Baidu
map

皮肤溃烂的罕见胰高血糖素瘤

2011-06-07 MedSci原创 MedSci原创

两年前,安徽的张女士洗澡时无意间发现自己的腰部长了3个绿豆大小的红斑,且有些瘙痒。她就诊于当地卫生院,局部涂抹了医生开的外用药,但一直未见好转。此后,正是这3颗红斑给张女士带来了噩梦般的生活。   张女士的先生告诉记者,两年前妻子身体非常好,什么疾病也没有,还能下地干农活,但是自从发现腰上长了这几个小红斑后,由于红斑的面积渐渐地越来越大且非常痒,妻子不停地抓挠,随后皮肤开始溃烂。在当地和南京其他

两年前,安徽的张女士洗澡时无意间发现自己的腰部长了3个绿豆大小的红斑,且有些瘙痒。她就诊于当地卫生院,局部涂抹了医生开的外用药,但一直未见好转。此后,正是这3颗红斑给张女士带来了噩梦般的生活。

  张女士的先生告诉记者,两年前妻子身体非常好,什么疾病也没有,还能下地干农活,但是自从发现腰上长了这几个小红斑后,由于红斑的面积渐渐地越来越大且非常痒,妻子不停地抓挠,随后皮肤开始溃烂。在当地和南京其他医院看了许多次,有的医生说是“湿疹”,有的医生怀疑是“天胞疮”,用了许多药物,花费了约30 万元,花光了家里所有的积蓄,但始终不见疗效。很快张女士的腰背部、胸腹、颈部、四肢、面部的皮肤都开始溃烂。尤其是夏季,天气炎热,张女士破损的皮肤、水泡和衣服粘连在一起,由于无法动身,只能简单地擦擦没有破损的皮肤,难闻的气味不时散发出来,又疼又痒,使得张女士根本无法入睡。张女士的丈夫看在眼里急在心里。

  张女士的病情十分复杂,出现了严重的低蛋白血症,有生命危险,当地医院建议他们转到江苏省人民医院就医。

  病情危重的张女士被先生抬着来到了江苏省人民医院,普外科胆胰组立即组织了皮肤科、呼吸科等多科室的多位专家会诊。由于患者无任何疾病史,只是偶尔出现血糖升高,专家建议对其行进一步检查。CT检查发现张女士的胰腺尾部有低密度占位性病变;反复多次监测发现张女士的胰高血糖素值竟然高达1600 pg/L(正常值为 50—100 pg/ml)。此时张女士结痂的皮肤还在不断地冒出新水疱,继而破溃,使其痛苦不堪。结合CT检查结果,胆胰外科专家考虑张女士所患的是非常罕见的高胰高血糖素瘤。

图1  病理检查示胰体尾神经内分泌肿瘤累及脂肪潜在恶性

 

图2  病理检查示胰体尾神经内分泌肿瘤局灶累及周围胰腺及脂肪组织

 

 图3   胰腺尾部的肿瘤被成功切除,病理检查证实为胰高血糖素瘤     

 

       据江苏省人民医院普外科苗毅主任和钱祝银主任介绍,胰高血糖素瘤是一种非常罕见的疾病,发病率仅为1例/2000万人。胰高血糖素瘤细胞分泌过量的胰高血糖素,临床主要表现为反复的皮肤游走型坏死性红斑,口角、唇、舌等部位的慢性炎症,指甲松动,贫血,糖尿病和严重的低蛋白血症等。因张女士的皮肤破损后色素沉着,咋看像是重度烧伤患者。此病罕见所以诊断非常困难,但是一旦确诊就必须立即手术切除肿瘤,否则患者病情会日益加重。

  考虑到张女士的基础状况非常差,耐受不了创伤很大的手术,所以最好能在尽量不切除其他脏器,尤其是脾脏的基础上为其实施手术切除。对此,苗毅主任、钱祝银主任和其他科室专家一起反复商议,决定为张女士实施“保留脾脏的胰体尾部切除”手术。经过近4个小时的努力,张女士胰腺尾部一个兵乓球大小的肿瘤被成功切除,病理检查证实为胰高血糖素瘤。

  术后第二天,奇迹逐步开始在张女士身上出现。血糖值在正常范围之内了,原来破损的皮肤创面开始慢慢地愈合,瘙痒和疼痛的感觉也逐渐消失。到张女士出院时,其全身的皮肤破损已经完全结痂愈合,而且生活完全可以自理,张女士一家非常高兴。

  钱祝银主任称,目前胰高血糖素瘤的病因尚不完全明确,在该院历史上,仅收治过4例如此患者,但在全国已属最大病例组之一了。以前由于手术技术的局限,手术创伤都很大,需要实施包括胰十二指肠切除或胰腺体尾部脾脏切除术。张女士应该是比较幸运的患者,能成功战胜病魔,很快康复,这和手术中的保留脾脏是有很大关联的。脾脏虽小,但却是很重要的免疫器官,可提高患者抗感染能力,所以在胰腺切除手术中,专家们精准定位,不“滥杀”无辜脏器也是手术获得成功的基础之一。(吴倪娜 卫积书)

版权声明:
本网站所有内容来源注明为“梅斯医学”或“MedSci原创”的文字、图片和音视频资料,版权均属于梅斯医学所有。非经授权,任何媒体、网站或个人不得转载,授权转载时须注明来源为“梅斯医学”。其它来源的文章系转载文章,或“梅斯号”自媒体发布的文章,仅系出于传递更多信息之目的,本站仅负责审核内容合规,其内容不代表本站立场,本站不负责内容的准确性和版权。如果存在侵权、或不希望被转载的媒体或个人可与我们联系,我们将立即进行删除处理。
在此留言
评论区 (4)
#插入话题
  1. [GetPortalCommentsPageByObjectIdResponse(id=1670398, encodeId=832616e039864, content=<a href='/topic/show?id=242684013f5' target=_blank style='color:#2F92EE;'>#胰高血糖素瘤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=84013, encryptionId=242684013f5, topicName=胰高血糖素瘤)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=66e226623910, createdName=smlt2017, createdTime=Sat Jan 28 11:22:00 CST 2012, time=2012-01-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1261039, encodeId=085312610395f, content=<a href='/topic/show?id=30c6102e2607' target=_blank style='color:#2F92EE;'>#高血糖#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=104, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=102726, encryptionId=30c6102e2607, topicName=高血糖)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=55ce62, createdName=hbwxf, createdTime=Thu Jun 09 12:22:00 CST 2011, time=2011-06-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1457584, encodeId=b9f3145e5849b, content=<a href='/topic/show?id=72148400568' target=_blank style='color:#2F92EE;'>#胰高血糖素#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=84005, encryptionId=72148400568, topicName=胰高血糖素)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b38f5964248, createdName=sjzlzc009, createdTime=Thu Jun 09 12:22:00 CST 2011, time=2011-06-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1467006, encodeId=3c75146e00675, content=<a href='/topic/show?id=ef32e9539e8' target=_blank style='color:#2F92EE;'>#罕见#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79539, encryptionId=ef32e9539e8, topicName=罕见)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=29f36868190, createdName=syscxl, createdTime=Thu Jun 09 12:22:00 CST 2011, time=2011-06-09, status=1, ipAttribution=)]
  2. [GetPortalCommentsPageByObjectIdResponse(id=1670398, encodeId=832616e039864, content=<a href='/topic/show?id=242684013f5' target=_blank style='color:#2F92EE;'>#胰高血糖素瘤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=84013, encryptionId=242684013f5, topicName=胰高血糖素瘤)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=66e226623910, createdName=smlt2017, createdTime=Sat Jan 28 11:22:00 CST 2012, time=2012-01-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1261039, encodeId=085312610395f, content=<a href='/topic/show?id=30c6102e2607' target=_blank style='color:#2F92EE;'>#高血糖#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=104, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=102726, encryptionId=30c6102e2607, topicName=高血糖)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=55ce62, createdName=hbwxf, createdTime=Thu Jun 09 12:22:00 CST 2011, time=2011-06-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1457584, encodeId=b9f3145e5849b, content=<a href='/topic/show?id=72148400568' target=_blank style='color:#2F92EE;'>#胰高血糖素#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=84005, encryptionId=72148400568, topicName=胰高血糖素)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b38f5964248, createdName=sjzlzc009, createdTime=Thu Jun 09 12:22:00 CST 2011, time=2011-06-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1467006, encodeId=3c75146e00675, content=<a href='/topic/show?id=ef32e9539e8' target=_blank style='color:#2F92EE;'>#罕见#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79539, encryptionId=ef32e9539e8, topicName=罕见)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=29f36868190, createdName=syscxl, createdTime=Thu Jun 09 12:22:00 CST 2011, time=2011-06-09, status=1, ipAttribution=)]
    2011-06-09 hbwxf
  3. [GetPortalCommentsPageByObjectIdResponse(id=1670398, encodeId=832616e039864, content=<a href='/topic/show?id=242684013f5' target=_blank style='color:#2F92EE;'>#胰高血糖素瘤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=84013, encryptionId=242684013f5, topicName=胰高血糖素瘤)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=66e226623910, createdName=smlt2017, createdTime=Sat Jan 28 11:22:00 CST 2012, time=2012-01-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1261039, encodeId=085312610395f, content=<a href='/topic/show?id=30c6102e2607' target=_blank style='color:#2F92EE;'>#高血糖#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=104, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=102726, encryptionId=30c6102e2607, topicName=高血糖)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=55ce62, createdName=hbwxf, createdTime=Thu Jun 09 12:22:00 CST 2011, time=2011-06-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1457584, encodeId=b9f3145e5849b, content=<a href='/topic/show?id=72148400568' target=_blank style='color:#2F92EE;'>#胰高血糖素#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=84005, encryptionId=72148400568, topicName=胰高血糖素)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b38f5964248, createdName=sjzlzc009, createdTime=Thu Jun 09 12:22:00 CST 2011, time=2011-06-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1467006, encodeId=3c75146e00675, content=<a href='/topic/show?id=ef32e9539e8' target=_blank style='color:#2F92EE;'>#罕见#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79539, encryptionId=ef32e9539e8, topicName=罕见)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=29f36868190, createdName=syscxl, createdTime=Thu Jun 09 12:22:00 CST 2011, time=2011-06-09, status=1, ipAttribution=)]
  4. [GetPortalCommentsPageByObjectIdResponse(id=1670398, encodeId=832616e039864, content=<a href='/topic/show?id=242684013f5' target=_blank style='color:#2F92EE;'>#胰高血糖素瘤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=84013, encryptionId=242684013f5, topicName=胰高血糖素瘤)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=66e226623910, createdName=smlt2017, createdTime=Sat Jan 28 11:22:00 CST 2012, time=2012-01-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1261039, encodeId=085312610395f, content=<a href='/topic/show?id=30c6102e2607' target=_blank style='color:#2F92EE;'>#高血糖#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=104, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=102726, encryptionId=30c6102e2607, topicName=高血糖)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=55ce62, createdName=hbwxf, createdTime=Thu Jun 09 12:22:00 CST 2011, time=2011-06-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1457584, encodeId=b9f3145e5849b, content=<a href='/topic/show?id=72148400568' target=_blank style='color:#2F92EE;'>#胰高血糖素#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=84005, encryptionId=72148400568, topicName=胰高血糖素)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b38f5964248, createdName=sjzlzc009, createdTime=Thu Jun 09 12:22:00 CST 2011, time=2011-06-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1467006, encodeId=3c75146e00675, content=<a href='/topic/show?id=ef32e9539e8' target=_blank style='color:#2F92EE;'>#罕见#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79539, encryptionId=ef32e9539e8, topicName=罕见)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=29f36868190, createdName=syscxl, createdTime=Thu Jun 09 12:22:00 CST 2011, time=2011-06-09, status=1, ipAttribution=)]
    2011-06-09 syscxl
Baidu
map
Baidu
map
Baidu
map