Insulinoma bụ ihe dị njọ (na 15% nke ikpe) yana yana oke ọria (85-90%) na-etolite na sel nke agwaetiti nke Langerhans. Ọ nwere ọrụ homonụ na-akpaghị aka ma na-akpata hyperinsulinism. Insulin na-amalite ịpụ iche n'echeghị echiche, nke na-eduga n'ọrịa hypoglycemic syndrome - nke a na-akpọ njikọta nke neuroglycopenic na mgbaàmà adrenergic.
N'etiti akwara niile nke nwere ọrụ homonụ, insulinoma nwere ihe dịka 70%.
Ihe dị ka 10% n'ime ha bụ akụkụ nke ụdị mbụ nke ọtụtụ endocrine adenomatosis. Ọtụtụ mgbe, insulinoma na-etolite n'ime ndị gbara afọ 40 ruo 60, nke a na-ahụkebe na ụmụaka.
Enwere ike ịchọta insulinoma n'akụkụ ọ bụla nke pancreas (ọdụ, isi, ahụ). Oge ụfọdụ ọ nwere ike nwegasịa ihe puru iche, dịka ọmụmaatụ, n'ọnụ ụzọ nke spleen, mgbidi nke afọ, duodenum, imeju, otite. Dịka iwu, ogo nke neoplasm ruru 1.5 - 2 cm.
Usoro nke hypoglycemia na insulinoma
A kọwara mmepe nke ọnọdụ a site n'eziokwu ahụ bụ na enwere ike ịchịkwa insulin na-achịkwa site na mkpụrụ ndụ b tumo. Dị ka ọ na-adịkarị, ọ bụrụ na ọkwa nke glucose n'ọbara na-ebelata, mgbe ahụ, imepụta insulin na ntọhapụ ya n'ọbara ahụ na-ebelata.
N’ime mkpụrụ ndụ tumor, usoro a anaghị arụ ọrụ, ma jiri mbelata nke ịba ụba, a machibidoro mkpuchi insulin, nke na-eduga n’ọbara mmepe hypoglycemic syndrome.
A na-ahụkarị hypoglycemia kacha njọ nke mkpụrụ ndụ ụbụrụ na-eji glucose dị ka isi iyi ike. N'akụkụ a, na mmepe nke etuto ahụ, neuroglycopenia na-amalite, ma site na usoro dị ogologo na sistemụ akwara dị n'etiti, mgbanwe dystrophic na-apụta.
Site na hypoglycemia, a na-ahapụ akụrụngwa dị n'ime ọbara - homonụ glucagon, norepinephrine, cortisol, nke na-eduga n'ọdịdị nke mgbaàmà adrenergic.
Mgbaàmà nke insulinomas
Na mmepe nke tumor, enwere oge na akara nke ọdịmma, nke a na-edochi anya site na ngosipụta nke ọrịa hypoglycemia na hyperadrenalinemia. N'oge obi iru ala, ọrịa ahụ nwere ike igosipụta onwe ya naanị site na agụụ iri nri na mmepe nke oke ibu.
N'ihi mmebi nke usoro mmegharị ahụ na sistemụ akwara dị ala na ihe ndị na - egbochi ọgwụ insulin, nnukwute hypoglycemic ọgụ nwere ike ime.
Ọ na-amalite n’afọ efu, na-abụkarị n’ụtụtụ, mgbe ogologo oge ezumike n’etiti nri. N'oge ọgụ, mgbaàmà na-egosi na glucose ọbara na-agbadata ruo 2.5 mmol / lita ma ọ bụ obere.
Ihe mgbaàmà nke Neuroglycopenic yiri ọrịa psychiatric nkịtị ma ọ bụ nkwarụ akwara. Ndị ọrịa na-enwe ike ike, ha na-agbagha, isi ọwụwa amalite.
Mgbe ụfọdụ enwere ike ịnwe nkụchi hypoglycemic site na mkpagide psychomotor:
- onye ọrịa ahụ na-enwe nchegbu,
- yuphoria
- hallucinations
- ngagharị iwe,
- mkpọtụ na-eme mkpọtụ.
Usoro ọmịiko-adrenal na-emeghachi omume na hypoglycemia na mberede na oke ahụ, ọdịdị nke ọsụsọ oyi, ụjọ, paresthesia, na tachycardia. Ọ bụrụ na ọgụ ahụ na-aga n'ihu, mgbe ahụ ihe ọdịdọ ga-eme, nsụhọ efuola, Coma nwere ike ibido.
Mwakpo a na-ejikarị glucose glucose na-akwụsị. Mgbe ha nwetasịrị onwe ha, ndị ọrịa, dịka iwu, anaghị echeta ihe ọ bụla gbasara ihe mere.
Mwakpo nwere ike ibute ọrịa myocardial n'ihi mmebi nke trophism nke akwara obi, yana hemiplegia na aphasia (ọnya mpaghara na usoro ụjọ), gbakwunyere na enwere ohere na insulin coma nwere ike ime, ọnọdụ a ga-achọ nlekọta mberede.
Ọrịa hypoglycemia na-adịghị ala ala na ndị ọrịa nwere insulinoma na-eduga n'ọgba aghara nke sistem ụjọ, nke na-emetụta usoro ọdịmma nke otu.
N'ime oge dị n'etiti ọgụ, enwere ike ịnwe nkwarụ anya, enweghi ikike ncheta, myalgia, enweghị mmasị. Ọ bụrụgodi na ewepụrụ akpụ ahụ, yabụ encephalopathy na mbelata ikike ọgụgụ isi na mgbaama ndị ọzọ na-adịgide, yabụ, ọnọdụ mmekọrịta mmadụ na mbụ na ikike ọkachamara nwere na-efu
Mụ nwoke ndị na-ebuso hypoglycemia ọgụ ugboro ugboro nwere ike ịbụ adịghị ike.
Nnyocha akwara ozi gbasara ndị ọrịa nwere akpụ na-ekpughe:
- asymmetry nke akaị na oge anya;
- reflexji afọ na-adị ala ma ọ bụ na-agbanwe agbanwe ha;
- nystagmus;
- paresis nke lere anya;
- mgbanwe nke usoro ọmụmụ nke Babinsky, Rossolimo, Marinescu-Radovich.
N'ihi eziokwu ahụ bụ na mgbaàmà nke ọrịa na-abụkarị polymorphic na nonspecific, ndị ọrịa nwere insulinoma na-ezighi ezi nyocha mgbe ụfọdụ, dịka ọmụmaatụ, Akwụkwụ na-adọ ma ọ bụ etuto na ụbụrụ, yana ọrịa strok, psychosis, neurasthenia, dystonia ahịhịa na ndị ọzọ.
Ọrịa insulinoma na ihe ndị kpatara ya
Na nnọkọ mbụ, dọkịta kwesịrị ịchọpụta site n'aka onye ọrịa akụkọ banyere ọrịa pancreatic. A ga-elebara anya nke ọma ka ndị ikwu nke onye ahụ nwee ọrịa ọria, yana ikpebi oge ihe ịrịba ama nke mbụ ahụ pụtara.
Iji ghọta ihe kpatara hypoglycemia na insulinoma, a na-eme nyocha ụlọ nyocha zuru ezu, nyocha ngwa ọrụ, nnwale ụlọ nyocha:
- Nyocha na agụụ: ụma akpalite hypoglycemia na Whipple triad ahụkarị insulinoma - ọdịda nke glucose ọbara ruo 2.76 mmol / lita (ma ọ bụ nke dị ala), ngosipụta nke ọdịdị neuropsychic n'oge agụụ, enwere ike iwelata mwakpo ahụ site na itinye glucose na akwara ma ọ bụ ịbanye.
- Iji mepụta steeti hypoglycemic, a na-achịkwa insulin na-ebu ibu (insulin-suppress test). N'otu oge, ọdịnaya C-peptide n'ime ọbara na-abawanye ọtụtụ oge, glucose nwekwara uru dị ala.
- Nnyocha insulin na-akpali akpali - a na-agbanye glucagon ma ọ bụ glucose ọbara n'ime intraven, nke na-eme ka mpụta nke insulin site na pancreas. Ọnụ ọgụgụ insulin dị na ndị mmadụ nwere ezi ahụike dị ala karịa ndị nwere akpụ. N'otu oge, insulin na glucose dị n'ọkwa 0.4 (na -adikarị ọnụọgụ a kwesịrị ịdị obere).
Ọ bụrụ na nsonaazụ nke ule ndị a dị mma, mgbe ahụ insulinoma ga-enyochakwu nyocha. Iji mee nke a, a na-eme nyocha nke ultrasound, ihe onyonyo ndọta na scintigraphy nke pensụra, usoro angiography (nchịkwa nke ọdịiche na nyocha x-ray), intraoperative gland ultrasonography, painia laparoscopy.
Ekwesịrị iche na insulinoma na:
- mmanya ma ọ bụ ọgwụ hypoglycemia,
- yana ọrịa cancer adrenal,
- pituitary na adrenal ụkọ,
- galactosemia,
- ọgbụgba na-egbu egbu.
Ọgwụ insulinoma
Ọtụtụ mgbe, insulinoma chọrọ ọgwụgwọ ịwa ahụ. Olu nke ịwa ahụ dabere n’otu insulinoma na ọnọdụ ya. N'ọnọdụ ụfọdụ, a na-eme insulinectomy (isi ọkụ nke etuto ahụ), na mgbe ụfọdụ ihe yiri akwara ahụ.
A na-enyocha ihe ịga nke ọma nke ọrụ a site na ịchọpụta ngwa ngwa glucose n'oge etinye uche.
Otu n'ime nsogbu ndị dị n'azụ oge a gụnyere:
pancreatic pancreatic necrosis, ma ọ bụrụ na achọpụtara ọbara ọgbụgba ọsịsa nke ọbara ọgbụgba, ihe na-akpata ọnwụ na nhịahụ dị kpọmkwem na ya. ;
- ọnya afọ;
- fistula na-egbu egbu;
- peritonitis.
Ọ bụrụ na insulinoma enweghị atụ, mgbe ahụ a na-eme ọgwụgwọ na Conservatively, a na-egbochi hypoglycemia, ọgụ na-akwụsị site n'enyemaka nke glucagon, adrenaline, glucocorticoids, norepinephrine. N'ime usoro mbido, a na-atụkarị ndị ọrịa ka ha weba ụba carbohydrates.
Maka insulinomas ọjọọ, a na-eji doxorubicin ma ọ bụ streptozotocin arụ ọrụ ọgwụgwọ.
Prognosis nke insulinoma
Ihe puru omume a gwọputa ogwu n’adiri insulinoma sitere na 65 rue 80%. Ngwa ngwa ka achoputara oria ma gha ya oria, a ga - enwe ike idozi mgbanwe kariri n ’usoro ụjọ.
A na - egbu egbu mgbe a wasịrị ya ahụ na 5-10% nke ikpe. N'ime pasent 3 nke ndị ọrịa, nlọghachi azụ nwere ike ime.
Na 10% nke ikpe, ajọ mbibi nwere ike ime, ebe uto na-eto eto na-amalite, ma metastases pụtara n'ime akụkụ na sistemụ dị anya.
N'ime oke adị ahụ, prognosis na-abụkarị ogbenye; naanị 60% ndị ọrịa na-anwụ afọ abụọ ọzọ.
Ndi mmadu nke nwere oria nke oria a na edebara ya na ndi dibia dibia na endocrinologist. Ha aghaghi dozie ihe ha riri, kwusi omume ojoo ma gha eme nyocha nke ulo ogwu kwa ubochi iji choputa ogo glucose n’ime ọbara.
