala omvera kapena osamva kwenikweni ndi mankhwalawa.

Cholinga chakuchepa kwa kukula kwa chotupa ndipo metastases yake idawonedwa theka la odwala. Mankhwalawa amaperekedwa kudzera mu kulowetsedwa ndi kulowetsedwa. Mankhwala - tsiku lililonse mpaka 2 g, ndipo amapita mpaka 30 g, tsiku lililonse kapena sabata iliyonse. Zotsatira zoyipa za streptozotocin ndi mseru, kusanza, nephro- ndi hepatotoxicity, kutsegula m'mimba, kuchepa kwa magazi m'thupi. Pakapanda zotupa kuti mutumikire ku streptozotocin, doxorubicin (adriamycin, adriablastin, rastocin) angagwiritsidwe ntchito (R. C. Eastman et al., 1977).

Zomwe zimapangidwira pancreas, yomwe ili pamalo osatheka kufikika, pafupi kwambiri ndi ziwalo zingapo zofunika, chidwi chake pakuchita opaleshoni, kugaya katundu kwa timadziti, kuyandikana kwambiri ndi kuchuluka kwa mitsempha, komanso kulumikizana ndi magawo a reflexogenic kumapangitsa magwiridwe antchito a opaleshoni pachipangachi komanso kusakanikirana. mpumulo wa wotsatira machiritso a bala. Pokhudzana ndi mawonekedwe a anatomical komanso zokhudza thupi kapamba, mafunso ochepetsa chiopsezo cha ntchito akhala akufunika kwambiri. Kuchepetsa chiopsezo pakuchitika kwa opaleshoni kumatheka ndi kukonzekera koyenera, kugwiritsa ntchito njira yabwino kwambiri yothandizira opaleshoni, kukwaniritsa zowawa poyang'ana ndikuchotsa chotupa, ndikuwongolera njira zochizira komanso zothandizira panthawi yothandizira.

Chifukwa chake, malinga ndi deta yathu, kuchuluka kwa insulin pamadwala ambiri omwe ali ndi insulinomas kumakulitsidwa, ndipo shuga ya magazi imachepetsedwa. Hypoglycemic imakumana ndi nthawi ya mayeso osala kudya kuyambira pa 7 mpaka 50 maola atatha kudya, odwala ambiri atatha maola 12-24.

The m`kamwa makonzedwe a leucine pa mlingo wa 0,2 ga pa 1 makilogalamu kulemera kwa pafupifupi odwala onse limodzi ndi kuwonjezeka kwa insulin ndi kuchepa kwambiri kwa shuga m'magazi 30-60 patatha kumwa mankhwala ndi kuchitika kwa kuukira kwa hypoglycemia.

Mitsempha yoyeserera ya tolbutamide ochulukitsa odwala idapangitsa kuwonjezeka kwamankhwala a insulin komanso kuchepa kwa shuga ndikukula kwa chiwopsezo cha hypoglycemia pambuyo pa mphindi 30-120 kuyambira poyambira.

Kuyerekezera kwa zitsanzo za matenda ozindikira odwala omwe ali ndi insulinomas adawonetsa phindu lalikulu kwambiri la mayesowo ndi njala.

Pakachitika kubwezeretsanso pambuyo pa ntchito, kusintha kwa shuga m'magazi ndi insulin panthawi ya kuyesedwa ndi kusala, leucine, tolbutamide anali chimodzimodzi ngati asanachitike opareshoni.

Kuyerekeza kwa kuchuluka kwa kafukufuku wama electroencephalographic omwe anachitika asanachitike komanso atachitidwa opaleshoni akuwonetsa kuti odwala ena omwe amakhala ndi nthawi yayitali yamatenda ndipo nthawi zambiri kuwukira kwa hypoglycemia kumakhalabe kusintha kosasintha muubongo. Pozindikira koyambirira komanso chithandizo chamankhwala chapanthawi yake, zosintha kuchokera ku dongosolo lamanjenje zimazimiririka, monga zikuwonekera ndi kafukufuku wa kafukufuku wa EEG.

Kufufuza kwatsatanetsatane kukuwonetsa kukhathamiritsa kwakukulu kwa njira yochitira opareshoni ndi insulin komanso kuyambiranso kwa wachibale wa ma neoplasms awa atachotsedwa. 45 (80.3%) ya odwala 56 adakumana ndi kuchira pambuyo pochotsa insulinoma.

Chithandizo chachikulu cha insulin chachikulu ndichakuchita opareshoni. Conservative tiba imalembedwa kwa odwala omwe sangathe kugwira ntchito, ngati akukana wodwalayo, komanso ngati sangayesere kupeza chotupa pa nthawi ya opareshoni.

R. A. Manusharova, Doctor wa Medical Science, Pulofesa
RMAPO, Moscow

Pamafunso a mabuku, lumikizanani ndi wofalitsa.

Insulinoma ndi chotupa chodziwika bwino cha pancreatic chomwe chimatulutsa insulin mosasunthika m'magazi ndipo chimayambitsa matenda a hypoglycemic.

Makhalidwe wamba

Hypoglycemic imagwira ndi matenda.

Kupanga kwa insulin kosalamulirika kumayendera limodzi ndi kupangika kwa mitundu yambiri ya adrenergic ndi neuroglycopenic - hypoglycemic syndrome.

Pancreatic insulinomas imakhala 70-75% ya kuchuluka kwa zotupa zamafuta pancreatic. Imakonda kuonedwa mwa anthu okulirapo (zaka 40-60). Malinga ndi ziwerengero, 10% yokha yammimba yomwe ndi yoyipa.

Insulinoma imatha kuchitika mu gawo lililonse la kapamba (thupi, mutu, mchira), kawirikawiri sakhala extrapancreatically, i.e. mu omentum, khoma la m'mimba kapena duodenum, chipata cha ndulu, chiwindi. Kukula kwa neoplasm nthawi zambiri kumachokera ku 1.5 mpaka 2 cm.

Pa nthawi ya matendawa, magawo azomwe amakhala bwino amawasiyanitsa, omwe amasinthidwa ndikuwonetsa hypoglycemia ndi hyperadrenalinemia. Nkhani yotsala, momwemo mawonekedwe a insulinoma amatha kukulirakudya, ndipo chifukwa chake - kunenepa kwambiri.

Chizindikiro cha insulinoma ndi vuto lodana kwambiri ndi vuto la hypoglycemic - chotulukapo cha kuphwanya kwamphamvu kwa dongosolo lamanjenje lamkati, lomwe limachitika pamimba yopanda kanthu, pambuyo pakupuma kwakudya kwambiri, makamaka m'mawa. Pakuwukira, glucose wamagazi amatsika pansi pa 2,5 mmol / L.

Zizindikiro za chotupa nthawi zambiri chimafanana ndi matenda amisempha ndi mitsempha ndipo zimawoneka ngati:

• chisokonezo,
• mutu
• ataxia (kusokoneza kayendedwe)
• kufooka kwa minofu.

Nthawi zina kuukira kwa hypoglycemia mwa anthu omwe ali ndi insulinoma kumatha kutsagana ndi psychomotor mukubwadamuka ndikuwonetsedwa monga:

• kuyerekezera
• kubuula
• nkhawa yamagalimoto
• nkhanza zosagwirizana,
• euphoria.

Dongosolo lachifundo-la adrenal limayankha kwambiri hypoglycemia mwa kuwoneka thukuta lozizira, kunjenjemera, tachycardia, mantha, paresthesias (dzanzi ndi kumva kugunda). Ndipo pakakhala vuto, kukomoka, kugona, komanso ngakhale kupsa kumatha kuchitika. Monga lamulo, kuukira kumasokonezedwa ndi kulowetsedwa kwa shuga mkati, koma akayambanso kuzindikira, wodwalayo sakumbukira zomwe zinachitika.

Pa vuto la hypoglycemia, kuphwanya magazi m'mimba kumachitika ngakhale chifukwa chakusowa kwambiri kwa mtima. Kuphatikiza apo, pali zizindikiro zakuwonongeka kwanthawi kwa masanjidwe amanjenje monga hemiplegia ndi aphasia. Ndipo ndi hypoglycemia wodwala, zochitika zamitsempha yamagetsi (zonse zapakati ndi zotumphukira) zimasokonekera, zomwe zingasokoneze gawo la gawo la kufananitsa bwino.

Zizindikiro mu nthawi yopatsirana ndi: myalgia, kusawona bwino, mphwayi, kuchepa kwa kukumbukira ndi luso la malingaliro.

Ngakhale atachotsa kutupira, monga lamulo, encephalopathy ndi kuchepa kwa nzeru kumatsalira, zomwe zimapangitsa kutayika kwa mbiri yakale yapamwamba komanso maluso aukadaulo. Nthawi zambiri kukomoka mobwerezabwereza kwa magazi kumatha kupangitsa kuti amuna asamagwire bwino ntchito.

Zizindikiro zimakumbukira kwambiri matenda ena, kotero odwala amatha kupatsidwa matenda olakwika, monga zotupa za ubongo, khunyu, vegetovascular dystonia, stroke, diencephalic syndrome, psychosis yapakati, neurasthenia, zotsalira za neuroinawon, etc.

Kodi insulinoma ndi chiyani?

Insulinoma ndi mtundu wa chotupa. Mitsempha ya chithokomiro imabisira insulini yambiri (yomwe imakhala yovulaza thupi).Kuchuluka kwa insulin, komwe sikumagwirizana ndi chizolowezi, kumabweretsa hypoglycemia (kuchuluka kwa glucose m'magazi a seramu).

Mtundu wofala kwambiri wamatendawa ndi pancreatic insulinoma. Mu ziwalo zina, mwachitsanzo, m'chiwindi kapena m'matumbo, matendawa amakula pafupipafupi.

Matendawa ali ndi "omvera" ake. Anthu azaka zapakati pa 25 ndi 55 ali pachiwopsezo. Mwa ana ndi achinyamata, matenda oterewa amakhala ndi mawonekedwe osowa kwambiri. Akatswiri amati mu 90% ya milandu, chotupa chotere sichikhala chowopsa, popeza ndi chochepa.

Chonde dziwani: musaiwale kuti ma neoplasms aliwonse mthupi amupweteka. Mosasamala mtundu wa chotupacho, ayenera kuchiritsidwa, kudziwa chomwe chimayambitsa (kapena zomwe zimayambitsa) ndikuyesera kudziteteza ku tizilombo toyambitsa matenda.

Madokotala amati kuwonetsa kwa chotupacho kungasonyeze mavuto ndi endocrine gland. Muyenera kufufuza mokwanira, kudutsa mayeso oyenera ndikupitilira ndi njira yomwe mukufuna.

Zizindikiro ndi matendawa

Pancreatic insulinoma imapitilira ndi zizindikiro zotsatirazi:

• Hypoglycemia chifukwa cha kuchuluka kwa insulin m'magazi a wodwala,
• kupezeka kwa zida zopanda nzeru za kufooka wamba komanso kutopa,
• kukomoka kwa mtima (tachycardia),
• kutuluka thukuta kwambiri
• nkhawa ndi mantha
• kumverera kwanjala yayikulu.

Zizindikiro zonse pamwambazi zimatha atatha kudya kwa odwala. Njira yowopsa ya matendawa imaganiziridwa kwa odwala omwe samva mkhalidwe wa hypoglycemia. Pachifukwa ichi, odwala oterowo sangathe kudya nthawi kuti asinthe matenda awo.

Mwazi wamagazi ukachepa, machitidwe a wodwala amatha kukhala osakwanira. Amavutitsidwa ndi kuyerekezera zinthu, komwe kumakhala limodzi ndi zithunzi zowoneka bwino komanso zowoneka bwino. Pali thukuta lotukwana, masisitere, masomphenya apawiri. Wodwalayo amatha kudya chakudya ndi anthu ena. Ndi kuchepa kwapadera kwa shuga wamagazi, kuwonjezeka kwa kamvekedwe ka minofu kumachitika, khunyu ikayamba.

Kupsinjika kwa magazi kumakwera, ana amachepetsa ndipo tachycardia imakulanso. Ngati wodwala sapatsidwa chithandizo chanthawi yake, chikomokere chingachitike. Chikumbumtima chatayika, ophunzira amachepetsa, kamvekedwe ka minofu kachepa, thukuta limayima, mtima ndi kupuma kwa phokoso kumachitika, kuthamanga kwa magazi kumatsika.

Ngati chikomoka cha hypoglycemic chachitika, wodwalayo amatha kudwala matenda osokoneza bongo.

Kuphatikiza pa kuwukira kwa hypoglycemia, chizindikiro china chofunikira cha insulinoma chimawonetsedwa ngati kuwonjezeka kwa thupi (kukula kwa kunenepa kwambiri).

Chofunikira ndikuwonetsetsa matendawa munthawi yake, kuti muchepetse kuukira kwa hypoglycemia ndikuletsa kutukuka kwa chikomokere kapena psychosis. Kuperewera kwa shuga kumakhudza ma neurons aubongo. Pachifukwachi, kupuma pafupipafupi ndi matenda kungayambitse chizindikiritso chokhazikika, parkinsonism, and discirculatory encephalopathy. Ndi vuto la hypoglycemic, myocardial infaration imayamba.

Pambuyo pa opaleshoni yochotsa chotupacho, zizindikiro za encephalopathy ndi kuchepa kwa luntha zitha kupitiriza. Izi zitha kubweretsa kutha kwa maluso aukadaulo komanso ulemu pagulu.

Nthawi zambiri kuwunikira kwa hypoglycemia mwa amuna kumatha kubweretsa mphamvu.

Kuzindikira matendawa

Pancreatic insulinoma ndizovuta kudziwa. Pazizindikiro zoyambirira za matenda, wodwala amayikidwa kuchipatala mwachangu. Maola 24-72 oyambilira amamulembera kusala moyang'aniridwa ndi madokotala.

Kuti mudziwe za matendawa, njira zotsatirazi zikugwiritsidwa ntchito:

• Kuyesedwa kwa magazi kuti mupeze kuchuluka kwa insulin ndi glucose m'magazi.
• Makompyuta ndi maginito a resonance imaging ndi ultrasound. Njira izi zimakuthandizani kuti mudziwe molondola komwe chotupacho.
• Nthawi zina, diagnostic laparotomy kapena laparoscopy amachitidwa.

Kuchiza matenda

Chithandizo chachikulu cha insulinomas ndikuchita opareshoni. Pa opaleshoni, insulinomas imachotsedwa. Kuchulukitsa kwa opaleshoni kumadalira kukula ndi malo a chotupacho.

Mitundu yotsatirayi imagwiritsidwa ntchito pochotsa insulinomas:

• insulinomectomy (chotupa chotupa),
• kapamba wamanyazi,

Mphamvu ya opareshoni imayesedwa poona kuchuluka kwa shuga m'magazi pakuchita opareshoni.

Pakati pazovuta za postoperative zitha kudziwika:

Ngati opareshoni pazifukwa zina sangathe kutero, chithandizo chamankhwala chakhazikika.

Chinsinsi cha chithandizo chosasamala chikutsatira izi:

• Zakudya zabwino za wodwala,
• Kuchotsa kwakanthaŵi kwa vuto la hypoglycemic,
• mankhwala kusintha kagayidwe kachakudya njira mu ubongo.

Nthawi zambiri kuthetsa kuukira kwa hypoglycemia kumachitika pogwiritsa ntchito maswiti kapena kapu ya tiyi wotentha wotentha. Ngati pakhale kuphwanya kudziwa kwa wodwala, dokotalayo amalembera njira yotseka shuga.

Wodwala akavutitsidwa ndi chiwopsezo cha psychosis, ndikofunikira kuyitanitsa galimoto yodzidzimutsa.

Matenda obwera ndi matenda

Nthawi zambiri, opaleshoni yochotsa chotupacho itatha, matendawa ndi abwino ndipo wodwalayo amachira.

Kufa kwa postoperative sikokwanira. Kubwereranso kumayamba. Ndi insulinomas yoyipa, matendawa ndi osauka.

Anthu omwe ali ndi matendawa ayenera kulembetsedwa ndi endocrinologist ndi neurologist, kudya zakudya zoyenera, ndikuiwala zikhalidwe zoyipa. Komanso, amayenera kukayezetsa thupi chaka chilichonse ndikuyang'anira kuchuluka kwa shuga m'magazi.

Insulinoma ndi cholakwika (mu 15% ya milandu), komanso chotupa (85-90%) chotupa chomwe chimayamba m'maselo a zilumba za Langerhans. Imakhala ndi zochita za mahomoni olamulira ndipo imayambitsa hyperinsulinism. Insulin imayamba kuonekera mosagwirizana, yomwe imayambitsa hypoglycemic syndrome - zomwe zimatchedwa kuphatikiza kwa chizindikiro cha neuroglycopenic ndi adrenergic.

Pakati pa zotupa zonse za pancreatic zomwe zimachitika ndi mahomoni, insulinoma imakhala pafupifupi 70%.

Pafupifupi 10% ya iwo ali m'gulu la mitundu yoyamba ya adenomatosis angapo. Nthawi zambiri, insulinoma imayamba mwa anthu azaka zapakati pa 40 mpaka 60, osapezeka kwambiri mwa ana.

Insulinoma imatha kupezeka mu gawo lililonse la kapamba (mchira, mutu, thupi). Nthawi zina amatha kukhala ndi zowonjezera pancreatic, mwachitsanzo, pachipata cha ndulu, khoma lam'mimba, duodenum, chiwindi, omentum. Monga lamulo, kukula kwa neoplasm kufikira 1.5 - 2 cm.

Limagwirira a hypoglycemia mu insulinoma

Kukula kwa mkhalidwewu kukufotokozedwa chifukwa chakuti kubisala kosasunthika kwa insulini ndi b-cell ya chotupa kumachitika. Nthawi zambiri, ngati kuchuluka kwa glucose m'magazi kumachepera, ndiye kuti kupanga kwa insulin ndikutulutsa kwake m'magazi kumacheperanso.

M'maselo a chotupa, njira iyi imasokonekera, ndipo ndi kuchepa kwa kuchuluka kwa shuga, insulin katulutsidwe sikuletsa, komwe kumayambitsa kukula kwa hypoglycemic syndrome.

Hypoglycemia yamphamvu kwambiri imamvekedwa ndi ma cell aubongo omwe amagwiritsa ntchito glucose ngati gwero lalikulu lamphamvu. Pankhaniyi, chitukuko cha chotupa, neuroglycopenia amayamba, ndipo ndi ndondomeko yotupa mkati mwa mantha amawonongeka.

Ndi hypoglycemia, ma contrainsular mankhwala amatulutsidwa m'magazi - mahomoni glucagon, norepinephrine, cortisol, omwe amatsogolera ku mawonekedwe a adrenergic.

Mankhwala a insulinoma

Nthawi zambiri, insulinoma imafunikira opaleshoni.Kuchulukitsa kwa operekera kumatengera kukula kwa insulinoma ndi malo ake. Nthawi zina, insulinectomy (kukulitsa chotupa), ndipo nthawi zina kuyambiranso kwa kapamba, kumachitika.

Kuchita bwino kwa opaleshoni kumawunikidwa ndikusintha mochititsa chidwi kuchuluka kwa shuga panthawi yolowerera.

Zina mwazovuta za postoperative ndi:

pancreatic necrosis ya kapamba, ndipo akapezeka ndi zovuta mkati mwake. ,

• pamimba
• fancula kapamba
• peritonitis.

Ngati insulinoma singathe kugwira ntchito, ndiye kuti mankhwalawa amachitika mosamala, hypoglycemia imaletsedwa, kuukira kumayimitsidwa mothandizidwa ndi glucagon, adrenaline, glucocorticoids, norepinephrine. Pa magawo oyamba, odwala nthawi zambiri amalimbikitsidwa kuti amwe chakudya chambiri.

Kwa insulinomas yoyipa, chemotherapy imachitika ndi doxorubicin kapena streptozotocin.

Kuzindikira kwa insulinoma

Kuthekera kwa kuchira kwamatenda atatha kuwonetsa insulinoma kuchokera 65 mpaka 80%. Chotupa chikangopezedwa ndikuthandizidwa, mankhwalawa amatha kusintha mosavuta.

Imfa pambuyo pakuchita opaleshoni imachitika mu 5-10% ya milandu. Mu 3% ya odwala, kuyambiranso kumachitika.

Mu 10% ya milandu, kufooka koyipa kumatha kuchitika, pomwe chimbudzi chikuwonongeka chikuyamba, ndipo metastases imawoneka m'ziwalo ndi machitidwe akutali.

Mu zotupa zoyipa, matendawa nthawi zambiri amakhala osauka; ndi 60% yokha ya odwala omwe amakhalanso ndi moyo zaka zina ziwiri.

Anthu omwe ali ndi mbiri yakale ya matendawa adalembetsa ndi neurologist ndi endocrinologist. Ayenera kudya zakudya zoyenera, kusiya zizolowezi zoipa ndikupita kukayezetsa pachipatala chaka chilichonse kuti adziwe kuchuluka kwa shuga m'magazi.

Insulin yowonjezera yomwe imapangidwa ndi thupi imatha kuyambika pazifukwa zosiyanasiyana. Hypoglycemia (vuto lomwe limayambitsidwa ndi insulin yochulukirapo) ikhoza kukhala chizindikiro choyamba kuti chotupa chodziwika bwino, insulinoma, chawoneka m'thupi la wodwalayo.

Insulinoma ndiyosowa kwambiri, chifukwa chake sichingafanane ndi kuchuluka kwa ma pathologies wamba. Monga lamulo, limakula mwa anthu azaka zopitilira 45. Insulinoma imatha kukhala chotupa choyipa, koma izi zimachitika mwaoposa odwala 7%.

Kuwoneka ngati chotupa kumayambitsa kusokonekera kwa mahomoni, chifukwa chomwe kuphatikiza kwa insulin kumawonjezeka. Insulin yowonjezera ndiyosatha ndipo ingayambitse hypoglycemia.

Zizindikiro zotsatirazi zikuthandizira kudziwa hypoglycemia:

• migraine ndi chizungulire,
• kufooka kwadzidzidzi ndi kugona,
• kusokonezeka ndende,
• kuchuluka kwanjala
• kumverera kwa nkhawa.

Ngati izi siziyimitsidwa pakapita nthawi, kuchuluka kwa glucose kumatsika kwambiri ndipo kukomoka kwa hypoglycemic kumatha.

Chifukwa chake, chotupa choyamba chimawoneka chomwe chimapangitsa kuti pakhale insulin komanso chimayambitsa hypoglycemia. Zomwe zimayambitsa ma insulinomas sizikudziwika bwinobwino.

Mitundu iwiri yamatenda

Chotupa chovomerezeka ndi matenda a endocrinological ndipo amathandizidwa ndi endocrinologist. Neoplasm imayambitsa kuphwanya kapangidwe ka mahomoni, motero mankhwalawa amasankhidwa ndi endocrinologist. Chiwopsezo chachikulu cha benign insulinoma ndi kukula kwa hypoglycemia. Kutsika kwakukulu kwa kugundidwa kwa glucose kumatha kukhala ndi zotsatirapo zoipa, mpaka kukomoka, komwe kungaphe.

Kuphatikiza pa mahomoni, isnulloma imatha kukhala ya oncological. Pankhaniyi, pali chiopsezo cha metastasis, monga momwe ziliri ndi vuto lililonse loiplasm.

Komwe insulinoma ili ndi kapamba, motero kuwunika kumaphatikiza kuyesa kapamba ndi kudziwa kapangidwe ka minofuyo.

Zizindikiro

Kuwonetsedwa kwa matendawa kumasiyanasiyana malinga ndi izi:

• mulingo wa ntchito ya chinthu chokwanira (insulin),
• kuyambira nthawi yomwe chotupa chiripo (subsidence / exacerbation),
• kukula kopanda,
• machitidwe a thupi.

Zizindikiro zazikulu zomwe zimatulutsidwa ndi insulinoma:

• hypoglycemia. Pafupipafupi ma mawonetseredwe awo ndimatha maola atatu mutatha kudya,
• mulingo wa shuga wa seramu ndi 50 mg.

Kuwonetsera kwina ndikutchingira zizindikiro za hypoglycemia potenga shuga.

Kodi amathandizidwa bwanji?

Ngati mukukayikira kuti wodwala ali ndi insulinoma, ngati zizindikiro za hypoglycemia zikupezeka pafupipafupi, muyenera kupita kwa dokotala kukamufufuza kwathunthu.

Ngati isnullinoma idatsimikiziridwa ndikuzindikira, mankhwalawa amayamba atazindikira mtundu wa chotupa. Chotupa chovomerezeka chimachotsedwa nthawi yomweyo. Chithandizo chowonjezereka ndicholinga chothetsa chizindikiro cha hypoglycemia ndi zotsatira zake. Opaleshoni nthawi zambiri imayambitsa zovuta zingapo, kotero chithandizo chimaphatikizanso kuwonongeka kwawo. Chithandizo chimafunikanso upangiri wa katswiri wamitsempha, chifukwa chotupacho chimapereka zovuta ku mitsempha.

Monga lamulo, benign isulinoma imayankha bwino pakalandira chithandizo. Kubwerezanso kwa matenda kumachitika kawirikawiri.

Insulinoma yodwalitsa imafunanso chithandizo choyenera, koma mwanjira iyi palibe katswiri yemwe angatsimikizire zotsatira zabwino za mankhwala. Mankhwalawa amachitidwa ndi oncologist.

Ngati anthu akukayikira insulin, simuyenera kudikirira kuti chotupacho chidutse chokha. Kuyendera dokotala panthawi yake kumatha kupulumutsa wodwala.

Mukaonana ndi dokotala liti?

Kuthandizira panthawi yake komanso kuwunika komweku kumapereka mpata kuti azindikire insulin, kuphatikizapo zilonda. Zotsatira za chithandizo chonsecho zimatengera momwe wodwala yemwe ali ndi vuto lowopsa la insulinoma amatembenukira kwa katswiri.

Zizindikiro zoyambirira za hypoglycemia zikawoneka, endocrinologist iyenera kuchezeredwa.

Kutanthauzira kwa chotupa m'miyeso yoyambirira kukuthandizira kupewa kukula kwa metastases komanso kuchitira panthawi yake chotupa chokhala ndi khansa.

Simuyenera kuganiza kuti benign isnullinoma siowopsa. Popanda chithandizo choyenera, mafupipafupi a hypoglycemia achulukira, ndipo amakhala ndi zovuta zambiri mpaka amakhala atakomoka. Milandu imadziwika komwe wodwala, adakomoka, adapita kwa adotolo, ndipo pokhapokha padapezeka insulinoma.

Kupewa komanso kudwala

Monga lamulo, chithandizo cha insulinomas chakanthawi yake chimathandiza kupewa kutenganso matenda. Komabe, atachotsa isnullinoma, matenda a kapamba monga kapamba amayamba. Amafuna chithandizo chachitali komanso choyenerera, komanso njira yamoyo komanso kusintha kwa zakudya.

Zomwe zimapangitsa kukula kwa neoplasm sizinadziwikebe, chifukwa chake, njira zopewera sizilipo. Ndizosatheka kupewetsa chotupa, komabe, poyang'anira thanzi lanu, mutha kudziwa zamomwe zimayambira komanso kuchitira chithandizo.

Ndikofunikira kuyeza kuchuluka kwa shuga m'magazi ndikuwunika kuchuluka kwa insulini yopangidwa ndi kapamba. Ndikokwanira kuti munthu wathanzi azitha kuyesedwa kamodzi pachaka kuti adziwe kuchuluka kwa mahomoni ndi shuga wamagazi kuti athe kukhala wodekha ku thanzi lake.

Kuti mudziwe za matendawa, tiyenera kumvetsetsa insulinoma - momwe mungadziwire ndi zomwe zili. Ngati chotupa chikuchepa, kuchira kwathunthu kumachitika mu 70% ya milandu, koma wodwalayo adalembetsedwa ndi endocrinologist wa moyo wake wonse ndipo amayenera kupimidwa nthawi ndi nthawi. Mu 30% ya milandu, kuyambiranso kwamatenda kumawonedwa.

Ngati matendawa ali a oncological chikhalidwe, matendawo siosangalatsa monga tikanafuna. Nthawi ziwiri mwa zitatu, chotupa sichitha kuchotsedwa.Mankhwalawa nthawi zambiri amalephera chifukwa chazindikira mochedwa ndipo mu 40% ya matendawa amatha kuimfa.

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 zotupa zonse zodziwika bwino zamafuta a kapamba. 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 ndi gawo limodzi la mtundu wa I MEN syndrome, lomwe limaphatikizanso zotupa za parathyroid, adenohypophysis, ndi zotupa za adrenal cortex (zomwe zimakonda kugwira ntchito 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).

Zizindikiro za Insulinoma

Kuwonetsedwa kwakukulu kwa insulinoma ndikuwukira kwa hypoglycemia, chifukwa cha kuchuluka kwa insulin m'magazi a odwala. Odwala amakumana ndi mwadzidzidzi kufooka kwakukulu, kutopa, limodzi ndi tachycardia (kuthamanga kwamtima), thukuta, mantha, nkhawa. Nthawi yomweyo, odwala amakhala ndi njala yayikulu. Mukatha kudya, zizindikiro zonse za insulinoma izi zimazimiririka nthawi yomweyo.

Njira yoopsa kwambiri ya insulinoma imakhala mwa odwala omwe samva mkhalidwe wa hypoglycemia. Motere, sangatenge chakudya munthawi yake ndikukhala bata. Ndi kuchepa kwinanso kwa kuchuluka kwa shuga m'magazi, machitidwe awo amakhala osakwanira. Odwala amakhala ndi kuyerekezera zinthu, limodzi ndi zithunzi zowala komanso zowoneka bwino. Pali malovu, thukuta labodza, masomphenya awiri. Wodwalayo amatha kuchitira nkhanza anthu omwe amakhala naye kuti awalande chakudya.

Kutsika kwinanso kwa glucose m'magazi a seramu kumawonjezera kuchuluka kwa kamvekedwe ka minofu, mpaka kugwidwa khunyu.Tachycardia imachuluka, kuthamanga kwa magazi kumakwera, ndipo ana amatha.

Ngati wodwala sapatsidwa chithandizo chamankhwala, ndiye kuti pali vuto la hypoglycemic. Chikumbumtima chatayika, ana amapukutika, kamvekedwe ka minofu kachepa, thukuta limayima, kugunda kwamtima komanso phokoso lakupumira limasokonekera, kuthamanga kwa magazi kumatsika. Potengera maziko a chikomokere, wodwala amatha kudwala matenda osokoneza bongo.

Kuphatikiza pa kuwopseza kwa hypoglycemia, chizindikiro china cha insulinoma ndikuwonjezera kuchuluka kwa thupi mpaka kukulitsa kunenepa kwambiri.

Ndikofunika kwambiri kuti odwala osati komanso mabanja awo apamtima azindikire bwino za insulinoma, kuti athe kusokoneza mwachangu vuto la hypoglycemia, kupewa kukula kwa psychosis kapena chikomokere.

Kuperewera kwa glucose kumakhudza kwambiri mitsempha ya muubongo. Chifukwa chake, kupuma pafupipafupi komanso kwa insulinoma nthawi yayitali kumapangitsa wodwala kuyamba matenda oopsa a m'mimba.

Insulinoma: mankhwala

Chithandizo chachikulu cha insulinoma ndikuchita opareshoni. Momwemo, chotupa chimachotsedwa mu malire a minofu yathanzi.

Ngati chithandizo cha insulinomas pazifukwa zilizonse sizingatheke, chithandizo chokhazikika sichingatheke. Amakhala mu chakudya chamagulu cha odwala, kupumula kwakanthawi kwa matenda a hypoglycemia, mankhwala othandizira odwala omwe ali ndi vuto la ubongo.

Kuletsa kuukira kwa hypoglycemia, ndikosavuta kupatsa wodwalayo kapu ya tiyi kapena maswiti otsekemera. Pangokhala vuto la kusokonezeka kwa magazi, njira ya glucose iyenera kuperekedwa kudzera m'mitsempha. Ndikapanga chiwopsezo cha psychosis kapena hypoglycemic coma, gulu la ambulansi liyenera kutchedwa yomweyo.

Kanema wochokera pa YouTube pamutu wankhani:

- chotupa chotupa cha β-cell cha ma pancreatic islets, ndikupanga insulin mopitirira muyeso ndikupangitsa kukula kwa hypoglycemia. Hypoglycemic ikugwira ndi insulinoma imayendetsedwa ndi kunjenjemera, thukuta lozizira, kumverera kwa njala ndi mantha, tachycardia, paresthesias, malankhulidwe, zowoneka ndi zamakhalidwe, ovuta kwambiri - kupweteka ndi chikomokere. Kuzindikira kwa insulinoma kumachitika pogwiritsa ntchito mayeso othandizira, kudziwa kuchuluka kwa insulin, C-peptide, proinsulin ndi glucose wamagazi, ultrasound ya kapamba, kusankha angiography. Ndi insulinoma, chithandizo cha opaleshoni chikuwonetsedwa - chotupa, kuchuluka kwa kapamba, kapangidwe ka kapamba, kapenanso kuzimiririka kwathunthu.

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, ubongo chotupa, vegetovascular dystonia, sitiroko, diencephalic syndrome, pachimake psychosis, neurasthenia, zotsalira CNS ndi ena.

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 ndikutukuka kwa hypoglycemic coma.

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 insulinoma ichedwe kwambiri. 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 kwanjenjemera 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.

Kusiyanitsa mitundu

Ngati, atakhala kuti umboni wotsimikizira wa organic hyperinsulinism, insulini sanawoneke, percutaneous kapena laparoscopic diagnostic punop biopsy ya kapamba imachitika.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.

Kuzindikira kwa pancreatic insulinoma

Ndi chithandizo chanthawi yomweyo cha benign insulinoma, matendawa ndi abwino.

Pancreatic insulinoma ndi chotupa chamafuta m'thupi chomwe chimapanga insulin yowonjezera. Njirayi imabweretsa kukula kwa hypoglycemia. Wodwala agwidwa omwe amayambitsa kunjenjemera kwa thupi, mawonekedwe a thukuta lozizira. Wodwalayo amadandaula chifukwa cha njala. Amayamba tachycardia, mantha amawoneka, zovuta zowonekera ndi zolankhula zimayamba, kusintha kwa machitidwe. Zilonda zingapo zotere zimayambitsa kukomoka, ndipo nthawi zina munthu amagwa. Chithandizo cha matendawa chimachitika ndi njira zopangira opaleshoni.

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 chosagwirizana ndi insulin b yochitika 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 poyamba amatenga ngati zizindikiro za kugwidwa.

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, ndiye kuti magwiridwe antchito a ubongo amasokonekera, gawo lakumanjoya limagwidwa. 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, angayambire kulephera, ndipo izi zimadzetsa kutaya kwa ukadaulo ndikukulitsa ulemu wa 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, kuchuluka kwa odwala matenda amtundu wa glucose kumatha 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 amayenera 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 akhalebe 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, kuoneka kwa fistulas pazinthu zomwe zimayendetsedwa ndizotheka. Mwa anthu ena, peritonitis imawoneka kapena kukulira pambuyo pakuchita opaleshoni. Zotheka.

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 kuchuluka kwa kupulumuka kwa zaka 2 pambuyo pochita maphunziro sikumaposa 58%.

Kubwerezedwanso matendawa kumawonekera mu 4% ya milandu yonse yamankhwala. Ngati munthu ali ndi mbiri yamatendawa, ndiye kuti amalembetsedwa ndi neurologist ndi endocrinologist.

Chithandizo chapamwamba

Kapamba, mankhwalawa omwe amalembedwa ndi katswiri wazovuta, amagwira ntchito zosiyanasiyana. Mwa zazikulu, kakulidwe ka ma enzyme omwe amalimbikitsa kuyamwa kwa chakudya, mapuloteni ndi mafuta ayenera kudziwika. Kuphatikiza apo, thupi limatulutsa insulini, kuchepa kwake komwe kumatha kuyambitsa matenda ashuga. Pali matenda osiyanasiyana a kapamba. Mulinso zotupa zosiyanasiyana: gastrinoma, insulin ndi ena. Pancreatitis ndi matenda ena otchuka a kapamba. Chithandizo cha pathologies sichimangotengera kumwa mankhwala. Zofunikanso monga kusunga kwa chakudya. Acute pancreatitis ndi kutupa komwe kwayamba kwambiri. Zina mwazifukwa zazikulu zakutukuka kwake zimayenera kutchedwa uchidakwa, kuperewera kwa zakudya m'thupi. Kuphatikiza apo, matenda am'mimba amatha kukhala zovuta za chifuwa, chimfine kapena zilonda zapakhosi. Pancreatitis imayendera limodzi ndi zowawa, zomwe zimatha kukhala zamtundu wa zoster. Amapangidwa makamaka m'dera la hypochondrium ndi epigastric. Ndi vuto lalikulu, kukoka kwake ndi kupsinjika kumachepa, kusanza kumachitika.Panthawi imeneyi, wodwala amafunikira kuchipatala mwachangu.

Njira zochizira pancreatitis

Zikondwererozo zikamayaka kwambiri, mankhwala okhala ndi mapiritsi satha. Kuti muchepetse vutoli, mankhwala amaperekedwa kudzera m'mitsempha. Wodwalayo amalandiranso michere ya makolo, popeza kulandila kumakhala kovuta. Pakati pa mankhwala omwe amagwiritsidwa ntchito kuti athetse vuto lodana kwambiri, ndikofunikira kutchula mankhwala monga Contrical (kutumikiridwa nthawi yomweyo, kamodzi pa mlingo wa magawo 10 mpaka 60,000), Pantripin, Gordoks. Mankhwalawa onse ndi othandizira a antienzyme. Kapangidwe ka zochita zawo kumatengera zoletsa za ntchito za ma protein (chymotrypsin, trypsin ndi ena). Ziyenera kunenedwa kuti mankhwalawa amathanso kuyambitsa mavuto osiyanasiyana, motero amawayikidwa limodzi ndi antihistamines.

Ndi mapiritsi ati a kapamba nthawi zambiri omwe amaperekedwa?

Kukonzekera kwaantacid sikofunikira kwenikweni pa mankhwalawa kapamba. Ntchito yawo ndikuyipitsa kapena kumanga hydrochloric acid, kupewa kuti ipangidwe. Komabe, kuzitenga padera kuchokera kubisalira zoletsa sizikulimbikitsidwa. Chithandizo cha kapamba ndi mapiritsi a Maalox ndizofala kwambiri. Monga antacid, mankhwalawa "Ranitidine" amagwiritsidwa ntchito. Mankhwala monga Spazgan, No-Shpa, Diclofenac, Papaverine ndi mapiritsi ena a ululu wa kapamba amadziwika ngati adjuvants. Amangochepetsa mkhalidwe wa odwala.

Mankhwala "Maalox"

Zikondazo zikapsa, chithandizo ndi mapiritsi chimalimbikitsidwa atachotsa matenda oopsa. Kuphatikizika "Maalox" kumakhala ndi zovuta za magnesium hydroxide ndi aluminium. Izi zimapereka chitetezo, zimawonetsa kukhudzika. Mankhwalawa ali ndi katundu woyamwa, wovuta komanso wokuta. Imwani mankhwalawa mutatha kudya, pambuyo pa ola limodzi ndi theka. Mankhwalawa amasungidwa mkamwa mpaka atayambiranso.

Mwa zomwe akuphwanya kutenga mankhwala a "Maalox", hypersensitivity ndikuwonetsa kuwonongeka kwa ntchito yaimpso kuyenera kuzindikirika. Kuchiza kwanthaŵi yayitali kwa kapamba wokhala ndi mapiritsi a Maalox kungayambitse kuchepa kwa phosphorous m'thupi. Izi ziyenera kukumbukiridwa.

Kutanthauza "No-spa"

Zikondwerero zikayamba kuvuta, chithandizo ndi mapiritsi chimayikidwa ndi katswiri. Monga tanenera kale pamwambapa, kuwonjezera pa mankhwala oyambira, ndalama zowonjezereka zimalimbikitsidwa. Ntchito yawo ndikuchotsa kuphipha ndi kupweteka. Chimodzi mwa mankhwala otchuka a antispasmodic ndi No-Shpa. Zomwe zimagwiritsidwa ntchito ndi drotaverine hydrochloride. Mankhwalawa amathetsa kukokana, amachepetsa kukula kwa ululu. Mlingo wa tsiku ndi tsiku wa akulu ndi mamilimita 120-240, wogawidwa pawiri kapena katatu. Kutalika kwa ntchito - zosaposa masiku 1-2.

Nkhani yothandiza? Gawani ulalo

Ngati ndi kotheka, nthawi yayitali ayenera kufunsa katswiri.

Mankhwala ena a kapamba

Akatswiri amati, ngakhale patakhala kuti matendawa alibe matenda, akhoza kutsatana ndi zotupa za bakiteriya. Pankhaniyi, chithandizo cha kapamba ndi mapiritsi okhala ndi mitundu yambiri ya antibayotiki ndi mankhwala. Makamaka, mankhwalawa amaphatikizapo Ampicillin, Tobramycin, Carbenicillin. Limagwirira ntchito ya mankhwalawa zachokera zoletsa ntchito za tizilombo tating'onoting'ono tokhala tcheru. Asanapereke mankhwala awa, kafukufuku wapadera wa labotale amachitidwa. Zimakupatsani mwayi kudziwa mtundu komanso kuchuluka kwa chidwi cha mabakiteriya.

Kutanthauza "Ampicillin." Kufotokozera kwapfupi

Mankhwala ndi a gulu la semisynthetic penicillin.Zochita zake zimakhazikitsidwa pakutha kupondereza kuphatikizika kwa khoma la khungu la bakiteriya. Wothandizirayo ali ndi mphamvu yotsutsana ndi tizilombo tosiyanasiyana tating'onoting'ono tating'onoting'ono tating'onoting'ono, kupatula tomwe timatulutsa penicillinase. Mlingo wa mankhwalawa umayikidwa payekha, molingana ndi kuopsa kwa zizindikiro ndi kulolera kwa wodwala.

Mwa contraindication amatchedwa lymphocytic leukemia, hypersensitivity, kuphwanya chiwindi ntchito. Mankhwalawa amayambitsa zovuta zingapo, zomwe zimakonda kwambiri.

Katundu wa enzyme

Pankhani ya kuchepa kwa ntchito ya exocrine ya gland, akatswiri amalimbikitsa mankhwala omwe ali ndi pancreatin. Kulandila ndalama zotere kumatha nthawi yayitali. Mlingo umayikidwa payekha. Mankhwalawa, makamaka, amaphatikizapo "Festal". Ziyenera kunenedwa kuti mankhwalawa amapatsidwa mankhwala apakhungu a kapamba. Kuchulukitsa kwa matenda kapena mawonekedwe ake owopsa ndi kuphwanya. Pankhaniyi, kulandila ndalama kuyenera kuchitika mosamalitsa malinga ndi malangizo a dokotala.

Mankhwala "Festal". Malangizo achidule: zofunikira

Mankhwala, monga tafotokozera pamwambapa, pancreatin ilipo. Pulogalamuyi ili ndi ma enzyme angapo omwe amathandizira kuti ntchito ya pancreatic ikhale yachilengedwe. Makamaka, lipase, amylase ndi proteinase zilipo. Zimayendetsa chimbudzi cha mapuloteni ndi zakudya zamafuta. Izi, zimathandizira kuyamwa kwawo mwachangu komanso kokwanira m'matumbo ang'onoang'ono. Enzyme ya hemicellulase, yomwe ilinso mu mankhwalawa, imathandizira pakuwonongeka kwachilengedwe kwa fiber.

Chifukwa cha izi, njira ya m'mimba imagaya bwino, kapangidwe ka mpweya m'matumbo amachepa. Mankhwalawa amakhalanso ndi choleretic, omwe amathandizira emulsia yamafuta ndikuwonjezera kuyamwa kwawo. Mankhwala "Festal" amalimbikitsidwa atangodya. Akuluakulu amalimbikitsidwa katatu patsiku kwa mapiritsi a 1-2. Ngati ndi kotheka, kumwa Mlingo wapamwamba muyenera kufunsa dokotala. Chithandizo cha zikondamoyo ndi mapiritsi a Festal amatha masiku angapo, miyezi, kapena zaka (ndikuyikidwa kwa mankhwala othandizira). Mankhwala ayenera kuyang'aniridwa ndi katswiri.

Tumor pathologies. Chithandizo

Zotupa za pancreatic ndimapangidwe a mahomoni. Amatha kukhala oopsa kapena owopsa. Kuzindikira kwa pathologies kumachitika ndi computer tomography kapena ultrasound. Chithandizo cha kapamba ndi mapiritsi awa sizothandiza. Monga lamulo, mankhwala amaikidwa kuti athetse kukomoka, kuthetsa vutoli. Njira zazikulu zochotsera matenda ndi kuyambitsa maopaleshoni.

Kodi pali mankhwala osokoneza bongo a kapamba?

Anthu ambiri amayesa kupewa kumwa mankhwala othandizira, makamaka kukonzekera kwachilengedwe, mankhwala azitsamba. Makamaka, monga momwe tikulimbikitsira, mwachitsanzo, mankhwala azikhalidwe, phula ndi wotchuka kwambiri. Ili ndi kuchuluka kwa zinthu zambiri zogwiritsa ntchito pakachilengedwe, mankhwala achilengedwe, mavitamini. Kuphatikiza apo, phula limakhala ndi kufufuza zinthu ndi mchere wofunikira m'thupi. Chipangizocho chimakhala ndi phindu pazochitika zambiri zamthupi, chimathandizira kukhazikika kwa ziwalo zamkati, makamaka, zimathandizira kugwira ntchito kwa kapamba. Ndi bwino kudya pafupifupi magalamu atatu a phula katatu patsiku musanadye. Iyenera kutafunidwa bwino.

Zosagwiranso ntchito kwambiri ndizo mafuta. A decoction amakonzekereratu. Kuti muchite izi, 250 g yaiwisi amathiridwa ndi theka la madzi. Osakaniza amapaka maola khumi. Kenako, kulowetsedwa kumawiritsa kwa theka la ola.Msuzi womwe unayambitsidwa umaloledwa kulowerera m'malo amdima, otentha. Pambuyo maola asanu ndi limodzi, iyenera kusefedwa ndi kuwonjezeredwa ku thanki yamadzi kuti voliyumu ndi lita imodzi. Hafu ya ola limodzi asanadye, msuzi umatengedwa pa 7 tbsp. l kangapo patsiku. Kutalika kwa nthawi yayitali kuli ngati milungu iwiri. Zothandiza pa kapamba ndi uchi. Ndikulimbikitsidwa kuti muzidya supuni musanadye. Ndi kutupa, madzi a mbatata amathandiza. Ma peeled tubers amayikidwa mu juicer. Mankhwala aledzera 100 magalamu asanadye pa ola limodzi. Pa nthawi yoyembekezera, mankhwala ndi osayenera. Ngati pali zovuta zina muzochitika zam'mapapo nthawi yayitali, njira yayikulu yothandizira ndikutsatira zakudya zapadera, zomwe zimasankhidwa ndi katswiri wazakudya.

Cancreas (kapamba) imakhala ndi mutu, thupi ndi mchira, imagwira ntchito zingapo mthupi la munthu: imatulutsa ma enzymes omwe amalimbikitsa chimbudzi cha chakudya, ndikupanga mahomoni (glucagon, insulin) omwe amawongolera kayendedwe ka metabolic mthupi la munthu. Nthawi zina, pancreatic cystadenoma imawonedwa - chosaopsa neoplasm yomwe imakhudza minofu ya limba. Pathology nthawi zambiri imakhudza thupi kapena mchira wa chiwalo ndipo imayang'aniridwa makamaka pakugonana koyenera.

Pancreatic cystadenoma ndi chotupa cha cystic benign chomwe chimapangika kuchokera ku epithelium ya chiwalo. Gawo lalikulu la neoplasms yomwe yapezeka ndi zotupa kapena zotupa, zomwe nthawi zambiri zimapezeka mu thupi ndi mchira wa kapamba, cystadenoma ya mutu wa kapamba ndizochepa kwambiri. Cysts amayikidwa mu kapamwamba kofiyira, komwe kali ndi khoma lokwanira masentimita ndi theka. Mitundu ya cystic imatha kukhala ndi timiyendo tambiri, tosiyanitsidwa ndi magawo, ndipo imakhala gawo limodzi lalikulu.

Etiology ya matenda

Nthawi zambiri, matendawa amakhudza azimayi kuyambira zaka makumi awiri ndi zisanu mpaka makumi asanu ndi awiri ndi zisanu. Mwa matenda onse otupa a kapamba, cystadenoma ndiofala kwambiri. Imapezeka mu 15% ya anthu omwe ali ndi cystic neoplasms ndipo 4% yokhala ndi zotupa za chiwalochi. Mwachilengedwe, pancreatic cystadenoma (ICD 10 pansi pa chiwerengero cha K85 - K86) ndiyopanda pake ndipo siziika pachiwopsezo chaumoyo ndi moyo.

Koma mitundu yake ina imatha kukhala ma neoplasms oyipa pakapita kanthawi. Nthawi zambiri izi zimakhala zotupa zopangidwa ndi papillary.

Zosiyanasiyana

Mankhwala, ndichizolowezi kusiyanitsa mitundu itatu yam'mimba yamatumbo a chosaopsa, chilichonse chomwe chili ndi mawonekedwe ake:

1. Serous cystadenoma, yomwe ili ndi timiyendo tambiri todzaza ndi madzi amadzimadzi ndipo imasiyanitsidwa ndi septa. Awa ma septa amagawa chotupacho m'magulu ang'onoang'ono a cysts. Amakula pang'onopang'ono, osasandulika kukhala wopweteka, ndipo amakula ngati kusinthana kwa imodzi ya ma chromosomes. Kukula kwa serous cystadenoma pafupifupi masentimita asanu ndi awiri. Kwa nthawi yayitali, siziwonetsera mwanjira iliyonse, chifukwa chake, monga lamulo, imapezeka mwangozi pakaunikira. Chofunikira apa ndikuzindikira kusiyanitsa, komwe ndikofunikira kuti tisasokoneze chotupacho ndi pseudocyst yotchedwa pseudocyst.
2. Mucinous cystadenoma. Ndi chotupa cha chipinda chambiri. Mkati mwake muli ntchofu. Madokotala ali ndi lingaliro kuti limachokera ku tiziwalo tambiri tchiberekero, tomwe timalowa m'matumbo mwa nthawi ya intrauterine. Mitundu yake ikukula mwachangu, imatha kukula mpaka ma sentimita khumi ndi asanu. Chofunikira pa matenda ngati mucinous cystadenoma ndikuti imatha kukhala dongo loyipitsa chotchedwa cystadenocarcinoma. Matenda akayamba, munthu amayamba kumva kupweteka komanso kusasangalala.Pankhaniyi, opaleshoni imagwiritsidwa ntchito nthawi zonse ndikuchotsa kwathunthu kwa zikondamoyo zomwe zakhudzidwa.
3. Papillary cystadenoma intraductal ndimatenda osowa kwambiri omwe amapezeka pamalungo a kapamba, ndipo amayimira kukula kwa epithelial. Mkati mwa chotupa chija muli ntchofu wa viscous. Imatha kukhala chopanda vuto. Diagnised intraductal papillary cystadenoma ndi zovuta. Pathology ikhoza kukhudza gawo linalake la kapamba. Chotupacho nthawi zonse chimachotsedwa ndi opaleshoni, pomwe amafufuza mwachangu histological.

Matendawa siofala ngati mankhwala. Mkhalidwe woipa wa zotupa umadziwika ndi mapangidwe a metastases, omwe amachititsa kukula kwa hypoglycemia ndi hyperinsulinism. Ndi mitundu yofatsa ya matendawa, tachycardia, kufooka ndi mseru, kuwonjezeka kwa mavuto kumawonedwa. Muzovuta kwambiri, kukomoka komanso kusokonezeka kwa thupi kumawonekera. Chifukwa chake, zizindikiro za pancreatic cystadenoma mwa odwala zimakhala zofatsa. Kunja, odwala amawoneka abwinobwino. Mwa khumi peresenti ya odwala, matendawa sadziwonetsa konse. Enawo ali ndi zizindikilo zomwe zimafanana ndi zomwe zimayambitsa kutukusira kwa ziwalo zam'mimba. Ambiri a neoplasms amatha kutha, pomwe pamakhala kupweteka pang'ono. Zizindikiro zazikulu za matendawa ndi monga:

• Kuphwanya kwa mphamvu ya mahomoni, yomwe imadziwonetsa mwa kufooka, kuda nkhawa, nthawi zina - kutaya chikumbumtima.
• Kupweteka kwapakati pamimba yapamwamba, yomwe imaperekedwa kwa phewa kapena mkono. Amatha kulimbitsa thupi atatha kuchita masewera olimbitsa thupi.
• Zovuta mukamayenda pamimba pamimba, epigastric dera.
• Kusanza, kusanza, kulemera m'mimba.
• Maonekedwe a jaundice.

Nthawi zina, pancreatic cystadenoma imatha kubweretsa kukula kwa mikhalidwe yoopsa: kapamba, khansa, endocrine pathology, kuledzera kwa biliary, etc.

Zizindikiro zakuwukira

Pakuwukira, kuwonetsa kwa hypoglycemia kumakulitsa, magulu a adrenaline amawonjezeka mofulumira. Gawo lachiwopsezo limatha kugwira magwiridwe antchito amanjenje. Ngati zoterezi zikuchitika, munthu angadwale matenda amanjenje kapena amisala. Kuwonetsedwa kwa insulin panthawi ya kukokosera:

• kupweteka kwambiri / kwam'mutu,
• kulumikizana mosasamala pakuyenda,
• kusuntha kwa zifukwa
• kuwonongeka kwamawonekedwe
• kuyerekezera
• Nkhawa ndi nkhawa
• maulendo owopa, otsatiridwa ndi euphoria kenako nkhalwe,
• miyendo yanjenjemera
• kugunda kwa mtima
• kutuluka thukuta kwambiri.

Zochita za insulin

Insulin ndi gawo la mahomoni a polypeptide, omwe ndi ofunikira kwambiri kwa "chilengedwe chonse cha munthu". Kodi ayenera kugwira ntchito ziti?

• Amapereka ma amino acid kumaselo ogwirira ntchito. Timadzi timene timathandizira "kutsegula" khungu kuti lisasowe glucose - gwero lamphamvu.
• Amagwira nawo ntchito yomanga minofu ya minofu.
• Chifukwa cha mahomoni, potaziyamu ndi amino acid amaperekedwanso m'maselo.

Kusintha kwa magawo am'madzi mwa polypeptide iyi kumatha kukhala limodzi ndi mutu, kupweteka kwam'mimba m'mimba, kugona, komanso kudzimbidwa. Pankhani ya malamba a kapamba, kapangidwe kabwino ka insulin kamasokonezeka.

Mlingo wambiri kapena wotsika kwambiri wa insulin m'magazi ndi alarm, muyenera kumvetsetsa zifukwa ndi nthawi ndikuchita zoyenera kuti mukhale ndi thanzi lanu kwazaka zambiri.

Chikhalidwe cha kukhalapo kwa mahomoni m'magazi chimachokera ku 5.5 mpaka 10 μU / ml. Uwu ndi avareji. Pamimba yopanda kanthu, mulingo wake umachokera pa 3 mpaka 27 mcU / ml. Komabe, mwa amayi nthawi yomwe ali ndi pakati, kuchuluka kwa mahomoni kumakhala kwakukulu kuposa 6-27 μU / ml. Chizindikiro ichi chikuchulukanso mwa anthu okalamba.

Muyenera kudziwa: kuchuluka kwa insulin kumayeza kokha pamimba yopanda kanthu.Mukatha kudya, chizindikiro chake chimachulukirachulukira. Kuyesedwa kwa magazi kotere, munthu akadya m'mawa, sizowona. Mukatha kudya, kuchuluka kwa insulin kumakula panthawi yaunyamata. Muubwana, palibe kudalira koteroko mu kupanga mahomoni.

Mwa madokotala, zimadziwikanso kuti mulingo wa 11.5 μU / ml kale ndi chizindikiro cha boma la prediabetes. Ndiye kuti, matenda a shuga omwe amapezeka amakhala.

Zizindikiro zakunja

Ndikosavuta kutsata nthendayo pokhapokha ngati tikuwopseza. Mawonekedwe amachepetsedwa, kutsika, ndikuwonetsa pang'ono. Ndi insulinomas panthawi yachikhululukiro, zotsatirazi zimachitika:

• kudya kwambiri kapena kukana chakudya kwathunthu,
• kulemera msanga, kapena, kwambiri kuwonda kwambiri,
• kukula kwa ziwalo,
• zopweteka / kusasangalala mukamasuntha
• kuwonongeka kwa nkhope
• kuphwanya njira zokumbukira,
• kutayika kwa maluso ndi ukadaulo waluso,
• kusowa chidwi ndi zokopa zakunja,
• kuchepa kwa milingo yamachitidwe amisala.

Mkhalidwe wotere umakhala wowonekeratu ndikuwonongeka kawirikawiri ndi chikomokere. Chonde dziwani: matenda omwe amayenda ndimatenda owopsa angayambitse kulumala.

Madzi a insulin adakula

Kodi chidzachitika ndi chiani ndi thanzi la munthu ndikadzikweza insulin? Shuga wamagazi amatha kukhala wabwinobwino kwakanthawi kochepa ngati izi. Kudya michere yokha kumabweretsa chakuti zikondamoyo zimayenera kusunga insulini nthawi zonse pamlingo wokwera. Koma popita nthawi, minyewa imayamba kugonjetsedwa ndi mahomoni, ndipo chimbudzi chimatulutsa zomwe zimapeza. Milingo ya insulin imayamba kugwa.

Glucose mpaka imadutsa m'magulu amafuta, glycogen (mphamvu yosagwiritsidwa ntchito) imayikidwa mu chiwindi. Shuga wamagazi samapitirira kuposa zomwe zimachitika nthawi yomweyo, mwa sabata limodzi kapena awiri. Izi zimachitika pang'onopang'ono. Mulingo wokwezeka wa insulin ndi wopanda pake ngati wotsika. Munthu amawopsezedwa ndi matenda otsatirawa kwakanthawi:

• matenda a mtima
• Matenda a Alzheimer's
• polycystic ovary mwa akazi,
• kukanika kwa amuna,
• matenda oopsa (kuthamanga kwa magazi).

Ngati insulin yokwezeka yapezeka, ikutanthauza chiyani? Izi zikutanthauza kuti kuwundana kwa magazi sikungasungunuke, kuthamanga kwa magazi, kuchuluka kwa mtima kumasokonekera, ndipo sodium amasungidwa impso. Ndiye kuti, mkhalidwe waumoyo ukukula nthawi zonse. Malinga ndi kuyerekezera koyipa, chiopsezo cha kuphwanya myocardial chikuwonjezeka mwa anthuwa pafupifupi kawiri.

Zizindikiro za insulin yowonjezereka

Kuzindikira kukana insulini ndikwabwino kwambiri momwe mungathere. Ngakhale thupi silinayende ku ma pathological. Kunena ngati insulini idakulira m'magazi kapena ayi, ndikokwanira kuti dokotala amufunse mafunso kuti adziwe ngati akumakumana ndi mavuto ngati awa:

• kutopa kwambiri
• kuganizira kwambiri,
• kuthamanga kwa magazi
• kulemera kumawonjezeka
• khungu lamafuta
• dandruff
• seborrhea.

Ngati zingapo mwazizindikirozi zikupezeka, ndiye kuti muyenera kuyesa magazi msanga. Ndipo ngati nthawi ndi nthawi wodwala amakhudzidwa ndi kupsinjika kwa hypoglycemia (kutsika kwa shuga, kuwonjezera apo, kowonda), ndiye kuti amapatsidwa zakudya zapadera. Mlingo wa shuga umasungidwa makamaka ndi yankho la shuga.

Zimayambitsa kuchuluka kwa insulin. Insulinoma

Ndikofunikira kudziwa chifukwa chake insulin yamagazi imakwezedwa. Zifukwazi zimakhala zosiyanasiyana. Mwachitsanzo:

• njala yayitali
• kulimbitsa thupi kwambiri,
• mimba
• kumwa mankhwala ena
• Pali zakudya zopatsa thanzi kwambiri za shuga
• kusagwira bwino ntchito kwa chiwindi.

Komabe, nthawi zina chimayambitsa vuto la kuperewera kwa zakudya m'thupi kwa nthawi yayitali ndikupangitsa kuti mantha azitha. Kenako mufunika kupuma kwakanthawi komanso kukhala ndi zakudya zabwino kuti mulingo wa mahomoni ubwerere mwakale.

Komanso anomatic yotere imayambitsidwa ndi neoplasm mu kapamba, wotchedwa insulinoma. Mu khansa, misempha ya insulin imakwezedwa nthawi zonse.Ndipo insulin imakhala ndi zizindikiritso zina zowonjezereka, zowawa kwambiri.

1. Kufooka minofu.
2. Kudzanjenjemera.
3. Zowonongeka.
4. Kusokonekera kwa mawu.
5. Mutu waukulu.
6. Zingwe.
7. Njala komanso thukuta lozizira.

Zizindikiro zimawonekera makamaka m'mawa kwambiri. Khansa ya kapamba samachiritsidwa. Chotupa chimatha kuyang'aniridwa ndikuyang'aniridwa kuti zotupa zachiwiri zisachitike mu ubongo kapena chiwindi.

Momwe mungachepetse insulin?

Koma nthawi zina zimachitika kuti shuga wokwezeka wapezeka pang'onopang'ono, pomwe insulini yamagazi ikutsatira kwathunthu ndi zizindikiro zowoneka bwino. Kusanthula uku kukusonyeza kuyambika kwa matenda ashuga. Kukhazikika kwokhala ndi phokoso m'moyo kumabweretsa kulemera ndi metabolic syndrome. Amadziwika kuti endocrinologists mwa dongosolo la prediabetesic boma.

Kusavomereza kwa insulin kumatchedwa insulin. Ili ndiye gawo loyamba la metabolic syndrome. Ndi njira imeneyi yomwe imayamba chakudya chotsekemera kwambiri, ndipo thupi limazolowera kwambiri insulin. Ndipo, ngakhale kuti kapamba amatulutsa michere yambiri ya polypeptide, shuga simalumikizidwa ndi thupi monga ayenera. Izi zimabweretsa kunenepa kwambiri. Koma nthawi zina izi zimachitika chifukwa chokana fructose pazifukwa zobadwa nazo.

Pofuna kupewa "insulin" ya insulin, muyenera kuthandiza thupi. Glucose imayenera kulowa minofu, kagayidwe kamayendetsedwa, ndipo kulemera kumabweranso kwabwinobwino. Pa nthawi yomweyo, kuchuluka kwa mahomoni ogonana ndiwabwino. Ndiye kuti, muyenera kupita kumasewera ndikusinthira kuzakudya zopatsa thanzi zomwe zikugwirizana ndi mawonekedwe anu komanso moyo wanu.

Wotsika insulin. Matenda a shuga

Insulin yocheperako imapangitsa shuga m'magazi kukula pang'onopang'ono. Maselo sangathe kupanga glucose yemwe amabwera ndi chakudya. Izi ndizowopsa. Kuchuluka kwa misempha ya shuga ndikosavuta kuwona. Zizindikiro zomwe zimayenderana ndi kuchepa kwa shuga ndi izi:

• kupuma pafupipafupi
• kuwonongeka kwamawonekedwe
• kusowa kwa chakudya
• nthawi zina nkhawa za kusanza komanso kupweteka m'mimba.

Mulingo wochepetsetsa kwambiri wa mahomoni ofunikira otere amadziwika ndi zinthu zotsatirazi:

1. Pali njala yamphamvu.
2. Kuda nkhawa ndi nkhawa zopanda pake.
3. Ndikumva ludzu.
4. Kutentha kumadzuka ndipo thukuta limamasulidwa.

Kuphatikizidwa kwa insulini pamapeto pake kumayambitsa matenda a shuga 1.

Matendawa amatenga ana ndi achinyamata, nthawi zambiri atadwala. Poterepa, ndikofunikira kuyang'anitsitsa kuchuluka kwa shuga pogwiritsa ntchito glucometer.

Matenda a shuga. Zotsatira za matenda ashuga

Popeza insulin imachulukitsa kuchuluka kwa glucose m'magazi, kugwira ntchito kwa mitsempha kumasokonekera pakapita nthawi. Pambuyo pazaka 10-15 zokhala ndi shuga wambiri wamagazi, matenda a shuga amayamba. Iagawika m'mitundu ingapo: kudziyimira payokha, kotalikirana komanso kowoneka bwino. Nthawi zambiri, odwala matenda ashuga amakhala ndi zizindikiro za zotumphukira neuropathy. Izi ndi izi:

• kuchepa mphamvu kapena kupindika kwa miyendo,
• kuphwanya mgwirizano
• kutaya bwino
• kumva kugwedezeka, dzanzi komanso kupweteka m'miyendo (nthawi zambiri kumapazi).

Pofuna kupewa kupitirira kwa neuropathy, muyenera kuperekera magazi pafupipafupi kuti muunikenso ndikuwunika kuchuluka kwa shuga. Kusiya kusuta fodya ndi mowa ndizofunikira.

Inde, matendawa amapezekanso pazifukwa zina - kuvulala, zovuta za poizoni, ndi zifukwa zina. Koma pafupifupi matenda a shuga omwe amapezeka, omwe amayamba pang'onopang'ono ndikuwononga pang'onopang'ono makhoma amitsempha yamagazi ndi minyewa yamitsempha, ndimomwe amachititsa neuropathy.

Zina zomwe zimachitika chifukwa cha matenda ashuga ndi glaucoma komanso kusokonezeka kwa magazi. Magazi amayenda mpaka zilonda zam'mimba zimatsatiridwa.

Chithandizo cha matenda ashuga

Malinga ndi kuyezetsa magazi kwa shuga, adotolo adzalembera chithandizo chofunikira.Mu shuga, chomwe chimapangitsa kuti pakhale osakwanira pancreatic secretion (ya mtundu woyamba), ndikofunikira jakisoni insulin kawiri pa tsiku. Dokotala amafotokozanso za kusowa kwa zakudya zoyenera kudya, zomwe ziyenera kuyang'aniridwa nthawi zonse.

Eya, matenda ashuga amtundu wachiwiri ndi zotsatira za kupsinjika ndi njira yolakwika, yosagwira ntchito, nthawi zambiri imapangitsa kuchuluka kwa insulin. Mtunduwu umatchedwa kuti shuga yemwe amadalira insulin, umathandizidwa ndimankhwala ena. Ndikofunika kupeza masewera aliwonse omwe mumakonda ndikukonzekera zolimbitsa thupi minofu. Komabe, mulingo wa insulini umafunikanso kuwunikidwa pafupipafupi ndikuyang'ana kwa dokotala-endocrinologist.

Zakudya zoyenera kwa odwala matenda ashuga

Maziko a shuga ndi zakudya. Zimatengera kuchuluka kwa insulin. Ngati insulini yamagazi ikwezedwa, zotsatirazi ziyenera kutsatiridwa.

1. Zinthu zamkaka ndizothandiza, koma zopanda mafuta.
2. Mphete Zonse.
3. Nsomba zamafuta ochepa.
4. Mazira owiritsa, osaposa 3 ma PC. kwa masiku 7.
5. Nyama iyenera kutayidwa, makamaka mafuta a nkhumba ambiri.

M'pofunika kudya munthawi yovomerezeka. Kenako thupi pakapita nthawi limatulutsa michere yonse yofunikira yokumba m'mimba.

Ndikofunikanso kuti zigawozo ndizochepa, koma muyenera kudya kasanu kapena kasanu ndi kamodzi patsiku.

Tikudziwa kuti insulini imawonjezera shuga m'magazi, motero kwa iwo omwe ali ndi matenda a shuga omwe amadalira insulin, zakudya zake zimakhala zowumitsa. Pazakudya zotere, ma calories onse ayenera kuwerengedwa mosamala kuti pakhale insulin yokwanira kuti isinthe molekyu iliyonse ya sucrose kukhala mphamvu.

Moyo wopanda zizolowezi zoipa ndiye njira yabwino yopewera

M'malo mwake, matenda ngati a shuga sakhala osachiritsika. Nthawi zina, kusintha kwa wodwalayo kumawonedwa. Muzochitika kuti nthawi zonse amayang'aniridwa ndi madokotala.

Koma moyenera, ngakhale kuwunika shuga pafupipafupi, matendawa amapita patsogolo ndipo zotsatira zake zingakhale chotupa cha khansa kapena kunenepa kwambiri, kufupika ndi vuto la mtima.

Ndikofunika kuyenda koyenda pafupipafupi, kuteteza dongosolo lanu lamanjenje kuti musapanikizike kwambiri mothandizidwa ndi zochitika zolimbitsa thupi komanso kusangalala ndi moyo. Zakudya zopatsa thanzi, zopanda mafuta ochulukirapo, popanda kudya mwachangu zidzakulitsa moyo wanu ndikupulumutsani ku matenda ambiri. Osati kokha kuchokera kuphwanya insulin.

Matenda a shuga ndi kupsinjika kudzakhala chinthu chakale

Matenda a shuga ndi omwe amayambitsa pafupifupi 80% yonse yamikwingwirima ndi kuduladula. Anthu 7 mwa anthu 10 amafa chifukwa cha mitsempha ya mtima kapena ubongo. Pafupifupi nthawi zonse, chifukwa chomaliza chomaliza ndi chimodzimodzi - shuga wamwazi.

Shuga akhoza ndipo amayenera kugwetsedwa, apo ayi. Koma izi sizichiritsa matendawa, koma zimangothandiza kulimbana ndi kufufuza, osati zomwe zimayambitsa matendawa.

Mankhwala okhawo omwe amavomerezeka pamankhwala othandizira odwala matenda ashuga komanso amagwiritsidwa ntchito ndi ma endocrinologists pantchito yawo ndi awa.

Kugwiritsa ntchito bwino kwa mankhwalawa, kuwerengera malinga ndi njira yokhazikika (kuchuluka kwa odwala omwe achiwonjezere kuchuluka kwa odwala omwe ali pagulu la anthu 100 omwe adachitiridwa chithandizo):

• Matenda a shuga - 95%
• Kuthetsa kwa mitsempha thrombosis - 70%
• Kuthetsa kwa kugunda kwamtima kwamphamvu - 90%
• Kuthana ndi kuthamanga kwa magazi - 92%
• Kulimbitsa tsiku, kukonza kugona usiku - 97%

Opanga si bungwe lazamalonda ndipo amalipidwa ndi chithandizo cha boma. Chifukwa chake, tsopano wokhala aliyense ali ndi mwayi.

Chotupa chija sichachilendo, munthu m'modzi mwa 1.25 miliyoni amadwala. Nthawi zambiri imakhala yaying'ono, mpaka 2 cm, yomwe imakhala mu kapamba. Mu 1% ya milandu, insulinoma imatha kukhala pakhoma la m'mimba, duodenum, pa ndulu, chiwindi.

Chotupa chokhala ndi mainchesi pafupifupi theka la sentimita chimatha kupanga kuchuluka kwa insulini komwe kumapangitsa kutsika kwa glucose pansi pazonse. Nthawi yomweyo, ndizovuta kuzizindikira, makamaka ndi kutengera kwa atypical.

Akuluakulu azaka zogwira ntchito nthawi zambiri amakhudzidwa ndi insulinoma, azimayi amakhala ndi mwayi wambiri nthawi 1.5.

Nthawi zambiri, benign insulinomas (ICD-10 code: D13.7), atatha kukula kwa 2,5 masentimita, ndi 15 peresenti yokha ya neoplasms yomwe imayamba kuwonetsa zizindikiro za vuto loyipa (code C25.4).

Chifukwa chomwe chimakhalira ndi momwe

Zomwe zimapangidwira insulinomas sizikudziwika kwenikweni. Malingaliro amapangidwa za kukhalapo kwa chibadwa chakuwonjezereka kwa kuchuluka kwa maselo, za kulephera kamodzi pakumagwirira ntchito kwa thupi, koma malingaliro awa sanatsimikizirepo sayansi. Mgwirizano wokhawo wa insulinomas wokhala ndi mitundu yambiri ya endocrine adenomatosis, nthenda yamtundu wachilendo momwe zotupa za mahomoni zimapangika, ndizokhazikika. Mu 80% ya odwala, zotupa zimawonedwa mu kapamba.

Insulinomas imatha kukhala ndi mawonekedwe aliwonse, ndipo nthawi zambiri madera omwe ali mkati mwa chotupa chomwecho amasiyana. Izi ndichifukwa cha kuthekera kosiyanasiyana kwa insulini kutulutsa, kusunga ndi kusunga insulin. Kuphatikiza pa maselo a beta, chotupacho chimatha kukhala ndi maselo ena a pancreatic, atypical komanso othandiza. Theka la neoplasms, kuwonjezera pa insulin, amatha kupanga mahomoni ena - pancreatic polypeptide, glucagon, gastrin.

Insulinomas yocheperako imaganiziridwa kuti ndi yayikulu komanso imakhala yoopsa. Mwina izi zimachitika chifukwa chazovuta kwambiri komanso kuzindikira mochedwa matendawa. Pafupipafupi hypoglycemia ndi kuchuluka kwa kuchuluka kwa zizindikiro ndizogwirizana ndi zotupa.

Dongosolo lamanjenje la autonomic limavutika ndi kusowa kwa glucose m'magazi, kugwira ntchito kwa chapakati kumalephera. Nthawi ndi nthawi, shuga wochepa wa m'magazi amathandizira kuchita zinthu zambiri zamanjenje, kuphatikizapo kuganiza ndi kudziwa. Ndizowonongeka kwa cortex ya ubongo yomwe nthawi zambiri imalumikizidwa ndi zosayenera za odwala omwe ali ndi insulinoma. Matenda a metabolism amachititsa kuwonongeka kwa makoma amitsempha yamagazi, omwe amachititsa kuti edema ya ubongo ipangike, ndipo mawonekedwe a magazi amapanga.

Zizindikiro zake za insulinoma

Insulinoma imatulutsa insulini mokhazikika, ndipo imakankha yokha pokhapokha, chifukwa chake zovuta za episodic za hypoglycemia zimasinthidwa ndi wachibale.

Komanso kuopsa kwa zizindikiro za insulinoma kumakhudzidwa ndi:

1. Muli zakudya. Mafani amaswidi amamva mavuto mthupi pambuyo pake kuposa otsatira mapuloteni.
2. Kuzindikira kwamunthu m'modzi ndi insulin: anthu ena amataya magazi ndi shuga wochepera 2,5 mmol / l, ena amalimbana ndi kuchepa koteroko nthawi zambiri.
3. Kupanga kwa mahomoni omwe chotupacho chimatulutsa. Ndi kuchuluka kwa glucagon, zizindikiro zimawonekera pambuyo pake.
4. Ntchito za tumor. Hormone yochulukira imatulutsidwa, ndikuwonekeranso zizindikilozo.

Zizindikiro za insulinoma iliyonse imayamba chifukwa cha njira ziwiri zotsutsana:

1. Kutulutsidwa kwa insulin, chifukwa chake, pachimake hypoglycemia.
2. Kupanga kwa thupi poyesa kuchuluka kwa insulini ya okonda, mahomoni, otsutsa. Awa ndi makatekolamaini - adrenaline, dopamine, norepinephrine.

Nthawi zambiri, kuukira kumachitika m'mawa m'mimba yopanda kanthu, pambuyo povutikira kapena kupsinjika kwamisala, mwa azimayi - kusamba.

Vuto la hypoglycemia limaletsedwa msanga ndi shuga, chifukwa chake, thupi limakumana ndi kuchepa kwa shuga chifukwa cha njala. Odwala ambiri mosazindikira amachulukitsa shuga kapena maswiti, ndipo amayamba kudya pafupipafupi. Kufunafuna kwakuthwa kwa maswiti popanda zisonyezo zina kumatha kufotokozedwa ndi insulinoma yaying'ono kapena yosagwira. Chifukwa cha kuphwanya zakudya, kulemera kumayamba kuchuluka.

Gawo laling'ono la odwala limachita mosiyana - amayamba kumva kupewera chakudya, akuchepetsa thupi, ayenera kuphatikiza kudzikongoletsa pakukonzekera chithandizo chawo.

Njira zoyesera

Chifukwa cha zizindikiro zowoneka bwino zamitsempha, insulin nthawi zambiri imalakwika chifukwa cha matenda ena. Matenda a khunyu, zotupa ndi magazi m'magazi mu ubongo, vegetovascular dystonia, psychoses imatha kupezeka molakwika. Dokotala waluso yemwe ali ndi insulin yolingalira amagwiritsa ntchito mayeso angapo a labotale, ndikutsimikizira kuti wapezeka ndi matendawa pogwiritsa ntchito njira zowonekera.

Mwa anthu athanzi, kuchepera kwa shuga pambuyo maola asanu ndi atatu a njala ndi 4.1 mmol / L, patapita tsiku kumatsika mpaka 3,3, atatu - mpaka 3 mmol / L, ndipo kwa amayi, kuchepa kumakhala kwakukulu kuposa kwa amuna. Odwala omwe ali ndi insulinoma, shuga amatsika mpaka 3,3 mu maola 10, ndipo hypoglycemia yovuta kwambiri yomwe ili ndi zizindikiro zazikulu ikupezeka kale patsiku.

Kutengera ndi izi, hypoglycemia imakwiya kuti idziwe insulinomas. Zimayimira kusala kudya kwamasiku atatu kuchipatala, komwe madzi okha ndi omwe amaloledwa. Kuyesedwa kwa insulin ndi shuga kumachitika maola 6 aliwonse. Shuga akamatsika mpaka 3 mmol / L, nthawi pakati pa kusanthula amafupikitsidwa. Kuyesedwa kumayima pomwe shuga imagwera mpaka 2.7 ndipo zizindikiro za hypoglycemia zimawonekera. Amayimitsidwa ndi jakisoni wa glucose. Nthawi zambiri, mkwiyo umatha patatha maola 14. Ngati wodwala amatha masiku atatu popanda zotsatira, alibe insulinoma.

Chofunika kwambiri pakuwonetsetsa ndikutsimikiza kwa proinsulin. Ndiwotsogola wa insulin wopangidwa ndi maselo a beta. Atawasiya, molekyulu ya proinsulin imayikidwa mu C-peptide ndi insulin. Nthawi zambiri, gawo la proinsulin mu kuchuluka konse kwa insulin limakhala lochepera 22%. Ndi benign insulinoma, chizindikirochi chimaposa 24%, zoyipa - kuposa 40%.

Kusanthula kwa C-peptide kumachitika ndi odwala omwe ali ndi zovuta zamaganiza. Chifukwa chake, milandu ya insulin yoyendetsedwa ndi jakisoni amawerengedwa popanda mankhwala a dokotala. Kukonzekera kwa insulin kulibe C-peptide.

Kuzindikira komwe kuli insulinomas mu kapamba amapangidwa pogwiritsa ntchito njira zamaganizidwe, mphamvu yawo imaposa 90%.

Doctor of Medical Science, Mutu wa Institute of Diabetesology - Tatyana Yakovleva

Ndakhala ndikuphunzira matenda a shuga kwa zaka zambiri. Zimakhala zowopsa anthu ambiri akamwalira, ndipo makamaka amakhala olumala chifukwa cha matenda ashuga.

Ndithamangira kunena mbiri yabwino - Endocrinological Research Center ya Russia Academy of Medical Science idatha kupanga mankhwala omwe amachiritsiratu matenda ashuga. Pakadali pano, kugwiritsa ntchito bwino kwa mankhwalawa kuyandikira 98%.

Nkhani ina yabwino: Unduna wa Zaumoyo wapanga kukhazikitsidwa komwe kumavomerezana ndi kukwera mtengo kwa mankhwalawa. Ku Russia, odwala matenda ashuga mpaka Marichi 6 (kuphatikiza) nditha kuipeza - Kwa ma ruble 147 okha!

1. Angiography - njira yothandiza kwambiri. Ndi chithandizo chake, kudziunjikira kwamatumbo kumapezeka komwe kumapereka magazi ku chotupacho. Ndi kukula kwa mtsempha wodyetsa komanso mgwirizano wazombo zazing'onoting'ono, munthu akhoza kuwunika kutukuka ndi kupendekeka kwa chotupa.
2. Endoscopic ultrasonography - imakupatsani mwayi kuti muwone 93% ya zotupa zomwe zilipo.
3. Zolemba pamakompyuta - ivumbulutsa chotupa cha kapamba mu 50% ya milandu.
4. Mayeso a Ultrasound - wogwira ntchito pokhapokha kulemera kwambiri.

Amayesetsa kuchotsa insulini posachedwa, atangozindikira. Nthawi yonseyi asanachitidwe opaleshoni, wodwalayo amalandila shuga m'magazi kapena m'mitsempha. Ngati chotupa chikuyipa, chemotherapy ndiyofunikira pambuyo pa opaleshoni.

Opaleshoni

Nthawi zambiri, insulinoma imakhala pamwamba pa kapamba, imakhala m'mphepete momveka bwino komanso imakhala yofiirira, chifukwa chake ndiosavuta kuchotsa popanda kuwononga chiwalo. Ngati insulinoma mkati mwa kapamba ndi yaying'ono kwambiri, ili ndi mawonekedwe a atypical, dokotala sangadziwone ngati akuchitidwa opaleshoni, ngakhale malo omwe chotupacho chinakhazikitsidwa panthawi yodziwitsa. Pankhaniyi, kulowererako kuyimitsidwa ndikuyika pambali kwakanthawi, mpaka chotupacho chikukula ndikuchotsedwa. Pakadali pano, chithandizo chokhwima chimachitika pofuna kupewa hypoglycemia komanso mkhutu wamisempha.

Akachitanso opaleshoni yachiwiri, amayesanso kupeza insulini, ndipo ngati izi sizikuyenda bwino, chotsani gawo la kapamba kapena chiwindi ndi chotupa. Ngati pali insulinoma yokhala ndi metastases, muyenera kuyesanso gawo lina la chiwalocho kuti muchepetse zotupa.

Chithandizo cha Conservative

Zizindikiro zochitira opaleshoni ya insulinomas zomwe zikuyembekezeredwa ndi chakudya chamagulu shuga. Zokonda zimaperekedwa ku zinthu,, zomwe zimapangitsa kuti shuga azigwirizana m'magazi. Magawo a hypoglycemia pachimake amayimitsidwa ndi chakudya chambiri, nthawi zambiri timadziti timene timakhala ndi shuga wowonjezera. Ngati kwambiri hypoglycemia ikupezeka ndi kusokonekera chikumbumtima, wodwalayo amapaka jakisoni wamkati kudzera m'mitsempha.

Ngati, chifukwa cha thanzi la wodwalayo, opaleshoni imachedwa kapena nkosatheka nkomwe, phenytoin ndi diazoxide ndi zotchulidwa. Mankhwala oyamba ndi antiepileptic mankhwala, wachiwiri umagwiritsidwa ntchito ngati vasodilator pamavuto oopsa. Kuphatikiza mankhwalawa ndi njira yodziwika bwino. Pogwiritsa ntchito drawback iyi pazabwino, mutha kusunga shuga wa magazi pamlingo woyandikira kwa zaka. Ma diuretics amalembedwa nthawi yomweyo ngati diazoxide, chifukwa imasungabe madzi mu minofu.

Ntchito ya zotupa zapang'onopang'ono za pancreatic zitha kuchepetsedwa pogwiritsa ntchito verapamil ndi propranalol, zomwe zingalepheretse chinsinsi cha insulin. Octreotide imagwiritsidwa ntchito pochiza insulinomas yoyipa, imalepheretsa kutulutsidwa kwa mahomoni ndikuwongolera kwambiri mkhalidwe wa wodwalayo.

Chemotherapy

Chemotherapy ndikofunikira ngati chotupa chilonda. Streptozocin imagwiritsidwa ntchito limodzi ndi fluorouracil, odwala 60% amawaganizira, ndipo 50% amakhala ndi chikhululukiro chonse. Njira yamankhwala imatenga masiku asanu, iyenera kubwerezedwa masabata 6 aliwonse. Mankhwalawa ali ndi poizoni pakhungu ndi impso, chifukwa chake, pakatikati pa maphunziro, mankhwala amathandizidwa kuti awathandize.

Zomwe muyenera kuyembekezera kuchokera kumatendawa

Pambuyo pakuchita opaleshoni, misempha ya insulin imachepera msanga, shuga wamagazi amawonjezeka. Ngati chotupachi chapezeka nthawi yake ndikuchotsedwa kwathunthu, 96% ya odwala amachira. Zotsatira zabwino zimakhala ndi zotupa zazing'ono za benign. Mphamvu ya mankhwalawa insulin ndi 65%. Kubwezerera kumachitika mu 10% ya milandu.

Kusintha kakang'ono mkati mwa dongosolo lamanjenje, thupi limadzichitira lokha, limabwezeretseka m'miyezi ingapo. Kuvulala kwamitsempha yambiri, kusintha kwachilengedwe mu ubongo sikungasinthe.

Onetsetsani kuti mwaphunzira! Kodi mukuganiza kuti kuyamwa kwa mapiritsi ndi insulini kwa nthawi yonse yokhayo ndi njira yokhayo yosungira shuga m'manja? Sichowona! Mutha kutsimikizira izi nokha ndikuyamba kuzigwiritsa ntchito.

Pancreatic insulinoma imatchulidwa ngati chotupa cha mahomoni m'thupi lolingana. Nthawi zambiri, zimakhala zabwino.Akatswiri amati kuchuluka kwa chitukuko cha insulinoma yoyipa ndi 15 peresenti. Zizindikiro za matendawa zimatha kukhala zosiyanasiyana. Kuwonetsera kwa chotupa kumakhudzidwa ndi: mulingo wa chitukuko, kuchuluka kwa chitetezo cha thupi, machitidwe a wodwala, zinthu zakunja / zamkati.

Insulinoma ili ndi mawonekedwe.