Pancreatic insulinoma: Zizindikiro, zimayambitsa, matenda, chithandizo, zotsatira zake

Insulinoma ndi chotupa cha kapamba (kapamba) kamene kamachokera ku ma cell a beta, islets of Langerhans. Mwachilengedwe, zimatanthauzira ku mitundu ya endocrine, ndiye kuti, imakhala yogwira timadzi. Zimasiyanasiyana chifukwa zimatulutsa insulini mu kuchuluka kosalamulirika, kumayambitsa hyperinsulinism, chifukwa, hypoglycemia.

Zizindikiro zonse ndi dzina lake zimagwirizanitsidwa ndi izi. Nthawi zambiri amakhala olimba, osakwatiwa, koma muzochitika 105 amatha kukhala angapo. Zochita zake za mahomoni zimayendera pawokha. Mu 85-90% ya milandu imakhala yovuta, ndipo mwa 10-15% yokha imakhala yoyipa. Itha kumera nthawi iliyonse, ngakhale khanda, koma izi ndizosowa. Chofala pambuyo pa zaka 45, mwa akazi nthawi 4 zambiri.

Insulinoma imatha kukula mgawo lililonse la kapamba, koma nthawi zambiri imakhala mbali yake ya kapamba. Mu 1% ya milandu, malowa ndi ectopic kapena extrapancreatic - chipata cha ndulu, khoma lam'mimba kapena duodenum, m'chiwindi.

Nthawi zambiri, kukula kwa chotupacho sikupitirira 2 cm (chifukwa chachikulu ndi cholakwika). Pafupipafupi matendawa ndi milandu imodzi pa miliyoni iliyonse. Kuchepa kotereku kumapangitsa kuti munthu adziwe zolakwika komanso samalandira chithandizo chokwanira, ndipo madotolo ambiri samakumana nazo panthawi yomwe akuchita.

Hormone yogwira chotupa

Zotupa zonse za benign pancreatic ndizosowa - 1-3 milandu / miliyoni.Ngati mwa amuna apanga 3.5%, mwa akazi - mpaka 16%. Ambiri aiwo ndi endocrine. Makulidwe osiyanasiyana amayambira pa 0.5 cm mpaka 15 cm. Malinga ndi kubisika kwa mahomoni, amagawika m'mitundu mitundu:

insulinoma - amatenga 75%,
VIPoma (nthawi zambiri, mu 70% ya milandu, imapezeka mwa azimayi pambuyo pa 45) - imatulutsa chotupa cham'mimba chovunda,
gastrinoma (imakhudzanso anyamata azaka zapakati),
glucagonoma - pafupipafupi ndi milandu 20 miliyoni, nthawi zambiri mwa azimayi, 80% imapweteka.

Zizindikiro za Insulinoma

Ngakhale insulinoma imakonda kukhala yovomerezeka, imakhala yovuta kwambiri. Kupanda kusamala kwa insulin ndi chotupa kumapangitsa kutsika kwa glucose m'magazi (hypoglycemia), ndipo izi zimayambitsa matenda. Zimatengera mwachindunji kuchuluka, kukula ndi ntchito ya chotupa. Tisaiwale kuti timadzi timeneti timapitilizidwa kupangika ndi maselo athanzi a kapamba.

Hypoglycemia

Chizindikiro chachikulu, chodabwitsa kwambiri cha matendawa ndikuwukira kwa hypoglycemia yovuta kwambiri, yomwe imatha kuwonekera m'njira zosiyanasiyana. Nthawi zambiri, kumenyedwa kumayambika m'mawa, pamimba yopanda kanthu, pamene nthawi yayitali yatha chakudya chatha komanso kuchuluka kwa shuga m'magazi kumakhala kochepa.

Ndizovuta kudzutsa munthu m'mawa panthawi yovutitsidwa, atadzuka amatha kukhalabe ndi nkhawa kwa nthawi yayitali, sangathe kuyankha mafunso osavuta, ndikuyenda mayendedwe osayenera. Izi ndi zizindikiro za kusokonezeka kwa chikumbumtima komwe kumayamba chifukwa cha chakudya champhamvu kwambiri chamanjenje.

Kuukira kumatha kuchitika osati m'mawa zokha, komanso masana, makamaka ngati nthawi yochulukirapo imatha pakati pa chakudya, kupsinjika kwamthupi ndi m'maganizo. Pachimake hypoglycemia akhoza limodzi ndi kuukira psychomotor mukubwadamuka. Odwala atha kuwonetsa kukwiya, kulumbira, kufuula, kuyankha mafunso mosakwanira, kunja kumawoneka ngati ndikoledzera kwambiri.

Kuphatikiza apo, odwala nthawi zambiri amagwidwa ndi khunyu, matenda okhudzana kwanthawi yayitali, kusuntha kosafunikira m'magulu osiyanasiyana a minofu, komanso kunjenjemera kwa zala. Odwala angadandaule kuti "aponyedwa" mu kutentha thupi, kenako kuzizira, pa, kumverera kosowa kwa mpweya, kumverera kosatha kwa mantha.

Kukula kwa hypoglycemia kungayambitse kusokonezeka kwamphamvu kwa chikumbumtima, popanda kupatsidwa chithandizo chamankhwala, wodwalayo amatha kufa.

Nthawi yothandizirana

Zizindikiro zomwe zimapezeka kwa odwala omwe ali ndi insulinoma panthawi yopatsirana sizodziwika mwachindunji ndipo nthawi zambiri zimakhala zamitsempha mwachilengedwe, zomwe zimapangitsa kuti zikhale zovuta kudziwa bwino.

Ndi hypoglycemia wautali, misempha yamkati imavutika, monga nkhope ndi glossopharyngeal. Izi zitha kuwonetsedwa ndi mawonekedwe a nkhope, kutsekeka kwa khola la nasolabial, kuchekeka kwa ngodya mkamwa, kutayika kwa nkhope, kusalala, kusokonezeka kwa kakomedwe, mawonekedwe a ululu m'dera la muzu wamalirime ndi matani. Mukamufufuza, adotolo amatha kuwona mawonekedwe ena am'maganizo omwe sapezeka mwa anthu athanzi. Odwala amazindikiranso kuwonongeka m'makumbukidwe ndi chidwi, zimawavuta kuchita ntchito yanthawi zonse, osayang'ana zomwe zikuchitika zikuwoneka. Zizindikiro zamitsempha zoterezi zimatha kuonedwanso ndi zotupa zazing'ono zopanda ntchito.

Chifukwa cha zisonyezo zosamveka za matendawa, odwala nthawi zambiri samathandizidwa kwa nthawi yayitali ndi akatswiri a matenda a m'mitsempha.

Matenda a insulinoma

Umboni wowonetsa kuti kuukira kumachitika m'mawa m'mimba yopanda kanthu, pambuyo kudya chakudya, masewera olimbitsa thupi, kusamba kwa msambo kwa azimayi akuyenera kumaganiziridwa kuti ali ndi chotupacho mwa wodwala.

Pali mitundu yambiri yazizindikiro zomwe zimapangitsa kuti azitha kukayika insulin:

kusala hypoglycemia,
shuga wamagazi panthawi ya kuukirayo ali pansipa 2.7 mmol / l,
mtsempha wa magazi a shuga amachititsa wodwala kuukira.

Pakakhala vuto, kuchuluka kwa insulin m'magazi kumatsimikiziridwa, nthawi zambiri chizindikirochi chimakwezedwa pamlingo wochepa kwambiri wa glucose. Kufunanso kwa prochnic ndi tanthauzo la kubisala kwa proinsulin ndi C-peptide.

Chifukwa chakuti ma neoplasms nthawi zambiri amakhala ochepa kwambiri, diagnostics a ultrasound ndi compact tomography ndiosasintha.

Mpaka pano, pancreatic angiography imadziwika kuti ndi njira imodzi yothandiza kwambiri yodziwira matenda, chifukwa zotupa nthawi zambiri zimakhala ndi network yayitali ya mtima. Izi zimakuthandizani kuti muzindikire molondola malo ndi kukula kwa insulinomas.

Insulinoma: mankhwala

Nthawi zambiri, amayamba kulandira chithandizo cha insulinomas pochotsa chotupacho.

Ngati chithandizo cha opaleshoni sichingatheke, odwala amapatsidwa mankhwala othandizira kuchepetsa insulin komanso kuti achepetse kukula kwa chotupa ndi metastases yake. Kudya pafupipafupi kwa zakudya zamatumbo kapena kumayambitsanso shuga kumalimbikitsidwanso kupewa matenda a hypoglycemia.

Dokotala uti kuti mulumikizane

Ngati munthu nthawi zina amakhala ndi vuto lakumva njala, kunjenjemera, kusokonezeka, kupweteka mutu, kutsatiridwa ndi kufoka kapena ngakhale kusazindikira, ayenera kulumikizana ndi endocrinologist. Kuphatikiza apo, kufunsira kwa akatswiri a mitsempha kungafunike. Chithandizo cha insulinomas nthawi zambiri chimachitika ndi dokotala wa opaleshoni.

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, chotupa cha 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 kungayambike.

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 kwakukuru m'magazi a 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 za Insulinomas

Pancreatic insulinoma imakhudza dongosolo la endocrine la wodwala. Chifukwa chake, zizindikiro zazikulu za matendawa zikukula mwachangu ndi kunenepa kwambiri kwa wodwala.

Zizindikiro za hypoglycemia zimachezera wodwala kumapeto kwa tsiku. Izi zimachitika chifukwa cha chakudya chochuluka tsiku lonse. Monga lamulo, hypoglycemia imasowa usiku, ndipo m'mawa wodwalayo amakhalanso bwino. Zizindikiro zoterezi zimatsogolera ku mfundo yoti odwala amayesetsa kuti asamayang'anire thanzi lawo ndipo safuna kukaonana ndi dokotala.

Kuphatikiza pa dongosolo la endocrine, insulinoma imachepetsa zochitika zam'magazi a wodwala.

Zizindikiro za matendawa kuchokera ku endocrine system:

kukula kwa tachycardia,
mantha akuwopsezedwa (kupanga mwadzidzidzi adrenaline),
thukuta lozizira
zala zanjenjemera.

Mchitidwe wamanjenje umakhudzana ndi neoplasm ndi izi:

kufooka, chizungulire komanso migraine,
nkhanza zopanda maziko
kusokonezeka ndende.

Chifukwa chake, pancreatic insulinoma (neoplasm) imakhala ndi zofanana ndi hypoglycemia. Akapezeka, muyenera kupita kwa dokotala nthawi yomweyo. Hypoglycemia ikhoza kuyambitsa kupweteka, komwe, kumayambitsa vuto la mtima. Popeza matendawa amakhudza anthu okulirapo, matendawa amatha kupha.

Kuzindikira matendawa

Kuzindikira kwa insulinoma kumachitika ndi endocrinologist. Kuzindikira kwakanthawi kumatsimikizira zotsatira zabwino komanso chithandizo chokwanira.

Kutsimikiza kwamankhwala a insulin,
kuwerenga zamatenda ach pancreatic,
Kutsimikiza kwa shuga m'magazi,
pancreatic ultrasound,
composed tomography ya kapamba.

Kuzindikira kwamitundu ingapo kumathandizira kusintha kwakukulu pakupanga kwa insulin ndi kuponderezedwa kwa glucose kutsimikiza. Kuzindikira kapamba kumapangitsa kudziwa mtundu wa insulinoma.

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 kungathandize kupewa kukula kwa metastases komanso kuchitira panthawi yake chotupa chokhala ndi khansa.

Simuyenera kuganiza kuti benign isnullinoma siowopsa. Popanda chithandizo choyenera, mafupipafupi a hypoglycemia adzakulirakulira, ndipo izi zimakhala ndi zovuta zochuluka, mpaka kumangika. 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 zimakhalira ndikuthandizira chithandizo.

Ndikofunikira kuyeza kuchuluka kwa shuga m'magazi ndikuwunika kuchuluka kwa insulini yopangidwa ndi kapamba. Ndikokwanira kuti munthu wathanzi kamodzi pachaka amayeza mayeso kuti adziwe kuchuluka kwa mahomoni ndi shuga wamagazi kuti akhale 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 amalembetsedwa ndi endocrinologist wa moyo wake wonse ndipo nthawi ndi nthawi amafunika kukayezetsa pancreatic. 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 kumapeto.

Insulinoma ndi chotupa chofala kwambiri cha pancreatic endocrine. Amakhala ndi 70-75% ya zotupa zamahomoni zothandiza m'thupi. Insulinoma imangokhala yokhayokha komanso zingapo, mu 1-5% ya milandu, chotupacho ndi gawo la adenomatosis angapo. Zitha kuchitika zaka zilizonse, koma nthawi zambiri - mwa anthu azaka 40-60, komanso pafupipafupi mwa amuna ndi akazi. Benign zotupa predomine (pafupifupi 90% ya milandu). Insulinoma ikhoza kukhala patali mu gawo lililonse la kapamba. Pafupifupi 1% ya odwala, imapezeka mu omentum, khoma lam'mimba, duodenum, chipata cha spleen ndi madera ena. Kukula kwa chotupacho kumasiyana mamilimita angapo kufika 15 cm, nthawi zambiri 1-2 cm.
Kuchuluka kwa ma cell omwe ali mu chotupa ndi ma cell a B, koma palinso ma cell A, cell opanda granules achinsinsi, ofanana ndi ma cell a ma excretory ducts. Insulinoma yodwalitsa imatha kupereka ma metastases ku ziwalo zosiyanasiyana, koma nthawi zambiri kwa chiwindi.

Zofunikira zazikulu za pathogenetic mu insulinoma ndizopanga mosaletseka komanso kubisalira kwa insulin, mosasamala ndi glucose wamagazi (ndi kuchuluka kwa insulini ndi maselo a chotupa, kuthekera kwawo kuyika propeptide ndi peptide kumachepetsedwa). Kuchoka ku hyperinsulinism kumayambitsa ambiri azizindikiro zamatenda.

Pamodzi ndi maselo a insulin, insulinomas imatha kupangidwa mwambiri ndi ma peptide ena - glucagon, PP.

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 azachipatala kwa 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 zimayenderana ndi ntchito yake ya mahomoni. Hyperinsulinism ndiye njira yayikulu yopangira pathogenetic yomwe chizindikiro chonse cha matendawa chimadalira. 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. Njira izi zimakhudza makamaka ma mahomoni 4 - norepinephrine, glucagon, cortisol ndi mahomoni okula. Zikuoneka kuti woyamba wokha ndiamene amayambitsa kuwonekera kwamankhwala. 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.

Chithandizo cha insulinoma:

Chithandizo cha mankhwala:

Ngati hypoglycemia imapitirira, diazoxide ingagwiritsidwe ntchito ndi koyamba mlingo wa 1.5 mg / kg pamlomo kawiri pa tsiku limodzi ndi natriuretics. Mlingo ukhoza kuwonjezeka mpaka 4 mg / kg. Analogue ya somatostatin octreotide (100-500 μg subcutaneous katatu patsiku) sikugwira ntchito konse ndipo kugwiritsidwa ntchito kwake kuyenera kuganiziridwa kwa odwala omwe ali ndi hypoglycemia, yomwe imalephera kugwira diazoxide. Odwala omwe chithandizo cha octreotide amatha kugwiritsidwa ntchito amatha kutumikiridwa mu 20-30 mg kamodzi patsiku. Mukamagwiritsa ntchito octreotide, odwala amafunikiranso kupereka michere ya kapamba, chifukwa imalepheretsa chinsinsi cha michere ya kapamba. Mankhwala ena omwe ali ndi gawo laling'ono komanso losinthika la insulin secretion amaphatikizapo verapamil, diltiazem, ndi phenytoin.

Ngati zizindikiro za insulinomas zikupitilira, chemotherapy ingagwiritsidwe ntchito, koma mphamvu yake imakhala yochepa. Streptozotocin imagwira ntchito mu 30% yamilandu, komanso kuphatikiza 5-fluorouracil, kugwirako kumafika mpaka 60% kutalika kwa zaka 2. Mankhwala ena amaphatikizapo doxorubicin, chlorozotocin, ndi interferon.

Insulinoma ndi chotupa chamafuta olimbitsa thupi omwe amayamba chifukwa cha maselo a b, zilonda za Langerhans, kapamba, kuphatikiza insulin yambiri, yomwe mosalephera imabweretsa kukula kwa hypoglycemia.

Pali ma benign (mu 85-90% ya milandu) kapena insulinoma yolakwika (mu 10-15% ya milandu). Matendawa amafala kwambiri mwa anthu azaka zapakati pa 25 ndi 55. Kwa achichepere, matendawa si owopsa.

Amayi amatha kutenga insulinoma kuposa amuna.

Insulinomas imatha kuwoneka mu gawo lililonse la kapamba, nthawi zina imawoneka khoma la m'mimba. Mizere yake ndi 1.5 - 2 cm.

Zolemba za matendawa

Insulinoma ili ndi izi:

kuchuluka kwa insulinoma kumapangitsa kuti insulin iwonjezeke komanso kuchepa kwa shuga m'magazi. Insulinoma imayipanga nthawi zonse, ngakhale thupi silikufuna.
maselo aubongo amatengeka kwambiri ndi hypoglycemia, popeza glucose ndiye chinthu champhamvu kwambiri,
ndi insulinoma, neuroglycopenia imachitika, ndipo ndi hypoglycemia ya nthawi yayitali, masinthidwe a CNS amawonetsedwa, ndikuphwanya kwakukulu.
Magazi a m'magazi amachepetsa bwino, koma kaphatikizidwe ka insulin amachepetsa. Izi ndizotsatira zamagulu abwinobwino a metabolism. Mu chotupa, ndi kuchepa kwa shuga, mapangidwe a insulin sachepa,
ndi hypoglycemia, mahomoni a noradrenaline amalowa m'magazi, zizindikiro za adrenergic zimawonekera,
insulinoma imapanga, imateteza ndikulekanitsa insulin m'njira zosiyanasiyana. Imadyetsa maselo ena onse a ziwalo,
mawonekedwe a chotupa chofanana ndi mawonekedwe a khungu lomwe lakhudzidwalo,
insulinoma ndi mtundu wa insuloma ya pancreatic ndipo yalembedwa ku ICD,
Munthu m'modzi mwa anthu 1.25 miliyoni ali ndi chotupachi.

The pathogenesis ya hypoglycemia yokhala ndi insulinoma

Insulinoma ndi chotupa chomwe chimatulutsa mahomoni. Chifukwa chakuti maselo a khansa omwe ali ndi insulinoma ali ndi mawonekedwe osakhazikika, amagwira ntchito osagwirizana, chifukwa chomwe kuchuluka kwa glucose m'magazi sikungoyendetsedwa. Chotupacho chimatulutsa insulini yambiri, yomwe imachepetsa kuchuluka kwa shuga m'magazi. Hypoglycemia ndi hyperinsulinism ndizomwe zimapangitsa kuti pakhale matendawa.

Pathogenesis ya insulinoma mwa odwala osiyanasiyana ikhoza kukhala yofanana, koma zizindikiro zakukula kwa matendawa ndizosiyanasiyana. Zizindikiro zoterezi zimachitika chifukwa chakuti munthu aliyense ali ndi vuto losiyana ndi insulin komanso hypoglycemia. Kwambiri, kusowa kwa glucose m'magazi kumamveka ndi minyewa yaubongo. Izi ndichifukwa choti ubongo umakhala wopanda chakudya, komanso sungagwiritsenso ntchito mafuta monga cholowa m'malo mwa mphamvu.

Kuzindikira kwa insulinoma

Ngati chotupa ndi chosaopsa, ndiye atasamutsa njira yochizira (opaleshoni yochotsa chotupacho), wodwalayo amachira. Chotupa chikakhala ndi kuthekera kwa paraendocrine, mankhwalawa a insulinoma nawonso azichita bwino.

Chotupa chikamapunduka, kuthandizira kwa mankhwalawo kumakhala kwakukulu. Zimatengera komwe chotupa, ndi kuchuluka kwa zotupa. Kupambana kwa mankhwala achemotherapeutic ndikofunikira kwambiri - zimatengera vuto lililonse la matendawa komanso kuzindikira kwa chotupa cha mankhwalawa. Nthawi zambiri 60% ya odwala amamvera kwambiri streptozocyton, ngati chotupa sichimva chidwi ndi mankhwalawa, adriamycin amagwiritsidwa ntchito. Monga momwe masewera amasonyezera, kupambana kwa opaleshoni ya insulinomas kumachitika mu 90% ya milandu, pomwe imfa pakuchita opareshoni imachitika mu 5-10%.

Chithandizo chaposachedwa

Chithandizo chowongolera amatanthauza opaleshoni yochotsa chotupacho. Wodwala angakane mwakufuna kwake opaleshoni kuti achotse chotupacho. Komanso, opaleshoni sichigwiritsidwa ntchito pamaso pa ziwonetsero zovuta zamunthu.

Chotupa chija chikakhala mchira wa kapamba, ntchito imachitidwa mwa kudula gawo la chiwalo chamanthu ndikuchotsa chotupacho. M'malo omwe insulinoma imakhala yovomerezeka ndipo imapezeka m'thupi kapena pamutu wa chithokomiro, amachitidwa enucleation (chotupa husking). Ngati chotupa chikuvulala ndi zotupa zingapo ndipo pakakhala kosatheka kuchichotsa kwathunthu, njira yothandizira mankhwalawa imagwiritsidwa ntchito. Chithandizo cha mankhwala chimaphatikizapo kumwa mankhwala monga diazoxide (proglycem, hyperstat) kapena octreatide (sandostatin). Kumwa mankhwalawa kumayambitsa kuchepa kwa kupanga kwa insulin, komanso kuletsa kwa ma hypoglycemia.

Chithandizo cha Conservative

Ndi mankhwala osokoneza bongo a insulinomas, zotsatirazi zimatsata: kupumula komanso kupewa kwa hypoglycemia, komanso zotsatira za chotupa.

Mu milandu yomwe chithandizo chachikulu sichitha, mwachitsanzo, chotupa choopsa chokhala ndi zotupa zingapo, chizindikiro cha mankhwala chimayikidwa. Chithandizo choterechi chimaphatikizaponso kudya ma carbohydrate. Ngati sizotheka kusintha mtundu wa insulin popanga mankhwala, wodwalayo amatsimikiza kuti apatsidwa mankhwala a chemotherapy, kenaka polychemotherapy.

Mutha kudziwa mosavuta kuti ndi zipatala ziti zomwe zimagwira insulinomas ku Moscow patsamba lathu.

Lowetsani zidziwitso zanu ndipo akatswiri athu adzakulumikizani ndikupatsani malangizo aulere pazinthu zomwe zimakukhudzani.

- Uwu ndi mtundu wa chotupa chamafuta chomwe chimakhudza ma isanc pancreatic (islets of Langerhans). Zimakhudza maselo a beta, chifukwa chotsatira chake kupanga 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 ndi 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 limba. Mukuwoneka, ndipangidwe kakang'ono, 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 insulini ndi chotupa, mosasamala kuchuluka kwa shuga m'magazi. Mwa anthu athanzi, 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 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 ndi mawonekedwe owonda kwambiri,
mavuto azaku kugonana.

Insulinoma ndi chotupa chopatsa mphamvu m'mimba mwa kapamba chomwe chimatulutsa insulini yambiri. Matendawa amapezeka pafupipafupi mwa azimayi a zaka zapakati komanso okalamba. Insulinomas mu 70% ya milandu ndi yoyipa zotupa zazing'ono (zosakwana 6 cm). 30% yotsala ya neoplasms ndi nyumba zoyipa.

Neoplasm ndi chotupa chogwira ntchito chopanga ma cell a chinsinsi, ndikupanga insulin yambiri. Njirayi imawonedwa ngati yowopsa kwambiri kwa anthu, chifukwa kuchuluka kwa insulin m'magazi kumapangitsa kuti shuga agwiritsidwe ntchito kwambiri, ndipo kuchepa kwake kumabweretsa kukula kwa hypoglycemia, limodzi ndi mavuto akulu azaumoyo. Kuphatikiza apo, pancreatic insulinoma pakalibe mankhwala okwanira amatha kuyambitsa zilonda.

Mtundu wamtunduwu, akatswiri adazindikira zingapo zomwe zimathandizira kuzindikira:

neoplasm ili ndi mawonekedwe ofiira omwe amapezeka mu kapisozi, zomwe zimapangitsa kuti zikhale zovuta kudziwa kapena kudwala,
Mtundu wa chotupacho umasiyana kuchokera ku pinki kupita pamtundu wakuda,
kukula kwa chotupa sikupitirira 5 cm.

Mitsempha yopanga insulin yochulukirapo imatha kuwoneka m'mbali iliyonse ya gland, koma nthawi zambiri imapezeka m'thupi la kapamba.Chowona chakuti zilonda zam'mimba zam'mimba zimachitika ndikuyamba kukulira zikuwoneka ndi mawonekedwe a metastases yogwira ntchito m'mitsempha ya m'mimba, mapapu, mawonekedwe, komanso chiwindi.

Gulu la insulin

Kusankha njira zamankhwala othandizira, kutsimikiza molondola momwe mawonekedwe a neoplasm ndikofunikira.

Pachifukwa ichi, mothandizidwa ndi azachipatala, gulu la matenda limayikidwa:

Choyamba, chotupa cha insulinoma chimagawidwa malinga ndi kuchuluka kwa zilonda. Mu 90% ya milandu, odwala amapezeka ndi benign neoplasm, ndipo otsala 10% amawerengedwa.
Malinga ndi kuchuluka kwa magawidwe mu ziwalo parenchyma, zida zosafunikira zimatha kukhala zokha (imodzi) komanso zingapo. Zoyambazo nthawi zonse zimakhala zazikulu komanso sizikhala ndi vuto lodana, ndipo zomalizirazo ndi timinong'onoting'ono tating'ono tomwe timaphatikizidwa timagulu tomwe timayamba kupweteketsa koyambirira.
Kutengera ndi gawo liti la kapamba owonongeka, insulinoma ya mutu, mchira ndi thupi zimasungidwa. Pa mtundu uliwonse wa neoplasm, mtundu wina wa zamankhwala ndizoyenera zomwe zitha kuyimitsa kapena kuthetsa kwathunthu njira ya pathological.

Hypoglycemia ndi insulinoma

Mkhalidwe wamtunduwu, womwe umakhala limodzi ndi insulin-secreting, umachitika motsutsana ndi maziko a kuchepa kwambiri kwamphamvu m'magazi a shuga. Mthupi la munthu wathanzi, kuchepa kwamagazi m'magazi, kupanga insulini, kofunikira pakapangidwe kake, kumachepera. Ngati maselo otulutsa insulini awonongeka ndi chotupa, njira yachilengedwe imasokonekera, ndipo ndi kuchepa kwa shuga m'magazi, insulin secretion siyimilira.

Kukula kwa hypoglycemia ndi insulinoma kumakhudzana mwachindunji ndi chinthuchi, ndiye kuti, kupanga kosapindulitsa komanso kosasunthika kwa insulin pogwiritsa ntchito zotupa zowonongeka pomwe kulibe kumabweretsa mkhalidwe wowopsa. Kuukira kwa hypoglycemia kumachitika panthawi yomwe chotupa chokhala ndi mahomoni chimatulutsa gawo latsopano la insulin m'magazi.

Mutha kudziwa kuyambika kwa vuto loopsya mwakuwonekera kwa zizindikiro zotsatirazi:

njala,
tachycardia ndi kunjenjemera kwa thupi lonse.
chisokonezo ndi mantha osadziwika,
zolankhula, zowoneka ndi zamisala,
kumasulidwa kwa kuzizira kwambiri, thukuta lotsekemera (thukuta pamphumi).

Woopsa milandu, pancreatic insulinoma, limodzi ndi hypoglycemia, zimatha kupangitsa munthu kuyamba kukomoka komanso kutseka.

Zoyambitsa Insulinoma

Akatswiri sangatchule chifukwa chodalirika chopangitsa kuti pakhale zotupa za mahomoni, komabe, malinga ndi akatswiri oncologists ambiri, kudalira kwa mahomoni ndi chinthu chachikulu chomwe chikuwonetseratu kukula kwake. Insulinoma imayambitsa kuwonongeka kwa maselo a beta m'mimba, chifukwa chakuchepa kwa zinthu zina kumatchulidwa. Kupezeka kotereku kumayambira ndikuyamba kusintha kwa maselo.

Pakati pazambiri zowopsa, akatswiri adziwona zotsatirazi za insulinoma, zomwe ndizofunikira:

chisokonezo pakuchitika kwa dongosolo la endocrine lomwe limagwirizanitsidwa ndi zolakwika zamtundu wa adrenal ndi gland pituitary,
pachimake mawonekedwe a zilonda zam'mimba kapena zilonda zam'mimba,
kuwonongeka kwa makina kapena mankhwala ku gland,
matenda osafunikira am'mimba,
kudziwika ndi zinthu zapoizoni,
cachexia (kutopa kwambiri),
mavuto azakudya.

Zizindikiro ndi ma insulinomas

Zizindikiro ndi kuwonetsa matendawa

Kuwonetsedwa kwa zizindikiro za mkhalidwe wosasangalatsa wa pathological kumadalira mwachindunji pamlingo wa ntchito ya mahomoni a chotupa. Matendawa amatha kupitilira mobisa, osawululira zinthu zosalimbikitsa, kapena kunena mawu owonetsa. Odwala omwe ali ndi insulinoma amakhala ndi njala yokhazikika, yomwe imawakwiyitsa kudya chakudya chochuluka (maswiti, chokoleti). Tikulimbikitsidwa kuti tizikhala ndi maswiti awa pafupipafupi kuti tipeze kuwukira.

Zizindikiro zotsatirazi za insulinoma zimawerengedwa mwachindunji:

kudwala, kufotokozedwa kufooka ndi kutopa kosalekeza kopanda pake,
kuchuluka kwa thukuta, kuzizira kwambiri,
kugwedezeka kwa (miyendo) ndi miyendo,
khungu
tachycardia.

Zizindikiro za insulinoma izi zimathandizidwa ndi zizindikiritso za kuwonongeka kwa gawo lamanzere laubongo: njira zamaganiza zimachepa, chidwi chimachepetsedwa, kuchepa kwa kukumbukira kumachitika nthawi zambiri. Muzovuta kwambiri, kupezeka kwa amnesia ndi matenda amisala kumadziwika.

Kanema wophunzitsa

Pancreatic insulinoma ndi chotupa chomwe chimatha kutulutsa insulin yambiri. Izi zimatha kudzetsa hypoglycemia odwala. Zotsirizazo zikutanthauza shuga wochepa wa magazi.

Nthawi zambiri, chotupa chamtunduwu chimayamba kupezeka mwa anthu azaka 25 mpaka 55. Ndiye kuti, kudwala kumene kumachitika mwa anthu azaka zogwira ntchito kwambiri. Muubwana ndi unyamata, insulinoma siyipezeka konse.

Nthawi zambiri, insulinoma ndi chosaopsa chotupa. Nthawi zina, insulinoma ndi chimodzi mwazizindikiro za adenomatosis ambiri.

Kukula, insulinoma nthawi zambiri imafika ku 1.5-2cm, ndipo imatha kukhala mbali iliyonse ya kapamba:

Tsoka ilo, zomwe zimayambitsa kukula kwa insulinomas sizikudziwika. Ambiri amakhulupirira kuti kukula kwa matenda amzeru kumayambitsa chibadwidwe chamtsogolo, zizolowezi zoipa, zinthu zoyipa zakunja ndi kulephera kwa njira zopimira. Komabe, zifukwa zonsezi pamwambapa ndi malingaliro oyerekeza chabe.

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 kwambiri yamatenda imayang'aniridwa mwa 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 panthawi yake kuti apewe kuukira kwa hypoglycemia komanso kupewa kutaya kwa chikomokere kapena psychosis. Kuperewera kwa shuga kumakhudza ma neurons aubongo. Pachifukwachi, kukomoka pafupipafupi ndi matenda kumatha kupangitsa kuti pakhale chizindikiro chodwala, parkinsonism, ndi discirculatory encephalopathy. Ndi vuto la hypoglycemic, myocardial infaration imayamba.

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

Nthawi zambiri kuwunikira kwa hypoglycemia mwa amuna kumatha kubweretsa mphamvu.

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, ndikuiwalanso za zizolowezi zoyipa. Komanso, amayenera kukayezetsa thupi chaka chilichonse ndikuyang'anira kuchuluka kwa shuga m'magazi.

Ambiri a ife, ngakhale osagwirizana ndi zamankhwala, tikudziwa kuti mawu azachipatala omwe ali ndi mawu akuti "ohm" amakhudzana ndi khansa. Palinso insulin. Nthawi zambiri, ndi chotupa cha kapamba, ndiko kuti, ma cell omwe amapanga mahomoni (ma cell a beta a isanger a Langerhans), ndipo amapezeka nthawi zambiri mchira wa chiwalocho. Nthawi zambiri, ma neoplasms opanga insulini amapanga maselo ena ndipo amatha kukhala pazipata za ndulu, chiwindi, matumbo ndi ziwalo zina. Muzochitika zambiri, chotupachi chimakhala chodetsa nkhawa, ngakhale kuti mitundu yoyipa ya chitukuko cha matendawa, mwatsoka, imapezekanso.

Chotupa chija chimatchedwa insulinoma chifukwa maselo ake mosasamala amabisa ma insulin m'magazi, yomwe imayang'anira metabolism ya carbohydrate. Ndi kutulutsidwa kosalekeza kwa timadzi tomwe timayambitsa matenda.

Matendawa amapezeka pafupipafupi kwa anthu azaka zapakati pa 30 mpaka 50, komabe, insulinoma imatha kuchitika zaka zilizonse, ndipo milandu yodziwika, ngakhale mwa makanda, imafotokozedwa. Matendawa siamodzi mwa ofala kwambiri, chifukwa chake, madokotala ambiri amakumana nawo kawirikawiri, kapena alibe chidziwitso pakuzindikira komanso kuchiza insulinomas. Pachifukwa ichi, pali kuthekera kwakukulu kozindikira koyipa ndikusankhidwa kwa chithandizo chopanda tanthauzo.

Zojambulajambula ndi mawonekedwe a kapamba

Kanyama kapamba ndiye chiwalo chofunikira kwambiri chamkati mwa munthu. Ndi ex- ndi endocrine England. Amapanga ma enzymes am'mimba (trypsin, chymotrypsin, amylase, lipase) ndi mahomoni (glucagon ndi insulin) kwa metabolism ya carbohydrate. Insulin imatsitsa shuga, ndipo glucagon, m'malo mwake, imawonjezeka. Matenda ake samachitika mwachilendo, chifukwa chake, kukhala ndi lingaliro la komwe akukhala ndi zizindikiro zake ndizofunika kwambiri.

Kodi kapamba amapezeka kuti? Amayikiridwa pamimba pamimba kumbuyo kwa m'mimba, imayanjana ndi duodenum mosamala, pamlingo wa 2 kumtunda kwa lumbar vertebrae.

KDP imapinda mozungulira mozungulira ngati mawonekedwe a kavalo. Kukula kwa gland wamkulu kumakhala 20-25 cm, kulemera - 70-80 g. Ili ndi mutu, thupi ndi mchira.

Mutu umafika kumtunda wa bile, mchira pafupi ndi ndulu umayenda pansi pa hypochondrium yamanzere. Mukawonedwa kuchokera kutsogolo, zonenerazo zidzakhala 10cm pamwamba pamchombo. Chifukwa chiyani mukudziwa izi? Chifukwa ululu pakatupa wake umagwera ndendende pamagawo awa.

Matenda a kapamba

Pali matenda ambiri kapamba ndipo mankhwalawa nthawi zambiri amakhala osakhazikika. Koma izi sizikugwira ntchito pa zotupa. Apa pokhapokha pazowonjezera. Kodi zikondamoyo zimapweteka bwanji (Zizindikiro)? Mukutupa, zofala kwambiri ndizopweteka komanso kugaya chakudya. Palibe kusiyana pakati pa amuna ndi akazi. Kupweteka kumadziwika ndi mawonekedwe ake othinana ndipo amadziwika mu hypochondrium kumanzere. Sipangaphatikizidwe ndi kudya zakudya, nthawi zambiri kumayendetsedwa ndi nseru, nthawi zina kusanza kwa acidic.

Kudya kumakhala kofupika kwambiri kapena kusakhalapo, kuying'ung'udza, kutulutsa m'mimba, ndi chopondapo sikokhazikika. Mu ndowe, nthawi zambiri pamatha kukhala zosakanikirana zamafuta kapena chakudya chosasokoneza.

Komanso, mu kutupa kwambiri, Zizindikiro za kuledzera zili ndi vuto la mutu, tachycardia, kufooka ndi thukuta, ndipo kutentha kumatha kuwuka. Chiwindi chimakulitsidwa.

Kodi kapamba (Zizindikiro) zimapweteketsa bwanji mu chifuwa chachikulu? Apa ululu sucheperachepera, koma pafupipafupi komanso wogwirizana ndi zolakwika pakudya. Kuopsa kwa chifuwa chachikulu ndichakuti kumatha kuyambitsa zotupa mu gland.

Etiology ya insulin

Zomwe zimayambitsa pancreatic insulinoma masiku ano sizikudziwika kwenikweni. Ofufuza ena amati izi zimachitika chifukwa cha chibadwa.

Koma oyambitsa zovuta amadziwika:

kulakwitsa kwa grenal ndulu ndi chida chonyansa,
zilonda zam'mimba kapena duodenum,
kuwonongeka kwa kapamba, mankhwala kapena makina,
matenda am'mimba
kutopa kwa thupi,
mavuto azakudya.

Mawonekedwe a tumor

The chotupa morphology anafunika kuzizindikira: mapangidwe akuwoneka ngati mnofu wokhazikika womata, izi sizomwe zimazindikira msanga kuchuluka kwake koopsa. Mtundu wake umakhala wa pinki mpaka wa bulauni, ndipo nthawi zambiri umakhala ndi njerwa. Makulidwe osaposa masentimita 5. Pakusintha, ma metastases omwe amapezeka m'mitsempha, m'mapapo, ma node, komanso chiwindi, chomwe chimathandizanso ndi mahomoni, amapezeka.

Mavuto a Insulinomas

Zotsatira za pancreatic insulinoma zimatha kukhudza chotupa chake ndi zipsera. Kubadwanso palokha ndivuta kale, kumachitika mu 10% ya milandu. Koma ngakhale izi sizichitika, zadziwika:

minyewa yamitsempha yokhala ndi mkodzo wamkati ndi glossopharyngeal nerve,
kukumbukira, kusawona, luso la malingaliro,
Kutha kubereka ndi kotheka mwa amuna,
kunenepa.

Mikhalidwe ya hypoglycemia imatha kubweretsa kukula kwa chikomokere, myocardial infarction.

Njira zosinthira

Chithandizo cha opaleshoni ndichabwino, mitundu yake: enucleation (chotupa husking), pancreatic resection, pancreatoduodenal resection kapena chancreatectomy, i.e. Kuchotsa kwathunthu. Mwambiri, zochitika pa kapamba nthawi zonse zimasankhidwa kuti ndizovuta.

Koma ngati munthu atha kukhala popanda chamba pambuyo pa opaleshoni kuti amuchotsere ndizosatheka kulosera. Zina zoyipa zomwe zimakhudza thupi, ndizochulukirapo. Kuchulukitsa kwa operekera kumatengera malo a insulinoma ndi kukula kwake.

Mlingo wa glucose umatsimikizika mu mphamvu mwachindunji pa opareshoni. Mu 10% ya milandu, opareshoni imapereka zovuta: fistulas ndi abscesses yam'mimba, peritonitis, kapamba, zilonda zam'mimba, chikhodzodzo cha imfa. Ophunzirawo sachitidwa ngati wodwalayo sakufuna izi kapena ngati pali ma pathologies enaake.

Kodi munthu angathe kukhala wopanda chamba? Zachidziwikire, inde! Koma pokhapokha kukhala ndi moyo wathanzi komanso kutsatira malingaliro onse a dokotala.

Ngati chotupa chikuyipa, chili ndi ma metastases angapo ndikuyamba kugwira ntchito, chemotherapy ndi mankhwala. Amapangidwa ndi "Streptozotocin", "5-fluorouracil", "Doxorubicin", etc. Chemotherapy ingathandize pokhapokha pa 60% yamilandu: kuchuluka kumeneku kumatsimikiziridwa ndi chidwi chachikulu ku "Streptozotocin". Pankhani ya chotupa pa Streptozotocin, m'malo mwake ndi Adriamycin.

Komanso, ngati opaleshoni sizingatheke, hypoglycemia imaletsedwa. Mwa izi, othandizira a hyperglycemic amagwiritsidwa ntchito (adrenaline, noradrenaline, glucagon, corticosteroids).

Poletsa kupanga insulini, "Diazoxide" ("Proglikem", "Hyperstat") kapena "Octreotide (sandostatin) ndi omwe amapatsidwa mankhwala. Amachepetsa kuopsa kwa vuto la hypoglycemia. zovuta zamtundu wa Cushing's syndrome.

Zakudya za insulin

Zakudya ziyenera kungokhala zochepa. Ndi insulinoma, wodwalayo ayenera kusiya kugwiritsa ntchito zakudya zamchere, zosuta, zonunkhiritsa, zamafuta ndi mafuta, komanso kuchepetsa zakumwa zoledzeretsa komanso khofi.

Makonda ndizakudya zonse zomwe zimakhala ndi CHIKWANGWANI. Zakudya zamafuta osavuta (zoyeretsa) siziphatikizidwa kwathunthu. Izi ndi shuga, makeke, makeke, chokoleti, komanso zinthu zomwe zimakhala ndi GKI yayikulu: mbatata, mikate yoyera, ma muffins, mkaka wonse.

Ulamuliro wakumwa umalimbikitsidwa, muyenera kumwa osachepera malita a 2 a madzi oyera tsiku lililonse, koma osamwa khofi ndi msuzi wokoma.

Ndi benign insulinomas, kuchuluka kwa kuchira mu 80% ya milandu. Mu milandu 3%, kubwezeretsanso nkotheka. Imfa ndi 5-10%. Ndi ectopic insulinomas, chithandizo chokhazikika chomwe chimalamulidwa.

Ngati pancreatic zilonda zam'mimba insulin, matulukidwe zimatengera metastases ndi kutengera kwa chotupa palokha. Chiwerengero cha anthu ovulala ndi 10%. Zaka 2 zakupulumuka pafupifupi 60%. Kuyambira pomwe azindikira kuti ali ndi insulinoma, wodwalayo amamuyeza mayeso autali wautali ndi endocrinologist ndi neurologist.