Izifo eziningi ze-pancreatic zithinta ngqo i-carbohydrate metabolism. I-insulinoma inyusa ukukhiqizwa kwe-insulin emzimbeni. Lapho ama-carbohydrate ekudleni okujwayelekile akwanele ukumboza lokhu kuvikelwa ngokweqile, i-hypoglycemia yenzeka kubantu. Ikhula kancane kancane, imvamisa kungabonakali esigulini, ilimaze kancane kancane uhlelo lwezinzwa. Ngenxa yobunzima bokuxilongwa nokutholakala kwe-insulinoma isiguli, isiguli singalashwa nodokotela oyi-neurologist noma wezifo zengqondo iminyaka ngaphandle kwemiphumela kuze kubonakale izimpawu ze-hypoglycemia.
Yini i-insulinoma
Ngaphezu kweminye imisebenzi ebalulekile, ama-pancreas anikela ngomzimba wethu ngama-hormone alawula i-carbohydrate metabolism - insulin ne-glucagon. I-insulin inesibopho sokukhipha ushukela wegazi ezicutshini. Ikhiqizwa ngohlobo olukhethekile lwamaseli atholakala emsileni wamanyikwe - amaseli we-beta.
I-Insulinoma iyi-neoplasm eyenziwe ngala maseli. Kungokwesimila se-hormone esekela futhi ikwazi ukwenza ngokuzimela ukufakwa kwe-insulin. Ama-pancreas akhiqiza le hormone lapho ukugcwala kweglucose egazini kukhuphuka. Isimila sihlala sikukhiqiza, ngaphandle kokubheka izidingo zomzimba. I-insulinoma enkulu futhi isebenza ngokwengeziwe, ikhiqiza i-insulin ngokwengeziwe, okusho ukuthi ushukela wegazi wehla ngaphezulu.
Isifo sikashukela nokucindezela kuzoba yinto yesikhathi esedlule
- Ukwehlela ushukela -95%
- Ukuqedwa kwe-vein thrombosis - 70%
- Ukuqedwa kokushaya kwenhliziyo okuqinile -90%
- Ukuqeda umfutho wegazi ophakeme - 92%
- Ukwanda kwamandla ngesikhathi sosuku, ngcono ukulala ebusuku -97%
Lesi simila sinqabile, umuntu oyedwa kwezigidi eziyi-1,25 uyagula. Imvamisa kakhulu yincane, ifinyelela ku-2 cm, etholakala kumanyikwe. E-1% yamacala, i-insulinoma ingatholakala odongeni lwesisu, i-duodenum 12, i-spleen, nesibindi.
Isimila esinobubanzi besigamu nje samasentimitha siyakwazi ukukhiqiza inani elinjalo le-insulin elizodala ukuthi i-glucose yehle ngaphansi kwelejwayelekile. Ngaso leso sikhathi, kunzima ukuyithola, ikakhulukazi ngokwenza kwasendaweni okuyi-atypical.
Abadala besikhathi sokusebenza bavame ukuthinteka yi-insulinoma, abesifazane basengozini ephindwe izikhathi ezi-1.5.
| Iminyaka yobudala | Ingxenye yeziguli,% |
| Kufika kuma-20 | 5 |
| 20-40 | 20 |
| 40-60 | 40 |
| Bangaphezu kuka-60 | 35 |
Imvamisa, ama-insulinomas yi-benign (ikhodi ye-ICD-10: D13.7), ngemuva kokweqisa ngosayizi ongu-2,5 cm, kuphela kumaphesenti ayi-15 ezimpawu ze-neoplasms zenqubo enobungozi eqala (ikhodi C25.4).
Kungani kuthuthukiswa futhi kanjani
Izizathu zokwakhiwa kwama-insulinomas azikaziwa kahle. Ukucabanga kwenziwa mayelana nokuba khona kwengqondo yelifa lokuchithwa kwamangqamuzana, cishe ngokwehluleka okukodwa ezinhlelweni zomzimba ezivumelanayo, kepha la ma-hypotheses awakabi nesiqinisekiso sesayensi. Ukuhlangana kuphela kwama-insulinomas nge-adenomatosis eminingi, isifo sofuzo esingajwayelekile lapho ama-tumic e-secreting tumors akhula khona, lapho sekusungulwe ngokunembile. Ku-80% yeziguli, izilonda ziyabonakala kumanyikwe.
Ama-insulinomas angaba nesakhiwo, futhi izindawo eziningi ezingaphakathi kwe-tumor efanayo nazo ziyahlukahluka. Lokhu kungenxa yekhono elihlukile le-insulin lokukhiqiza, ukugcina nokugcina i-insulin. Ngaphezu kwamaseli we-beta, isimila singaba namanye amaseli we-pancreatic, atypical futhi asebenzayo angasebenzi. Ingxenye yama-neoplasms, ngaphezu kwe-insulin, iyakwazi ukukhiqiza amanye ama-hormone - i-pancreatic polypeptide, glucagon, gastrin.
Ama-insulinomas angasebenzi kahle acatshangelwa ukuthi makhulu futhi maningi amathuba okuba ahlukunyezwe. Mhlawumbe lokhu kungenxa yezimpawu ezingathi sína kanye nokutholwa kwesifo sekwephuzile. Imvamisa ye-hypoglycemia kanye nezinga lokwanda kwezimpawu lihlobene ngqo nomsebenzi we-tumor.
Uhlelo lwezinzwa lwe-autonomic lunenkinga yokuntuleka kweglucose egazini, ukusebenza kwalona oluphakathi kuyaphazamiseka. Izikhathi ezithile, ushukela wegazi ophansi unomthelela emsebenzini ophakeme wezinzwa, kufaka phakathi ukucabanga nokwazi. Kungukulimala kwe-cortex ye-cerebral evame ukuhlotshaniswa nokuziphatha okungalungile kweziguli ezine-insulinoma. Ukuphazamiseka kwemetabolic kuholela ekulimaleni ezindongeni zemithambo yegazi, ngenxa yokuthi ikhula kanjani i-edema yengqondo, kanye nefomu lokuqhekeka kwegazi.
Izimpawu nezimpawu ze-insulinoma
I-insulinoma ikhiqiza i-insulin njalo, futhi iyikhipha ngokwayo imvamisa ethile, ngakho-ke ukuhlaselwa kwama-episodic kwe-hypoglycemia ebushelelezi kuthathelwa indawo yi-lull ehlobene.
Futhi, ubukhulu bezimpawu ze-insulinoma buthinteka ngu:
- Ifaka umsoco. Abalandeli bamaswidi bazozwa izinkinga emzimbeni kamuva kunabalandeli bokudla kwamaprotheni.
- Umuzwa ngamunye we-insulin: abanye abantu balahlekelwa ukwazi ngo-ushukela wegazi ongaphansi kuka-2,5 mmol / l, abanye babekezelela ukwehla okunjalo ngokujwayelekile.
- Ukwakheka kwama-hormone akhiqizwa yile tumor. Ngesilinganiso esikhulu se-glucagon, izimpawu zizovela ngokuhamba kwesikhathi.
- Umsebenzi weTumor. Kukhululwa ama-hormone amaningi, aqhakambisa izimpawu.
Izimpawu zanoma iyiphi i-insulinoma zibangelwa izinqubo ezimbili eziphikisanayo:
- Ukukhishwa kwe-insulin futhi, ngenxa yalokho, i-hypoglycemia eyingozi.
- Ukukhiqizwa komzimba ukuphendula i-insulin eyeqile yabaphikisi bayo, ama-hormone, izitha. Lawa yi-catecholamines - adrenaline, dopamine, norepinephrine.
| Imbangela yezimpawu | Isikhathi sokwenzeka | Izimpawu |
| I-Hypoglycemia | Ngokushesha ngemuva kokukhishwa kwe-insulinoma, enye ingxenye ye-insulin. | Indlala, intukuthelo noma ukudabuka, isimilo esingafanele, ukukhubazeka kwenkumbulo kuze kufike ku-amnesia, umbono ofiphele, ukozela, ukuqaqamba noma ukuqunjelwa, iminwe nasezinzwaneni. |
| Ama-catecholamini amaningi | Ukulandela i-hypoglycemia, kuyaqhubeka isikhathi esithile ngemuva kokudla. | Ukwesaba, ukuthuthumela kwangaphakathi, ukujuluka ngokweqile, i-palpitations, ubuthakathaka, ikhanda, umuzwa wokuntuleka komoya-mpilo. |
| Ukulimala ohlelweni lwezinzwa ngenxa ye-hypoglycemia engapheli | Kubonwa kahle ngezikhathi zokuphila okuhle. | Ukwehliswa kwekhono lokusebenza, ukunganaki ezintweni ezithokozisayo zangaphambili, ukulahleka kwekhono lokwenza umsebenzi omuhle, ubunzima bokufunda, ukungasebenzi kahle kwe-erectile emadodeni, i-asymmetry yobuso, ukubukeka kobuso obulula, umphimbo obuhlungu. |
Imvamisa, ukuhlaselwa kubonwa ekuseni ngesisu esingenalutho, ngemuva kokuzivocavoca ngokomzimba noma ukucindezelwa kwengqondo, kwabesifazane - ngaphambi kokuya esikhathini.
Ukuhlaselwa kwe-hypoglycemia kumiswa ngokushesha ngenxa yokudla kwe-glucose, umzimba-ke uphendula ngokuwohloka koshukela ngokuhlaselwa yindlala ebukhali. Iningi leziguli likhulisa ukudla kwabo ushukela noma amaswidi, bese liqala ukudla kaningi. Isifiso esibukhali se-pathological samaswidi ngaphandle kwezinye izimpawu singachazwa yi-insulinoma encane noma engasebenzi. Ngenxa yokuphulwa kokudla, isisindo siqala ukukhula.
Ingxenye encane yeziguli iziphatha ngendlela ehlukile - iqala ukuzizwa ithambekele ekudleni, inciphisa isisindo, kufanele ifake ukulungiswa kokukhathala ezinhlelweni zayo zokwelashwa.
Izindlela zokuxilonga
Ngenxa yezimpawu ezicacile zemizwa, i-insulin ivame ukwenziwa iphutha kwezinye izifo. Isithuthwane, ukuvuvukala kanye nokuxinana kwegazi ebuchosheni, i-vegetovascular dystonia, psychoses ingatholakala ngephutha. Udokotela onekhono ne-insulin esolwayo wenza izivivinyo eziningana zaselebhu, abese eqinisekisa lokhu kutholwa okusolwa ngezindlela zokubuka.
Ebantwini abaphilile, umkhawulo ophansi kashukela ngemuva kwamahora ayisishiyagalombili wokulamba yindlala ingu-4.1 mmol / L, ngemuva kosuku iyehla iye ku-3.3, kokuthathu - kuze kufike ku-3 mmol / L, futhi kwabesifazane ukwehla kukhulu kakhulu kunasemadodeni. Ezigulini ezine-insulinoma, ushukela wehla ufike ku-3.3 emahoreni ayi-10, kanti i-hypoglycemia esibi enezimpawu ezinzima isivele ikhula ngosuku.
Ngokusekelwe kule mininingwane, i-hypoglycemia icasulwa ukuthola i-insulinomas. Imelela ukuzila kwezinsuku ezintathu esibhedlela, lapho kuvunyelwe khona amanzi kuphela. Ukuhlolwa kwe-insulin neglucose kwenziwa njalo emahoreni ayi-6. Lapho ushukela wehlela ku-3 mmol / l, izikhathi eziphakathi kokuhlaziywa zifushaniswa. Ukuhlolwa kuyama lapho ushukela wehlela ku-2.7 bese kuvela izimpawu ze-hypoglycemia. Zimisiwe ngomjovo weglucose. Ngokwesilinganiso, ukucasuka kuphela ngemuva kwamahora ayi-14. Uma isiguli sibekezelela izinsuku ezingama-3 ngaphandle kwemiphumela, ayinayo i-insulinoma.
Okubaluleke kakhulu kulokhu kuxilonga ukuzimisela kwe-proinsulin. Ungumbandule we-insulin okhiqizwa amaseli we-beta. Ngemuva kokuphuma kubo, molecule ye-proinsulin ifakwa ku-C-peptide ne-insulin. Ngokuvamile, isilinganiso se-proinsulin esilinganisweni se-insulin singaphansi kwama-22%. Nge-benign insulinoma, le nkomba ingaphezulu kuka-24%, inobungozi - ingaphezulu kuka-40%.
Ukuhlaziywa kwe-C-peptide kwenziwa iziguli ezinokukhubazeka kwengqondo okusolwayo. Ngakho-ke, amacala okuphathwa kwe-insulin ngomjovo abalwa ngaphandle kwemithi kadokotela. Ukulungiselela kwe-insulin akunayo i-C-peptide.
Ukuxilongwa kwendawo yama-insulinomas kuma-pancreas kwenziwa kusetshenziswa izindlela zokucabanga, ukusebenza kwawo kungaphezulu kwe-90%.
Ingasetshenziswa:
- I-Angiography - indlela ephumelela kunazo zonke. Ngosizo lwayo, kutholakala ukunqwabelana kwemithambo enikeza ukulethwa kwegazi esiswini. Ngosayizi womthambo wokuphaka kanye nenethiwekhi yemikhumbi emincane, umuntu angahlulela ukwenziwa kwasekhaya nobubanzi be-neoplasm.
- I-Endoscopic ultrasonography - Ivumela ukuthi uthole ama-93% amathumba akhona.
- I-Tomography ehlanganisiwe - Kwembula isimila pancreatic ku 50% amacala.
- Ukuhlolwa kwe-Ultrasound - Isebenza kuphela lapho kungekho isisindo ngokweqile.
Ukwelashwa
Bazama ukususa i-insulin ngokushesha okukhulu, ngokushesha emva kokuxilongwa. Sonke isikhathi ngaphambi kokuhlinzwa, isiguli sithola i-glucose ekudleni noma emzimbeni. Uma isimila sinobungozi, i-chemotherapy iyadingeka ngemuva kokuhlinzwa.
Ukuhlinzwa
Imvamisa, i-insulinoma itholakala ngaphezulu kwamanyikwe, inemiphetho ecacile nombala obomvu onsundu, ngakho-ke kulula ukuyisusa ngaphandle kokulimaza isitho. Uma i-insulinoma engaphakathi kwe-pancreas incane kakhulu, inesakhiwo se-atypical, udokotela kungenzeka angayitholi ngenkathi ihlinzwa, noma ngabe indawo yesimila isungulwe ngesikhathi sokuxilongwa. Kulokhu, ukungenelela kuyamiswa futhi kubekwe eceleni isikhashana, kuze kube yilapho isimila sikhula futhi singasuswa. Ngalesi sikhathi, ukwelashwa okulondoloziwe kwenziwa ukuvikela i-hypoglycemia nomsebenzi wezinzwa ongasebenzi kahle.
Ngokuhlinzwa kaninginingi, baphinde bazame ukuthola i-insulin, futhi uma lokhu kungaphumeleli, susa ingxenye yamanyikwe noma isibindi enesimila. Uma kune-insulinoma enama-metastases, kufanele futhi wenze kabusha ingxenye yengxenye yesitho ukuze unciphise izicubu zesimila.
Ukwelashwa okuqondayo
Ukwelashwa okubonakalayo kokuhlinzwa kwe-insulinomas kusalindwe ukudla okuphezulu ushukela. Kuthandwa kuqala imikhiqizo enama-carbohydrate aphambili, ukuthambekela okuqinisekisa ukuvela okufana kokugaya ushukela egazini. Iziqephu ze-hypoglycemia eyingozi zimiswa ama-carbohydrate asheshayo, imvamisa ngamajusi anoshukela ongeziwe. Uma i-hypoglycemia ebukhali ivela nokuqwashisa okungasebenzi kahle, isiguli sifakwa ngeglucose emzimbeni.
Uma, ngenxa yesimo sempilo sesiguli, ukuhlinzwa kubambezelekile noma kungenzeki nhlobo, kubikwa iphenytoin ne-diazoxide. Umuthi wokuqala umuthi owelapha i-antiepileptic, owesibili usetshenziswa njenge-vasodilator yezinkinga ezinkulu kakhulu. Hlanganisa le mithi nemiphumela emibi esejwayelekile - hyperglycemia. Usebenzisa le -backback okuhle, ungagcina ushukela wegazi ezingeni eliseduze nelokujwayelekile leminyaka. Ama-diuretics anqunywa ngasikhathi sinye i-diazoxide, njengoba igcina uketshezi kwizicubu.
Umsebenzi wamathumbu amancane we-pancreatic ungancishiswa ngokusebenzisa i-verapamil ne-propranalol, engavimba ukuphepha kwe-insulin. I-Octreotide isetshenziselwa ukwelapha i-insulinomas enobungozi, ivimbela ukuphuma kwehomoni futhi ithuthukise kakhulu isimo sesiguli.
I-Chemotherapy
I-Chemotherapy iyadingeka uma isimila sinesihlungu. IStreptozocin isetshenziswa ihlanganiswe ne-fluorouracil, ama-60% eziguli azwela zona, kanti ama-50% anokuxolelwa okuphelele. Inkambo yokwelashwa ihlala izinsuku ezingama-5, kuzofanela iphindwe njalo emavikini ayi-6. Umuthi unomphumela onobuthi esibindini nasezinso, ngakho-ke, ngezikhathi ezithile phakathi kwezifundo, imithi ibekelwa ukuba ibasekele.
Ongakulindela kulesi sifo
Ngemuva kokuhlinzwa, amazinga e-insulin ancipha ngokushesha, ukukhuphuka kwegazi glucose. Uma isimila sitholwa ngesikhathi futhi sisuswe ngokuphelele, ama-96% eziguli ayalulama. Umphumela omuhle kakhulu unama tumors amancane e-benign. Ukusebenza kokwelashwa kwe-insulin ebabayo kungama-65%. Ukubuyela emuva kwenzeka ngamaphesenti ayi-10.
Ngokushintshwa okuncane ohlelweni lwezinzwa oluphakathi, umzimba ubhekana ngokuzimela, baphinda baphenduke ezinyangeni ezimbalwa. Ukulimala kwezinzwa okukhulu, izinguquko eziphilayo ebuchosheni azinakuguqulwa.
