ʻO ka Insulinoma kahi ʻano ʻokoʻa o ka maʻi maʻi i loko o ka pancreas e ulu ana me ka hoʻopau ʻana i nā pūnae huna huna insulin. ʻO kona hele ʻana ke kumu o ka hoʻouka ʻana o ka hypoglycemia koʻikoʻi i kekahi manawa. ʻAʻole maʻalahi ka loaʻa ʻana o ka tumora i nā manawa a pau. He kiʻekiʻe ka holomua o ka wehe ʻana i ke kaʻe.

Definition

ʻO ka insulinoma ka maʻi ʻōpū o ka pancreas, i kapa ʻia ʻo endocrine no ka mea e hoʻoulu ai i ka huna ʻana o ka insulin. Hana ʻia kēia hormone hypoglycemic ma ke ʻano i hoʻoponopono ʻia e kahi papa o nā cell i loko o ka pancreas, nā cell beta, e hoʻohaʻahaʻa i nā pae glucose koko ke piʻi kiʻekiʻe. Akā ʻaʻole kaohi ʻia ka huna ʻana o ka insulin e ka ʻōpū, e alakaʻi ana i nā ʻāpana o ka mea i kapa ʻia ʻo "functional" hypoglycemia i nā poʻe olakino olakino, non-diabetic.

Ma kahi o 90% o nā insulinomas i hoʻokaʻawale ʻia nā maʻi maʻi benign. ʻO kahi hapa liʻiliʻi e pili ana i nā maʻi maʻi he nui a / a i ʻole - ʻike ʻia nā mea hope e ka hiki ʻana o nā metastases.

He ʻuʻuku kēia mau maʻi koko: ʻeiwa o ka ʻumi ʻaʻole i ʻoi aku ma mua o 2 knm, a ʻekolu i loko o ka ʻumi ma lalo o 1 knm.

Nā kumu

ʻO ka hapa nui o nā insulinomas e ʻike pinepine ʻia, ʻaʻohe kumu i ʻike ʻia. I nā hihia liʻiliʻi, pili nā kumu hoʻoilina.

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Pono e noʻonoʻo ʻia ka loaʻa ʻana o kahi insulinoma i ka wā e hōʻike ai ke kumuhana non-diabetic i nā hōʻailona o nā manawa hou o ka hypoglycemia me ke kumu ʻole ʻē aʻe (ka waiʻona, renal, hepatic a adrenal insufficiency, lāʻau lapaʻau, etc.).

Hōʻike ʻia ka Insulinoma e nā pae glucose koko haʻahaʻa i hui pū ʻia me nā pae insulin kiʻekiʻe kiʻekiʻe. No ka hōʻike ʻana i kēia, hoʻomaʻamaʻa mākou i ka hoʻāʻo hoʻokē ʻai a lōʻihi ka lōʻihi o 72 mau hola ma lalo o ka mākaʻi olakino. Hoʻokumu ʻia ka hōʻailona ma nā hoʻāʻo koko i lawe ʻia i ka wā e loaʻa ai nā hōʻailona o ka hypoglycemia. Hoʻopau ʻia ka hoʻāʻo ʻana i ka wā e hāʻule nui ai ka pae glucose koko.

A laila hana ʻia nā hoʻokolohua kiʻi no ka ʻimi ʻana i ka insulinoma. ʻO ka nānā ʻana he echo-endoscopy, kahi e hiki ai ke aʻo pololei i ka pancreas me ka hoʻohana ʻana i kahi paipu maʻalahi i hoʻopili ʻia me ke kāmela a me kahi ʻimi ultrasound miniature, i hoʻokomo ʻia i loko o ka ʻōnaehana digestive ma o ka waha. Hiki ke kōkua ʻia nā hoʻokolohua ʻē aʻe e like me ka angio-scanner.

ʻOiai ka holomua o ke kiʻi ʻana, paʻakikī ka ʻimi ʻana i nā maʻi maʻi liʻiliʻi. Hana ʻia i kekahi manawa ma hope o ke kaʻina ʻimi ʻimi e hoʻomaikaʻi i ka palpation i hui pū ʻia me kahi ultrasound intraoperative, me ka hoʻohana ʻana i kahi ʻimi ultrasound kikoʻī.

Pili ka poʻe

ʻOiai ʻo ia ke kumu maʻamau o ka maʻi hypoglycaemia maʻi i nā pākeke, noho mau ka insulinoma i kahi maʻi ʻaʻai loa, e pili ana i ka 1 a 2 mau kānaka no ka miliona kānaka (50 a 100 mau hihia hou i kēlā me kēia makahiki ma Farani).

Hoʻohana pinepine ʻia ka ʻike ma kahi o 50 mau makahiki. ʻIke kekahi mau mea kākau i kahi predominance wahine liʻiliʻi.

Nā mea pilikino

Kakaʻikahi, pili ka insulinoma me ka type 1 multiple endocrine neoplasia, he maʻi hoʻoili ʻole ʻia i hōʻike ʻia ma ka loaʻa ʻana o nā maʻi koko i loko o kekahi mau ʻōpū endocrine. ʻO ka hapahā o kēia mau insulinomas he ʻino. ʻO ka pilikia o ka ulu ʻana o ka insulinoma e pili pū me nā maʻi hoʻoilina ʻē aʻe (maʻi von Hippel Lindau, Recklinghausen neurofibromatosis a me Bourneville tuberous sclerosis).

Hōʻike pinepine ʻia nā ʻāpana o ka hypoglycemia hohonu - akā ʻaʻole maʻamau - i ke kakahiaka me ka ʻōpū ʻole a ma hope o ka hoʻoikaika kino.

Ka hopena i ka ʻōnaehana nerve o ka nele o ka glucose 

ʻO nā hōʻailona e like me ka nawaliwali a maikaʻi ʻole me ka ʻike ʻole a i ʻole ka ʻike ʻole, ke poʻo, ka ʻike maka, ka naʻau, nā mākau kaʻa a i ʻole ka hoʻonohonoho ʻana, ka pōloli koke ... ʻO kekahi mau hōʻailona e like me ka huikau a i ʻole ka haunaele i ka noʻonoʻo ʻana, ke ʻano a i ʻole ke ʻano e hoʻohālikelike i ka psychiatric a neurological pathology, e hoʻopiʻi i ka maʻi. .

E ʻai i ka hypoglycemic

I nā hihia koʻikoʻi loa, hoʻomaka ka hypoglycemia i kahi coma hoʻomaka koke, ʻoi aku ka hohonu a i ʻole ka hohonu a hele pinepine ʻia me ka hoʻoulu ʻana.

ʻO nā hōʻailona ʻē aʻe

Hoʻopili pinepine ʻia kēia mau hōʻailona me nā hōʻailona o ka hopena autonomic i ka hypoglycemia:

• hopohopo, haalulu
• Nausea,
• ka manaʻo o ka wela a me ka hou,
• ʻulaʻula,
• ʻo tachychardie…

   

Hiki i nā manawa hou o ka hypoglycemia ke alakaʻi i ka piʻi paona.

Hāʻawi ka wehe ʻana i ka insulinoma i nā hopena maikaʻi loa (ma kahi o 90%).

I ka wā hoʻokahi a ʻike ʻia ka ʻōpū, hiki ke hoʻopaʻa ʻia (enucleation) a ʻo ke ʻokiʻoki liʻiliʻi loa i kekahi manawa lawa. Inā pololei ʻole ka wahi a i ʻole he nui nā maʻi maʻi, hiki nō ke hana i kahi wehe ʻana o ka pancreas (pancreatectomy).

Kāohi kō koko

ʻOiai e kali ana no ka ʻoki ʻana a i ʻole e mau ana nā hōʻailona ma hope o ka ʻoki ʻana, hiki i nā lāʻau lapaʻau e like me ka diazoxide a i ʻole somatostatin analogues ke kōkua i ka pale ʻana i ke kō koko mai ka hāʻule nui ʻana.

Ke alo nei me kahi insulinoma malignant hiki ʻole ke hana, hōʻailona a holomua paha, hiki ke hoʻokō ʻia nā ʻano lapaʻau anti-cancer:

• Pono e noʻonoʻo ʻia ka Chemotherapy e hōʻemi i ka nui o ka maʻi tumora.
• Hiki ke kōkua ʻo Everolimus, kahi lāʻau antitumor immunosuppressive, inā mau ka hypoglycaemia.
• Hoʻohana ka metabolic radiotherapy i nā mea radioactive i lawelawe ʻia ma ke ala venous a waha paha, kahi e hoʻopaʻa pono ai i nā pūnaeau maʻi maʻi e luku iā lākou. Mālama ʻia ia no nā ʻōpū e hōʻike ana i nā metastases iwi liʻiliʻi a / a i ʻole e ulu mālie ana.