Zizindikiro za insulinoma, zoyambitsa, zizindikiro ndi chithandizo

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.

Zimayambitsa insulinoma

Zomwe zimayambitsa insulinoma sizikudziwika konse. Ndinapeza kufanana kwa insulinomas ndi endocrine adenomatosis, zomwe zimathandizira kuti pakhale zotupa zomwe zimapanga mahomoni. Mu 80% ya milandu, matendawa amapezeka m'mapapo.

Insulinoma sinatengeredwe, ndipo imawoneka kawirikawiri, koma nthawi zambiri kuposa mitundu ina ya pancreatic insulomas.

Mu thupi, zonse zimalumikizana komanso thupi likasinthidwa, kulumikizidwa kumayendetsedwa nthawi yomweyo chifukwa cha kukonzanso, katulutsidwe, komanso kagayidwe. Pakakhala kusowa kwazinthu kwina, ndiye kuti zimayendetsedwa, ndipo zonse zimachitika ngati zapezekanso pazinthu zilizonse zapezeka.

Mwachidziwitso, zomwe zimapangitsa kuti insulini ipangidwe imabisika pakulakwitsa kwa chakudya m'mimba. Ndipo pali kusokonezeka pakuchitika kwa ziwalo zonse mthupi la munthu, chifukwa ndiye kuti chinthu chofunikira kwambiri pakukonza zinthu zonse zomwe zimagwiritsidwa ntchito ndi anthu pamodzi ndi chakudya.

Zomwe zimayambitsa matendawa:

• kusabala
• kusala kudya kwanthawi yayitali
• kuwonongeka kwa chakudya cham'madzi kudzera m'makoma am'mimba,
• pachimake kapena matenda a enterocolitis,
• kufufuma kwam'mimba,
• kuchuluka kwa poizoni pazakhungu,
• aimpso glucosuria,
• anorexia, komanso neurosis,
• kusowa kwa mahomoni a chithokomiro cha magazi,
• Kulephera kwaimpso ndi kutsitsa shuga,
• kuchepa kwa magawo a gawo la chida cha pituitary chomwe chimafooketsa kukula.

Kufufuza zomwe zimayambitsa matendawa chifukwa cha chithandizo chake chodalirika pakadali pano ndichimodzi mwazovuta kwambiri zamankhwala.

Zizindikiro za Insulinomas

Ndi insulinoma, Zizindikiro ndi izi:

• wodwala amakhala ndi mayendedwe osamveka bwino,
• pali nkhanza kwa ena,
• polankhula, chisangalalo cholankhula, nthawi zambiri zopanda tanthauzo kapena mawu,
• kuchepa kwa magazi
• maulendo osangalatsa osaneneka komanso osangalatsa,
• chisokonezo chikuwonekera
• kuyerekezera zinthu zina kumachitika
• mizimu yayikulu mwadzidzidzi
• pali kusowa kokwanira pakuwunika momwe munthu alili,
• kufooka kwa minofu kapena matenda ena ammimba otumphera (ataxia),
• kuphwanya mawonekedwe a miyendo pakusintha kwawo ndikukula,
• kuona kwakumaso kumachepa
• pali kugunda kwamtima kwachangu,
• pali chikhalidwe cha nkhawa, mantha,
• kupweteka kwambiri m'mutu
• kufooka kwakanthawi
• kupweteka, kusasangalala panthawi yosuntha ma eyeb,
• mawonekedwe a nkhope, kuchepa kwa nkhope, kusowa kwa kukoma.

Dokotala nthawi zambiri amawulula kupezeka kwa ma pathologies omwe sapezeka mwa anthu athanzi. Odwala azindikira kusintha kosinthika kwakumbuyo ndi chidwi, sangathe kuchita ntchito wamba, alibe chidwi ndi zomwe zikuchitika. Izi zimawonekeranso ndi zotupa zazing'ono.

Madai ndi anamnesis:

• kutaya m'mawa m'mimba yopanda kanthu,
• kuchuluka kunenepa kuyambira pomwe kuukira kunayamba.

Zizindikiro Asanachitike:

Zizindikiro zazikulu za kuukira zimathetsedwa ndi kukhazikika kwa 40% shuga.

Zizindikiro

Chifukwa cha zowonekera bwino zamavuto amisala, insulin nthawi zambiri imalakwika chifukwa cha matenda ena. Amadziwika kuti ali ndi khunyu, zotupa, psychosis. Dokotala wodziwa bwino za insulin yemwe amayesedwa angapo amayesa ma labotale angapo, kenako amapanga kupezeka kwa insulinoma m'njira zowoneka.

Nthawi zambiri, madokotala, pogwiritsa ntchito njira zodziwika bwino zoyeserera, sangathe kuzindikira insulini mwanjira iliyonse. Chifukwa chake, pali zovuta zolakwika za insulinomas ndipo matenda osiyanasiyana amathandizidwa.

Njira zotsatirazi zakugwiritsa ntchito:

• Angiography - Njira yabwino kwambiri yodziwira insulinomas. Zimathandizira kupeza mitsempha yamagazi yomwe imapereka magazi ku chotupa. Mwa kuchuluka kwa zombo zazikulu ndi zazing'ono, lingaliro la malo ndi mulifupi wa chotupacho limapezeka.
• Kuwunikira kwamayendedwe kudziwa kuchuluka kwa insulin.
• Zolemba pamakompyuta imathandizira kupeza insulinomas yayikulu. Kuchita kwake kuli mndandanda wa 50-60%.
• Hypoglycemia. Pakupita masiku atatu, makasitomala samadya kuchipatala, akungogwiritsa ntchito madzi okha. Pambuyo pa maola 6, kuyesedwa kumachitika, kenako ndikubwereza nthawi yomweyo kubwerezedwa. Mkulu wa shuga akatsika mpaka 3 mmol / L, zopangidwazo zimachepa. Ndi kuchepa kwa shuga mpaka 2.7, komanso kupezeka kwa zizindikiro za hypoglycemia, kuyimitsidwa. Amatsekedwa ndi jakisoni wa glucose. Chiyesocho chimatha pambuyo pa maola 14. Ngati kasitomala akutsutsana ndi masiku atatu ndi usiku popanda zotsatira, kufufuza kwa insulinoma sikupezeka.
• Kuyesa kwa proinsulin. Proinsulin ndiyotsogolera kwa insulin. Gawo labwinobwino la proinsulin mu insulin yonse ndi 22%. Ndi malo abata, ndizoposa 24%, pagawo loopsa - oposa 40%. Izi zimakuthandizani kuti muwone ngati matendawa akuchulukirachulukira ndikuyamba kuchita zoyenera.
• Kuwunika kwa peptide. Milandu yoyendetsedwa ndi insulini ndi jakisoni amawerengedwa posakhala chilolezo cha dokotala. Kugwiritsa ntchito kwambiri, kuyesaku sikumapereka zotsatira zoyenera.

Dokotala amalingalira za kufunikira kwa maphunziro othandizirawa.

Mwambiri milandu, kufupikitsa insulin edema sikuyenda limodzi ndi kuphwanya kwa ziwalo zamkati. Pambuyo masiku angapo, insulin edema imadutsa yokha, osafuna chithandizo chapadera, osawerengera kuyimitsidwa kwakanthawi pomwa mankhwala a insulin ena. Mwa maimidwe ena, okodzetsa amafotokozera.

Kupewa

Popewa matendawa, zotsatirazi zingalimbikitsidwe:

• osamwa zakumwa zoledzeretsa,
• Idyani zakudya zopatsa thanzi zokha
• osadandaula ndipo khalani odekha
• Dziwani ndi kuchitira matenda onse amtundu wa panthawi yake,
• kuyeza shuga
• kuyeserera kosalekeza kwa dokotala, kutsatira malingaliro ake.

Anthu omwe amawunika zaumoyo wawo, choyambirira, ayenera kusamala ndi zakudya, chifukwa mawonekedwe ndi chitukuko cha matendawa zimadalira kwenikweni. Zakudya zolemera ndi malo othandizira ayenera kupewedwa. Yesetsani pafupipafupi, chitani zolimbitsa thupi tsiku lililonse.

Ndikofunikira kuphunzira moyenera, kuyeretsa thupi lanu ndi ziwalo zake zonse, zomwe ambiri amaiwala kuchita.

65-80% ya odwala atachitidwa opaleshoni akuchira. Kuzindikira kwakanthawi ndi kuchitapo kanthu opaleshoni kumathandizira kubwezeretsa mkati mwa dongosolo lamanjenje.

Kukula kwa odwala atachitidwa opaleshoni chifukwa cha izi:

• imfa pambuyo pa opaleshoni - 5-10%,
• kubwerezanso (kubwereza matendawa) - 3%,
• ndi matenda omaliza, osapitilira 60% ya anthu omwe ali ndi moyo,
• mu 10% ya milandu yachipatala pamakhala kusintha komwe kumadziwika ndi chotupa chowopsa komanso mawonekedwe a metastases mu ziwalo ndi machitidwe. Ndi matenda amtunduwu, kuwunika kumangoyipa. Kuchiza muzochitika zotere kumayang'ana pa kuwonongeka kwa zizindikiro za munthu,
• ndi opaleshoni ya panthawi yake, odwala 96% amapezanso thanzi.

Pambuyo pa chithandizo, thupi limagwirizana ndikusintha kwamkati mwazinthu zamkati pakokha, zimatha pakatha miyezi ingapo.

Amakhala kuti zotsatira zabwino zimapezeka pafupifupi 80% ya odwala. Pafupifupi 3% ya milandu, kuyambiranso nkotheka. Ndi chitukuko cha mankhwala, izi zimasintha osati kuchuluka kokha, komanso moyenera, ndi kuchepa kwa zovuta pambuyo pakuchita opareshoni.

Pancreatic Insulinoma: Zinthu Zakukula ndi Kukula

Pancreatic insulinoma

Neoplasm ndi chotupa chogwira ntchito chopanga ma cell a chinsinsi, ndikupanga insulin yambiri. Njirayi imawonedwa kuti ndi yowopsa kwambiri kwa anthu, chifukwa kuchuluka kwa insulini yamagazi kumadzetsa kuchuluka kwa shuga, ndipo kuchepa kwake kumabweretsa kukula kwa hypoglycemia, limodzi ndi zovuta zazikulu zaumoyo. 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 kuti ndi yovomerezeka kapena yopweteka,
• Mtundu wa chotupacho umasiyana kuchokera ku pinki kupita pamtundu wakuda,
• kukula kwa chotupa sikupitirira 5 cm.

Mitsempha yopanga kuchuluka kwa insulini imatha kuwoneka m'mbali iliyonse ya gland, koma nthawi zambiri imapezeka m'thupi la kapamba. Mfundo yoti zilonda zam'mimba zimachitika ndipo ma oncology adayamba kukulira zikuwonetsedwa ndi kuwonekera kwa metastases yogwira ntchito mu mahomoni a m'mimba, mapapu, ma cell, ndi chiwindi.

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 10% yotsala ndi khansa ya kapamba.
• 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.

Mkhalidwe wamtunduwu, womwe nthawi zonse umakhala ndi chotupa cha insulin, 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.

Akatswiri sangatchule chifukwa chodalirika chomwe chimapangitsa kuti pakhale chotupa chokhala ndi 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 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.

Kuwonetsera kulikonse kwamtundu wa insulinoma ndi chifukwa chosagwirizana ndi katswiri. Kuti mudziwe chomwe chimayambitsa matenda omwe amakhumudwitsa, dokotala choyamba amapanga anamnesis matendawa. Kuti achite izi, apeza kuchuluka kwa mphamvu ya cholowa (kukhalapo kwa ma pathologies a kapamba mwa abale amwazi) ndikuwona kuyambira kwa chotupa ndi zizindikiro zamankhwala.Chotsatira, odwala amapatsidwa matenda a labotale a insulinoma, omwe amakhala ndi mayeso osala kudya: wodwala amakwiya mwadala kuti akuwopseza hypoglycemia ndikuwona ngati angathe kuchotsedwa ndi kulowetsedwa kwa intravenous kapena kukonzekera kwa glucose.

Kuzindikiranso kwa insulinoma ndiko kuchititsa maphunziro othandiza:

• Kuyerekeza Ultrasound. Ngati insulinoma ikayamba, ma ultrasound amawonetsa kukula ndi malo a neoplasm.
• Kusankha zolaula zosiyanitsira pakati. Njira imeneyi imagwiritsidwa ntchito pofufuza kutuluka kwa magazi komwe kudyetsa chotupacho.
• MRI

Njira yolondola kwambiri yodziwitsira matenda, kulola kuzindikira mitundu ndi mitundu ya chotupa, komanso chikhalidwe chake komanso kutengera kwina koyambirira kwa magawo a chitukuko. Insulinoma ya MRI imawoneka ngati yongoyerekeza kapena yochititsa chidwi kwambiri.

Kuchita kafukufuku wofufuza kwathunthu kumapangitsa akatswiri kuti adziwitse matenda molondola, poganizira mawonekedwe onse omwe ali ndi chotupa cha pancreatic-secreting chotupa ndikusankha protocol yoyenera yovomerezeka pankhaniyi.

Nthawi zina njira ya pathological imachitika osati ma cell omwe amapanga insulin, komanso m'magulu a ma cell omwe amapanga mitundu ina ya mahomoni. Pankhaniyi, matendawa adadziwika ndi dzina la matenda onse awiri, mwachitsanzo, pakupanga insulin ndi gastrin, mbiri yakale imapezeka mu mbiri yaumoyo wodwala: insulinoma gastrinoma. Pankhaniyi, njira zochizira zidzalimbana ndikuchotsa zotupa zonse ziwiri.

Kwenikweni, insulin ya pancreatic imachotsedwa ndi opaleshoni.

Mankhwala othandizira insulinomas angathe kuchitika motere:

• Mpweya (leachingation) wa chotupa kuchokera pansi pa chithokomiro. Chithandizo chachikulu kwambiri cha opaleshoni ya insulinomas chogwiritsa ntchito laparoscopy.
• Distal pancreatectomy. Kuchotsa thupi kapena mchira wa chimbudzi chokhala ndi chotupa chopangidwira pamenepo.
• Ntchito ya Whipple (pancreatoduodenal resection). Mtundu wa opaleshoni yamtunduwu umaphatikizapo kuchotsedwa kwa insulinomas pamutu wa England.

Zofunika! Kuchita opaleshoni yamatenda sikuti kumakhala kovuta, komanso kowopsa, kotero kuyenera kuchitidwa ndi dokotala wodziwa bwino komanso wodziwa ntchito. Dokotala wodziwa bwino adzaonetsetsa kuti insulinoma yachotsedwa kwathunthu ndipo ingalepheretse kukula kwa zovuta za postoperative.

Pambuyo pochita opaleshoni yochotsa insulinoma, wodwalayo amasungabe zizindikiro za hyperglycemia masiku angapo. Ichi ndi chifukwa cha postoperative, yokhudzana mwachindunji ndi zoopsa, kutupa ndi ziwalo edema.

Ngati opaleshoni yolowerera pazamankhwala (thanzi la wodwalayo, kukula kwakukulu kwa chotupa, kukhalapo kwa metastases) sikutheka, odwala amalembedwa mankhwala a insulinomas. Imachitika pogwiritsa ntchito phenytoin ndi diazoxide. Koma mankhwalawa ali ndi vuto limodzi - amakhalanso ndi chizindikiro cha insulinomas. Kuti muchepetse, odwala amathandizidwanso hydrochlorothiazide ndipo kugwiritsa ntchito chakudya nthawi zambiri kumalimbikitsidwa.

Kuchita bwino kwa mankhwala a insulinomas kumatheka kokha ndikusintha kwa zakudya. Zakudya zophatikizidwa muzakudya za tsiku ndi tsiku ziyenera kukhala ndi zopatsa mphamvu zochepa zopatsa mphamvu kuti muchepetse kunenepa kwambiri, kuchepetsa zotsatira za njira zochizira.

Zakudya za insulinoma zimatengera malamulo otsatirawa:

• Zakudya ziyenera kukhala zofatsa. Odwala omwe ali ndi mbiri ya kutupa kwa insulin-amasungidwa amalangizidwa kuti adye zakudya zamchere, zosuta, zonunkhira, zamafuta ndi zamkaka, ndikuchepetsa zakumwa zoledzeretsa komanso khofi.
• Zakudya za tsiku ndi tsiku ziyenera kukhala ndi kuchuluka kwa zakudya zomwe zimakhala ndi fiber.
• Zakudya zopatsa thanzi ndi insulinoma zimaphatikizapo kuchepetsa kumwa kwa zovuta zam'mimba zomwe zimapezeka m'minyewa, pasitala, ufa wa wholemeal, komanso kupatula kwathunthu kosavuta (maswiti okonzedwa, omwe amaphatikizapo shuga, makeke, makeke, chokoleti).
• Limbitsani zakumwa zakumwa - imwani osachepera malita awiri a madzi oyera tsiku lililonse, koma osamwa khofi ndi msuzi wotsekemera.

Thanzi la pancreatic insulinoma limaphatikizapo kuphatikizidwa ndi zakudya zomwe zimakhala ndi insulin yayikulu komanso glycemic index (mbatata, mkaka wathunthu, mafuta ophika buledi, buledi woyera).

Kubwezeretsanso kwa odwala omwe ali ndi insulinoma kumatheka pokhapokha ngati athandizidwa opareshoni. Insulinoma yosagwira, ngakhale ndi maphunziro a mankhwala, imachepetsa kwambiri mwayi wa odwala wokhala ndi moyo wautali.

Muzochita zamankhwala, pali ziwonetsero zotsatirazi zamatchulidwe a matendawa:

• Kuposa 90-95% ya ma pathologies panthawi yopezeka ndi benign insulinoma. Pankhaniyi, chithandizo chamankhwala chapanthawi yake chimapereka zabwino - pafupifupi 99% ya zotupa zimazimiririka.
• 5-10% ya zotupa ndi vuto la insulinoma. Imawerengedwa kuti ndiyabwino. Nthawi yayitali yochotseka kwa postoperative imachitika mu 65% yokha yamankhwala. Imfa zoyambirira zimachitika mwa 10% ya odwala. Otsala a odwala khansa, monga ziwerengero zamankhwala akuwonetsa, ali ndi zovuta zobwerezabwereza matendawa ndipo sakhala ndi moyo wazaka zisanu zovuta.

Njira zotetezera kukula kwa insulinomas mu kapamba sizikupezeka. Chopewera chokha cha matenda ndi kuyezetsa magazi kwapachaka kuti muone kuchuluka kwa shuga. Komanso, ngati pali chizindikiro chimodzi chokha chomwe chingapereke limodzi ndi insulinoma, ndikofunikira kufunsa uphungu wa akatswiri ndikumuyesa mayeso ofunikira kuti mudziwe matenda omwe akudwala.

Osanyalanyaza njira zodzitetezera zomwe zingateteze kapamba kuti asawonongeke:

• musiyiretu kusuta - uchidakwa komanso uchidakwa.
• munthawi yake chitani matenda onse otupa am'mimba,
• kutsatira zakudya zoyenera zomwe zimakonzedwa tsiku lililonse komanso zakudya zoyenera.

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Insulinoma - chotupa chotupa cha β-cell cha ma pancreatic islets, ndikupanga insulin mopitirira muyeso ndikupangitsa kukula kwa hypoglycemia. Hypoglycemic ikugwidwa ndi insulinoma imayendetsedwa ndi kunjenjemera, thukuta lozizira, njala ndi mantha, tachycardia, paresthesias, malankhulidwe, zowoneka ndi zamakhalidwe, m'malo ovuta - kukomoka komanso kukomoka. 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, kapamba, kapangidwe ka kapamba, kapena chizindikiritso chonse.

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

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

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

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

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

Kuopsa kwa hypoglycemic kwachitika chifukwa chakutha kwa kusintha kwa magwiridwe antchito a mantha amkati ndi zinthu zina zaposachedwa. Kuukira kumayamba m'mimba yopanda kanthu, pambuyo pakupuma kwakudya kwambiri, nthawi zambiri m'mawa. Pakuwukira, glucose wamagazi amatsika pansi pa 2,5 mmol / L.

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

Zomwe zimachitika mwanjira yomvera chisoni-adrenal kwambiri hypoglycemia ndi mawonekedwe a kunjenjemera, thukuta lozizira, tachycardia, mantha, paresthesias. Ndi kupitirira kwa kuukira, kugwidwa, khunyu, kuzindikira, ndi kupsa mtima kumatha. Nthawi zambiri kuukira kumayimitsidwa ndi kulowetsedwa kwa shuga mkati, komabe, atachira, odwala samakumbukira zomwe zinachitika. Panthawi ya vuto la hypoglycemic, kulowetsedwa kwam'mnyewa kumatha kuyamba chifukwa cha zovuta za kudya kwa minofu ya mtima, Zizindikiro zakuwonongeka kwakanthawi kwamanjenje (hemiplegia, aphasia), yomwe ingakhale yolakwika chifukwa cha stroke.

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

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

Zoyeserera zingapo za labotale, mayeso ogwira ntchito, kupenyerera maphunziro othandizira amatithandizira kukhazikitsa zomwe zimayambitsa hypoglycemia ndikusiyanitsa insulini kuchokera ku ma syndromes ena othandizira. Kuyesererako kumayesedwa kuti kupangitse hypoglycemia ndipo kumayambitsa Whipple triad yomwe ndi pathognomonic for insulinoma: kuchepa kwa shuga m'magazi mpaka 2.78 mmol / L kapena m'munsi, kukulitsa mawonetseredwe a neuropsychiatric panthawi ya kusala, kuthekera kwa kuyimitsa kuukiridwa ndi makonzedwe amkamwa kapena kulowetsedwa kwa glucose.

Pofuna kukhazikitsa boma la hypoglycemic, kuyesa kopatsa insulin pokhazikitsa insulin. Pankhaniyi, kuchuluka kwakukulu kwa C-peptide m'magazi kumawonedwa mosiyana ndi maziko a glucose otsika kwambiri. Kuchita insulin yotsutsa inshuwaransi kapena shuga (glucagon) kumalimbikitsa kutulutsidwa kwa insulin, komwe odwala omwe ali ndi insulinoma amakhala wamkulu kwambiri kuposa mwa anthu athanzi, pomwe chiopsezo cha insulin ndi glucose chimaposa 0,4.

Ndi zotsatirapo zabwino zoyeserera zolimbikitsa, diagnostics a insulinoma ochita kupanga: Insulin iyenera kusiyanitsa ndi mankhwala osokoneza bongo ndi mowa hypoglycemia, pituitary ndi adrenal insufficiency, adrenal khansa, kutaya matenda, galactosemia ndi zina.

Mu endocrinology yokhudza insulinoma, machitidwe opangira opaleshoni amasankhidwa. Kuchulukitsa kwa ntchito kumatsimikiziridwa ndi malo ndi kukula kwa mapangidwewo. Pankhani ya insulinoma, onse a chotupa enulination (insulinomectomy) ndi mitundu yosiyanasiyana ya kapangidwe ka pancreatic (distal, mutu resection, pancreatoduodenal resection, chonse pancreatectomy) chitha kuchitika. Kuchita bwino kwa kulowererako kumawunikidwa mwa kudziwa kuchuluka kwa shuga m'magazi. Pakati pazovuta za postoperative, kapamba, kapamba, kapamba, chifuwa cham'mimba, kapena peritonitis.

Pankhani ya insulinomas yogwira ntchito, chithandizo chokhazikika chimachitika ndikuyimitsa ndi kupewa hypoglycemia pogwiritsa ntchito othandizira a hyperglycemic (adrenaline, norepinephrine, glucagon, glucocorticoids, etc.). Ndi insulinomas yoyipa, chemotherapy (streptozotocin, 5-fluorouracil, doxorubicin, etc.) imachitidwa.

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

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

Zizindikiro 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, kupweteka m'mutu, palpitations, kumverera kosowa kwa mpweya, kutuluka thukuta, kumverera kosatha kwa mantha.

Kupitilira patsogolo kwa hypoglycemia kumatha kudzetsa kusokonezeka kwamphamvu kwa chikumbumtima, popanda kupereka 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 makola amkamwa, kuchepa kwa mawonekedwe amkamwa, kuchepa kwa mawonekedwe a nkhope, kusalala, kusokonezeka kwa kakomedwe, mawonekedwe a ululu m'dera la muzu wa lilime ndi matayilosi. 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, alibe chidwi ndi zomwe zikuchitika. 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.

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 kuyambitsa shuga kumalimbikitsidwanso kuti muchepetse matenda a hypoglycemia.

Dokotala uti kuti mulumikizane

Ngati munthu ali ndi vuto lanjala, kunjenjemera kwa minofu, 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.

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 5-10%.

Limagwirira a hypoglycemia mu insulinoma

Kukula kwa mkhalidwewu kukufotokozedwa chifukwa chakuti kubisala kosasunthika kwa insulini ndi ma b-cell a 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 imamveka ndi ma cell aubongo omwe amagwiritsa ntchito glucose ngati gwero lalikulu lamphamvu. Pankhaniyi, chitukuko cha chotupa, neuroglycopenia chimayamba, ndipo ndi ndondomeko yotupa mkati mwa mantha amkati, kusintha kwa dystrophic kumachitika.

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 pancreatic necrosis, ndipo ngati hemorrhagic pancreatic necrosis ipezeka, chifukwa cha kufa ndi kuphatikizika kumakhalamo. ,

• 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.

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.