超声内镜诊断胰岛内分泌肿瘤2例-第三军医大学学报.doc

超声内镜诊断胰腺内分泌肿瘤2例 艾启雄（1） 吴会超（2） 1.遵义医学院,研究生学院;2.遵义医学院附属医院,消化内科,贵州遵义（563003） 作者贡献分布:本文写作及查阅相关文献由艾启雄完成;诊断思路及指导文章修改由吴会超完成. 通讯作者:艾启雄,研究生,563003,贵州省遵义市大连路201号,贵州省遵义市遵义医学院研究生学院.523866906@. 摘 要 本文报告2例患者均以反复发作低血糖为临床特点,均曾误诊为癫痫,行上腹部CT均提示胰腺未见明显病变,行超声内镜考虑为胰腺内分泌肿瘤.术后病理证实为胰岛细胞瘤.超声内镜对胰腺内分泌肿瘤具有较高诊断价值. [关键词]超声内镜;胰腺内分泌肿瘤;胰岛细胞瘤. Two cases of Pancreatic Enddocrine Tumors Diagnosed by Endoscopic Ultrasonography Qi-Xiong Ai1, Hui-Chao Wu2 1 Graduate School of Zunyi Medical College 2 Department of Gastroenterology, Affiliated Hospital of Zunyi Medical College, Zunyi 563003, Guizhou Province Correspondence to: Qi-Xiong Ai,graduate student , Department of Graduate School of Zunyi Medical College, 201 Dalian Road, Zunyi, Guizhou Province, China. 523866906@ Abstract This paper reports 2 cases of patients with recurrent hypoglycemia as the clinical characteristic，All had been misdiagnosed as epilepsy, and there are no obvious lesions of pancreas using upper abdominal CT scan and enhancement. Endoscopic ultrasonography (EUS) reveals a pancreatic endocrine tumor located in the body, and it is confirmed by the postoperative pathology. EUS is of high value for the diagnosis of pancreatic endocrine tumors. Keys words: Endoscopic ultrasonography; Pancreatic endcrine tumors; Insulinoma 1 引言 胰腺内分泌肿瘤(Pancreatic Neuroendocrine Tumors,PETs)是源发于胰腺多能神经内分泌干细胞的一类肿瘤,临床较少见,症状复杂多样,可由良性逐渐发展为恶性,病程缓慢,易与内分泌原发疾病混淆，根据临床有无症状及其分泌的激素水平,可分为功能性及无功能性两类：前者包括胃泌素瘤（gastrinomas）、胰岛素瘤（insulinoma）、胰高血糖素瘤（glucagonoma）、血管活性肠肽（vasoactive intestinal peptide）瘤、生长抑素瘤（somatostatinoma）、生长因子释放因子（growth-hormone releasing factor）瘤、ACTH瘤、胰多肽（pancreatic polypeptide）瘤、致类癌综合征PETs、致高血钙综合征PETs等10种[1,2],无功能性是指无症状,激素分泌水平低[1].临床医生对本病认识普遍不足,易延误或漏诊,常见误诊为癫痫、脑血管病、癔症、精神分裂症等,导致病人长期误诊误治,甚至出现严重的不可逆的损害[3],该病人群发病率约在（4-5）/100万,仅占胰腺发病率的1%-2%[1],可发生于任何年龄,男女比例约为13:9[4]，近年来有逐渐增加趋势,本文分析反复低血糖发作,误诊为癫痫患者的诊治过程,以期提高对胰腺内分泌肿瘤的诊疗,减少误诊率. 2 病例报告 病例1:患者,女,49岁,因“反复乏力、意识丧失2年,加重1月”于2013-07-15就诊于我院内分泌科,2年前开始出现反复突发全身乏力,神志丧失，呼之不应,好发于凌晨5点至6点,每次持续时间不等,无大小便失禁,无口角偏斜,就诊于当地某医院,考虑为“癫痫”,