Pancreatic insulinoma (zimayambitsa, zizindikiro, njira zamankhwala)

Matenda ambiri a pancreatic amakhudza mwachindunji kagayidwe kazakudya. Insulinoma imakulitsa kupanga insulin mthupi. Ngati chakudya chamagulu m'thupi mwa chakudya chokwanira sichokwanira kungobisa katulutsidwe kameneka, hypoglycemia imapezeka mwa anthu. Amayamba pang'onopang'ono, nthawi zambiri mopanda chidwi kwa wodwalayo, pang'onopang'ono kuwononga dongosolo lamanjenje. Chifukwa cha zovuta kuzindikiritsa komanso kuperewera kwa insulinoma, wodwala amatha kuthandizidwa ndi neurologist kapena psychiatrist kwazaka zingapo kuti asapezeke mpaka zizindikiro za hypoglycemia ziwonekere.

Kodi insulinoma ndi chiyani?

Kuphatikiza pa ntchito zina zofunika, kapamba amapatsa thupi lathu mahomoni omwe amawongolera kagayidwe kazakudya - insulin ndi glucagon. Insulin ndi amene amathandiza kuchotsa shuga m'magazi. Amapangidwa ndi mtundu wapadera wamaselo omwe amakhala mchira wa kapamba - maselo a beta.

Insulinoma ndi chopinga chopangidwa ndi maselo amenewa. Ndi ya zotupa zotulutsa mahomoni ndipo zimatha kuchita payokha insulin. Zikondazo zimatulutsa timadzi timeneti pamene kuchuluka kwa shuga m'magazi kumachuluka. Chotupa nthawi zonse chimatulutsa, osaganizira zofunikira zathupi. Ya insulinoma yokulirapo komanso yogwira ntchito, momwe amapangira insulin yambiri, zomwe zikutanthauza kuti shuga m'magazi amachepetsa kwambiri.

Matenda a shuga ndi kupsinjika kudzakhala chinthu chakale

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

Chotupa chija sichachilendo, munthu m'modzi mwa 1.25 miliyoni amadwala. Nthawi zambiri imakhala yaying'ono, mpaka 2 cm, yomwe imakhala mu kapamba. Mwa 1% ya milandu, insulinoma imatha kukhala pakhoma la m'mimba, duodenum 12, ndulu, ndi chiwindi.

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

Nthawi zambiri, insulinomas ndi benign (ICD-10 code: D13.7), atatha kukula kwa 2,5 cm, 15% yokha ya neoplasms ndiyomwe imayamba kuwonetsa zizindikilo zakusayipa (code C25.4).

Chifukwa chomwe chimakhalira ndi momwe

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

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

Ma insulinomas ocheperako amaganiza kuti ndi okulirapo ndipo amatha kukhala ovulaza. Mwinanso izi zimachitika chifukwa chazovuta kwambiri komanso kuzindikira mochedwa matendawa. Pafupipafupi hypoglycemia ndi kuchuluka kwa kuchuluka kwa zizindikiro ndizogwirizana ndi zotupa.

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

Zizindikiro zake za insulinoma

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

Komanso, kuwopsa kwa zizindikiro za insulinoma kumakhudzidwa ndi:

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

Zizindikiro za insulinoma iliyonse imayamba chifukwa cha njira ziwiri zotsutsana:

1. Kutulutsidwa kwa insulin ndipo, chifukwa chake, pachimake hypoglycemia.
2. Kupanga kwa thupi poyang'anira insulin yowonjezereka ya otsutsana naye, mahomoni, adani. Awa ndi makatekolama - adrenaline, dopamine, norepinephrine.

Nthawi zambiri, kuukira kumachitika m'mawa m'mimba yopanda kanthu, pambuyo poti thupi limakhalapo kapena kusokonezeka m'maganizo, mwa azimayi - kusamba.

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

Gawo laling'ono la odwala limachita mosiyana - amayamba kumva kupewera chakudya, akuchepetsa thupi, akuyenera kuphatikiza kukonzekera kutopa mu dongosolo lawo lamankhwala.

Njira zoyesera

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

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

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

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

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

Itha kugwiritsidwa ntchito:

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

Chithandizo

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

Opaleshoni

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

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

Chithandizo cha Conservative

Zizindikiro zochitira opaleshoni ya insulinomas zomwe zikuyembekezeredwa ndi chakudya chachikulu cha shuga. Zokonda zimaperekedwa ku zinthu zomwe zimakhala ndi chakudya pang'onopang'ono, zomwe zimapangitsa kuti shuga azigwirizana m'magazi. Magawo a hypoglycemia pachimake amayimitsidwa ndi chakudya champhamvu kwambiri, nthawi zambiri timadziti timene timakhala ndi shuga wowonjezera. Ngati kwambiri hypoglycemia ikupezeka ndi kusokonekera chikumbumtima, wodwalayo amapaka jekeseni wa magazi m'mitsempha.

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

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

Chemotherapy

Chemotherapy ndikofunikira ngati chotupa chilonda. Streptozocin imagwiritsidwa ntchito limodzi ndi fluorouracil, odwala 60% amawaganizira, ndipo 50% amakhala ndi chikhululukiro chonse. Njira yamankhwala imatenga masiku 5, iyenera kubwerezedwa masabata 6 aliwonse. Mankhwalawa ali ndi poizoni pakhungu ndi impso, chifukwa chake, pakatikati pa maphunziro, mankhwala amathandizidwa kuti awathandize.

Zomwe muyenera kuyembekezera kuchokera kumatendawa

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

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