I-pancreatic insulinoma iyi-neoplasm engavamile eyakheka kusuka kumaseli we-beta. Imvamisa, i-neoplasm enjalo inemvelo engeyinhle, kodwa futhi ilimaza ku-15% yamacala okuthola kwe-pathology.
Le ndlela yokusebenza ibonakala ngokuba khona kokuzenzela kwama-hormone okuzenzela, okubandakanya ukwanda kokuqashelwa kwe-hormone insulin, okuholela ekuthuthukisweni kwe-hyperinsulinism.
I-insulin iqala ukubonakala ngokungalawulwa, okucasulayo ukwenzeka kwe-hypoglycemic syndrome.
I-Hypoglycemic syndrome iyinkimbinkimbi yezimpawu ze-neuroglycopenic ne-adrenergic.
Kuwo wonke ama-tumic anhlobonhlobo akha izicubu ze-pancreatic futhi andise imisebenzi ye-hormonal, lolu hlobo lwe-neoplasm luthatha cishe ama-70%.
Ukuthuthukiswa kwe-hypoglycemia ku-insulinoma kanye nokuhlukaniswa kwe-neoplasms
Ngokuvamile, ukuthuthukiswa kwesimila kuqoshwa kubantu abaneminyaka engama-40 kuye kwengama-60. Ezimweni ezingandile kakhulu, i-pathology enjalo ingakhula ebuntwaneni.
Ukuvela kwesimila kungenzeka kunoma iyiphi ingxenye yamanyikwe. Amacala okwenziwa kokugxilwa kwe-pathological awatholakalanga emzimbeni we-gland kuphela, kepha futhi nomsila kanye nekhanda. Amasayizi we-insulinomas angahluka ukusuka ku-1.5 cm ukuya ku-2 cm ubukhulu.
Ukuthuthukiswa kwe-hypoglycemia lapho kukhona i-insulinoma kwezicubu zamanyikwe kuhlanganiswa nokukhiqizwa nokukhululwa kwenani elikhulu le-insulin egazini.
Esimweni esejwayelekile, ngokuncipha kwenani le-glucose, kukhona ukwehla ekukhiqizweni kwe-insulin ngamaseli e-beta. Ezingxenyeni zokugxila kwe-tumor, le ndlela yokuqondisa ayithinteki, ngakho-ke, ngokwehla kwesamba samakhamzimba egazini, akukho ukwehla ekukhiqizweni kwe-insulin. Ama-hormone amaningi abangela ukuvela kwezimpawu ze-hypoglycemic.
Imvamisa, ukubonakala kwezimpawu ezinzima ze-hypoglycemic syndrome kubonwa ebusuku, esiswini esingenalutho noma yindlala ende.
Ngokuya ngohlobo lwe-neoplasm, wonke ama-insulinomas angahlukaniswa ngamaqembu amabili:
- I-Neoplasms enesimo esihle.
- Ama-tumors anesimo esibuhlungu.
Ngokuhambisana nezibalo zezokwelapha, ukuthuthukiswa kwalesi sifo kubantu besifazane kuqoshwa kaningi kakhulu kunakwabesilisa.
Ngokusho kokucatshangelwa kweningi lodokotela abaqhuba ucwaningo, isizathu sokubonakala kwe-insulin silele kokuphulwa kokusebenza kwegciwane lesisu elenzeka ngenxa yokwehlulwa yisifo.
Ngaphezu kwalokho, izimbangela ezilandelayo zingathinta ukubonakala nokukhula kwama-insulinomas kwezicubu zamanyikwe abantu:
- ukukhathala komzimba ngenxa yokuzila ukudla isikhathi eside;
- malabsorption of carbohydrate emathunjini;
- ukuthuthukiswa kwe-enterocolitis ebi kakhulu noma engamahlalakhona;
- resection esiswini;
- ukuvezwa kobuthi kwezicubu zesibindi;
- ukuthuthukiswa kwe-renal glucosuria;
- i-anorexia ehambisana ne-neurosis;
- ukuvela kokuntuleka kwama-hormone egilo egazi;
- ukubonakala kwesimo esibi sokuntuleka kwe-adrenal cortex nokuncipha kwama-glucocorticoids kanye namazinga kashukela;
- ukunqatshelwa kwemisebenzi ye-anterior pituitary gland.
I-insulinoma akulona uhlobo lwesifo futhi ifa, kodwa imvamisa kunamanye ama-insuloma angalimaza izicubu ze-pancreatic.
Izimpawu ze-pancreatic insulinoma
Ngokuqhubeka kwe-pathology, izikhathi zokuphila kahle zihlukaniswa, esikhundleni sezikhathi zokubonakaliswa kokuthuthukiswa kwe-hypoglycemia ne-hyperadrenalinemia esebenzayo.
Ngesikhathi senhlala-kahle, i-pathology iziveza kabi. Kumuntu phakathi nalesi sikhathi kunesifiso sokudla kanye nokukhuluphala okuthuthukile.
Esikhathini sokubonakaliswa kwe-hypoglycemia kanye ne-hyperadrenalinemia esebenzayo ngenxa yokungasebenzi kahle ekusebenzeni kwezindlela zokuguquguquka kwesistimu yezinzwa nemiphumela yezici ezilwa ne-insulin, kungaba nokuhlaselwa okubucayi kwe-hypoglycemic.
Imvamisa, ukukhula kokuxhuga kubonakala ngesisu esingenalutho ekuseni. Ngaphezu kwalokho, le nto ingenzeka phambi kwekhefu elide phakathi kokudla. Ngesikhathi sokukhula kokuhlaselwa, izimpawu zikhombisa ukwehla okukhulu ekugxilweni kwe-glucose egazini. Inkomba ingehla ifike ezingeni le-2,5 mmol / ilitha futhi kwezinye izimo iphansi.
Izimpawu zezimpawu ze-neuroglycopenic zalesi sifo ziyafana nokuphazamiseka kwengqondo okuvamile noma ukuphazamiseka kwemizwa.
Iziguli zizizwa zikhala kakhulu kubuthakathaka emisipha, ukudideka kwenzeka, kuvela ikhanda elinzima.
Kwezinye izimo, ukuquleka kungahle kuhambisane nokuvela kokuphazamiseka okungajwayelekile kwengqondo:
- Kuvela ukukhathazeka kwezimoto.
- Kuvela lapho umuzwa we-euphoria.
- Ukuvela kwezimpawu kuyabonakala.
- Kukhona ukuhlaselwa kobutha obungenakulawulwa.
- Ukuvela kokukhuluma kuyavela.
Uhlelo lokuzwela-i-adrenal luphendula ekuhlaselweni kwe-hypoglycemic ngokuvela kokuthuthumela, ukubila okujuluka, ukubonakala komqondo ongafanele wesabe, kanye nokuthuthukiswa kwe-tachycardia.
Ngokuqhubeka kokuhlaselwa, kuvela ukubanjwa kwesithuthwane, ukulahleka kwengqondo kuqashelwe, kuthi lapho kukhuphuka umdlandla.
Ukukhululeka kwezimpawu zokuhlaselwa kwenziwa ukuphathwa kanzulu kwekhambi le-glucose.
Ukuthuthukiswa kokuhlaselwa kwe-hypoglycemic kungadala ukushaya kwenhliziyo kanye nomonakalo wasekhaya ohlelweni lwezinzwa. Kukhona ithuba lokuthuthukisa i-insulin coma.
Ukuvela kwe-hypoglycemia engalapheki lapho kukhona i-insulinoma kuvusa ukubukeka kokuphazamiseka ekusebenzeni kwesistimu yezinzwa ephakathi, okuholela ekutheni kube khona isikhathi sesigaba sokuphila kahle.
Esikhathini esiphakathi kokuhlaselwa, ukuwohloka kombono nokukhumbula kuyabonakala.
Ngokuvamile, ngisho nangemva kokususwa kokugxilwa kwe-tumor, isiguli sinokwehla kwamakhono obuhlakani, okuholela ekulahlekelweni yisimo senhlalo esidlule somphakathi.
Ukuxilongwa kwe-pancreatic insulinoma
Ekuhlolweni kokuqala, udokotela oholayo ngenxa yocwaningo uthola ukuthi kukhona ama-pathologies ekusebenzeni kwamanyikwe ezihlotsheni zegazi eziseduze.
Ngaphezu kwalokho, inqubo yocwaningo yembula lapho kuvela izimpawu zokuqala zobukhona bokuphazamiseka kwe-pathological.
Ukubona ubukhona be-insulinomas, ukuhlolwa okuyinkimbinkimbi kwelebhu, izivivinyo zensiza ezibukwayo nokuhlolwa kwelebhu kwenziwa6
- Kwenziwa ukuhlolwa kokuzila ukudla, okubandakanya ukuvusa ngenhloso kwe-hypoglycemia kanye neWhipple triad ejwayelekile yesimila.
- Ukuvusa umbuso we-hypoglycemic, kusetshenziswa i-ejenti yezokwelapha equkethe i-insulin engaphandle ekwakhiweni kwayo - kwenziwa ukuhlolwa kwe-insulin. Kulokhu, okuqukethwe okuphezulu kwe-C-peptide esegazini kwembulwa ezingeni eliphansi likashukela.
- Kwenziwa ukuhlolwa kwe-insulin, okubandakanya ukuphathwa kwe-glucagon noma i-glucose, okuvusa ukukhishwa kwe-insulin. Ngokwesilinganiso se-insulin ekhishwe, ukuba khona kokugxila kwe-tumor kuyahlulelwa.
Uma izifundo ezenziwe zinikeza umphumela omuhle, khona-ke ezinye izifundo zenziwa.
Kulokhu, izindlela ezilandelayo zokuxilonga ziyasetshenziswa:
- I-Ultrasound yamanyikwe;
- I-MRI
- i-pancreatic scintigraphy;
- i-angiography ekhethiwe;
- i-pancreatic intraoperative ultrasonography;
- i-diagnostic laparoscopy.
Lapho wenza ukuhlolwa kwe-insulinoma kufanele kwehlukaniswe kuma-pathologies anjengalawa:
- I-Alcoholic nezidakamizwa hypoglycemia.
- Umdlavuza we-Adrenal.
- Ukuntuleka kwendawo kanye ne-adrenal.
- I-Galactosemia.
- Isifo sokulahla inkunkuma.
Ngemuva kokwenza izivivinyo eziyinkimbinkimbi ezidingekayo, baqala ukwelashwa kwesimila.
Ukwelashwa Kwe-pancreatic Insulinoma
Ukwelashwa okuvame kakhulu kwe-insulin ukuhlinzwa.
Umthamo wokungenelela kokuhlinzwa uhlangene ngokuphelele ngosayizi wokugxila kwe-tumor nendawo yendawo yakhona.
Kwezinye izimo, kwenziwa i-insulinectomy noma ukumisa kabusha kwezicubu ze-pancreatic.
Impumelelo yokuhlinzwa ihlolwa ngokuthola amandla weglucose emzimbeni ngesikhathi sokungenelela.
Njengomphumela wokuhlinzwa, ukubukeka kwezinkinga ezingemuva kokusebenza, okulandelayo:
- ukuvela kwesisu;
- ama-pancreatic fistulas ayakhiwa;
- i-peritonitis iba.
Esimweni lapho isiza se-tumor singasebenzi, khona-ke ukwelashwa okulondoloziwe kwenziwa, kusetshenziswa izindlela zokuvimbela ukuthuthukiswa kwe-hypoglycemia, ukuthathwa kulawulwa kusetshenziswa i-glucagon, i-adrenaline, i-glucocorticoids ne-norepinephrine.
Esigabeni sokuqala sokuthuthukiswa kwe-pathology, iziguli zinconywa ukuthi zidle ngokuqukethwe okuphezulu kwe-carbohydrate.
Uma kutholakala izimpawu zokulimala kwesisu se-tumor, izifundo ze-chemotherapy zenziwa kusetshenziswa i-doxorubicin noma i-streptozotocin.
I-chemotherapy ebukhali ayiqinisekisi ukululama futhi inyusa ingozi yokufa ifinyelela kuma-60%
Imvamisa yokwelashwa okuphelele lapho usebenzisa indlela yokwelashwa efinyelela ku-90%.
Ngesikhathi sokwelashwa kwe-neoplasms, ukudla kufanele kubuyekezwe kakhulu; ngaphezu kwalokho, ukudla okubandayo kufanele kusetshenziswe. Imvamisa yokudla kufanele ibe okungenani kahlanu ngosuku. Futhi izingxenye zokudla ukudla kufanele zibe zincane.
Zonke iziguli ezine-insulinoma ekhonjiwe kufanele zifakwe kwi-akhawunti ye-disensary ne-endocrinologist nodokotela oyi-neurologist.
Ukuvimbela ukukhula kwesimo se-hypoglycemic, ezinye izindlela zokwelapha zingasetshenziswa ezingalawula ngempumelelo izinga leshukela legazi lesiguli.
Ukuqashelwa kwama-insulinomas
Amathuba okululama kwesiguli ngemuva kokuhlinzwa kwe-tumor site kusuka ku-65 kuye ku-80%.
Ukuqala ukwakheka kwe-pathological kutholakele, kuphakeme ngamathuba okululama kwesiguli ngemuva kokwelashwa okufanele, futhi izinguquko ezenzeka kalula ekusebenzeni kohlelo lwezinzwa zingalungiswa.
Ukuqala kokushona ngemuva kokuhlinzwa kubonwa emacaleni angama-5-10%. Cishe i-3% yeziguli iphinde ibuye emuva ekusebenzeni kabusha.
Isiguli esisodwa kweziyishumi sinokuwohloka okulimazayo kokugxila kwe-tumor. Kulokhu, ukukhula okulimazayo kwesimila kuqondisiwe. Ngasikhathi kanye nokukhula kokugxila okuyinhloko, ukwakheka kwama-metastases kwizitho ezikude nezinhlelo zomzimba wesiguli kwenzeka.
Lapho kukhona isifo sokulimala kwezifo, lesi sifo asisihle, cishe zingama-60% iziguli ezisindayo iminyaka emibili ngemuva kokuhlinzwa.
Uma kunomlando walesi sifo, iziguli kufanele zishintshe indlela ezidla ngayo futhi ziyeke imikhuba emibi. Ngaphezu kwalokho, kufanele uvivinywe njalo esikhungweni sezokwelapha okungenani kanye ngonyaka. Ukuhlolwa kumele kufake phakathi ukunqunywa kwezinga le-glucose esegazini legazi lesiguli.
Njengomthetho, ukuthuthukiswa kwe-pathology kuholela ekuqhamukeni nasekuqhubekeni kwe-pancreatitis emzimbeni wesiguli.
I-Insulinoma ichazwe kule vidiyo kule ndatshana.
