功能性胰腺神经内分泌肿瘤综合诊治策略（附3例报告）

外科理论与实践››2025,Vol. 30››Issue (05): 438-443.doi:10.16139/j.1007-9610.2025.05.10

功能性胰腺神经内分泌肿瘤综合诊治策略（附3例报告）

计蓓, 商正晔, 庹必光, 刘雪梅()

遵义医科大学附属医院消化病医院遵义医科大学附属医院消化内科，贵州遵义 563000

收稿日期:2025-06-29出版日期:2025-09-25发布日期:2025-12-09
通讯作者:刘雪梅，E-mail:onlyoneliuxuemei@163.com
基金资助:
国家自然科学基金(82470540);国家自然科学基金(32460215);贵州省科技计划项目(黔科合平台人才-HZJD[2021]001);贵州省科技计划项目(黔科合基础-ZK[2023]重点059);贵州省科技计划项目(黔科合平台人才-CXTD[2023]001);贵州省高层次创新型人才“百层次人才”计划(黔科合平台人才-GCC[2023]043)

Comprehensive diagnosis and treatment strategy for functional pancreas neuroendocrine neoplasm： a report of 3 cases

JI Bei, SHANG Zhengye, TUO Biguang, LIU Xuemei()

Department of Gastroenterology, Affiliated Hospital of Zunyi Medical University, Guizhou Zunyi 563000, China

Received:2025-06-29Online:2025-09-25Published:2025-12-09

摘要/Abstract

摘要：

功能性神经内分泌肿瘤能分泌激素，引发复杂多变的临床症状，诊治难度较大，早期识别与规范诊疗对改善预后尤为重要。本文汇总3例临床上稍常见的功能性胰腺神经内分泌肿瘤病例，总结其诊断要点与规范化诊疗路径，以期为该类罕见肿瘤的早期识别、多学科诊疗协作和个体化治疗提供参考。

关键词:神经内分泌肿瘤,功能性胰腺神经内分泌肿瘤,胰高血糖素瘤,胰岛素瘤,胰腺血管活性肠肽瘤

Abstract:

Functional neuroendocrine neoplasm, which secrete hormones and lead to diverse clinical symptoms, pose significant challenges in diagnosis and treatment. Early identification and standardized management are crucial for improving patient prognosis. This article summarized three clinically relatively common cases of Functional pancreatic neuroendocrine neoplasm (F-pNENs), focusing on analyzing their diagnostic key points and standardized therapeutic pathways. It aimed to provide reference for early clinical identification of rare tumors and improvement of standardized multidisciplinary diagnosis and treatment as well as personalized treatment strategies.

Key words:Neuroendocrine neoplasm,Functional pancreatic neuroendocrine neoplasm (F-pNEN),Glucagonoma,Insulinoma,Vasoactive intestinal peptide tumor (VIPoma)

中图分类号:

R735.9

计蓓, 商正晔, 庹必光, 刘雪梅. 功能性胰腺神经内分泌肿瘤综合诊治策略（附3例报告）[J]. 外科理论与实践, 2025, 30(05): 438-443.

JI Bei, SHANG Zhengye, TUO Biguang, LIU Xuemei. Comprehensive diagnosis and treatment strategy for functional pancreas neuroendocrine neoplasm： a report of 3 cases[J]. Journal of Surgery Concepts & Practice, 2025, 30(05): 438-443.

图/表6

图1

Time	Blood glucose （mmol/L）	Serum insulin （μIU/mL）	Serum C-peptide （nmol/L）
Fasting	9.5	25	2.2
1-hour postprandial	16.13	65	3.8
2-hour postprandial	14.26	50	3.0
3-hour postprandial	12.91	40	2.5

表1

图2

Time	Blood glucose （mmol/L）	Serum insulin （μIU/mL）	Serum C-peptide （nmol/L）
Fasting	2.64	65	2.8
1-hour postprandial	7.56	118	3.9
2-hour postprandial	5.46	97	3.2
3-hour postprandial	3.82	73	3.0

表2

图3

图4

参考文献12

[1]	中国抗癌协会神经内分泌肿瘤专业委员会, 陈洁, 聂勇战, 等. 中国抗癌协会神经内分泌肿瘤诊治指南(2025年版)[J].中国癌症杂志,2025,35(1):85-142. doi:10.19401/j.cnki.1007-3639.2025.01.010
	Society of Neuroendocrine Neoplasm of China Anti-Cancer Association, CHEN J, NIE Y Z, et al. China Anti-Cancer Association guideline for diagnosis and treatment of neuroendocrine neoplasms (2025 edition)[J].China Oncol,2025,35(1):85-142.
[2]	CLIFT A K, KIDD M, BODEI L, et al. Neuroendocrine neoplasms of the small bowel and pancreas[J].Neuroendocrinology,2020,110(6):444-476. doi:10.1159/000503721pmid:31557758
[3]	MALLINSON C N, BLOOM S R, WARIN A P, et al. A glucagonoma syndrome[J].Lancet,1974,2(7871):1-5. pmid:4134714
[4]	LIU Z P, YANG F J, HAO Y J, et al. Case report: surgical treatment and literature review of a recurrent case of glucagonoma[J].Front Oncol,2024,14:1437102.
[5]	MORGAN R E, POMMIER S J, POMMIER R F. Expanded criteria for debulking of liver metastasis also apply to pancreatic neuroendocrine tumors[J].Surgery,2018,163(1):218-225. doi:10.1016/j.surg.2017.05.030 URL
[6]	CRINÒ S F, NAPOLEON B, FACCIORUSSO A, et al. Endoscopic ultrasound-guided radiofrequency ablationversussurgical resection for treatment of pancreatic insulinoma[J].Clin Gastroenterol Hepatol,2023,21(11):2834-2843.e2. doi:10.1016/j.cgh.2023.02.022 URL
[7]	徐天铭, 李景南. 胰腺神经内分泌肿瘤诊治进展[J].临床内科杂志,2023,40(9):581-583.
	XU T M, LI J N. Advances in the diagnosis and treatment of pancreatic neuroendocrine tumors[J].J Clin Intern Med,2023,40(9):581-583.
[8]	吴文铭, 陈洁, 白春梅, 等. 中国胰腺神经内分泌肿瘤诊疗指南(2020)[J].协和医学杂志,2021,12(4):460-480.
	WU W M, CHEN J, BAI C M, et al. The Chinese guidelines for the diagnosis and treatment of pancreatic neuroendocrine neoplasms (2020)[J].Med J PUMCH,2021,12(4):460-480.
[9]	FALCONI M, ERIKSSON B, KALTSAS G, et al. ENETS consensus guidelines update for the management of patients with functional pancreatic neuroendocrine tumors and non-functional pancreatic neuroendocrine tumors[J].Neuroendocrinology,2016,103(2):153-171. doi:10.1159/000443171pmid:26742109
[10]	刘一铭, 连帆, 周翔飞, 等. 肝动脉栓塞术联合长效奥曲肽降低中低级别神经内分泌瘤肝转移负荷的疗效及安全性分析[J].中华医学杂志,2019,99(15):1142-1146.
	LIU Y M, LIAN F, ZHOU X F, et al. Safety and efficacy of transarterial embolization combined with octreotide LAR on reducing tumor burden for neuroendocrine tumor liver metastasis[J].Natl Med J China,2019,99(15):1142-1146.
[11]	WAHBA A, TAN Z, DILLON J S. Management of functional neuroendocrine tumors[J].Curr Probl Cancer,2024,52:101130.
[12]	中华医学会病理学分会消化疾病学组, 2020年中国胃肠胰神经内分泌肿瘤病理诊断共识专家组. 中国胃肠胰神经内分泌肿瘤病理诊断共识(2020版)[J].中华病理学杂志,2021,50(1):14-20.
	Division of Digestive Diseases, Chinese Society of Patho-logy, 2020 Chinese Consensus on the Pathological Diagnosis of Gastrointestinal and Pancreatic Neuroendocrine Neoplasms Experts Group. Chinese consensus on the pathological diagnosis of gastrointestinal and pancreatic neuroendocrine neoplasms(2020)[J].Chin J Pathol,2021,50(1):14-20.

[1]	计蓓, 苏薇, 庹必光, 刘雪梅.《中国抗癌协会神经内分泌肿瘤诊治指南（2025年版）》更新精要：消化内镜诊疗解析[J]. 诊断学理论与实践, 2025, 24(04): 401-406.
[2]	鲁姗姗, 纪元.第5版WHO内分泌和神经内分泌肿瘤分类解读：甲状腺滤泡细胞起源肿瘤的更新及进展[J]. 外科理论与实践, 2025, 30(01): 27-33.
[3]	张慧慧, 方姝, 吴梦雄, 刘方韬, 贺娜英, 董海鹏, 严福华.深度学习重建技术在改善磁共振冠状位T1WI显示垂体神经内分泌肿瘤图像质量中的研究[J]. 诊断学理论与实践, 2024, 23(06): 594-601.
[4]	周恒花, 林斓, 朱桂香, 刘敏, 黄文涛.2例膀胱纯上皮性神经内分泌肿瘤临床病理特征差异及文献复习[J]. 诊断学理论与实践, 2024, 23(06): 602-611.
[5]	韩亮, 刘昊楠, 仵正.欧洲神经内分泌肿瘤学会：无功能胰腺神经内分泌肿瘤2023指南解读[J]. 外科理论与实践, 2024, 29(01): 14-26.
[6]	张婕, 毕宇芳.神经内分泌肿瘤发病的代谢危险因素[J]. 内科理论与实践, 2023, 18(04): 251-255.
[7]	韩序, 王文权, 楼文晖, 刘亮.免疫检查点抑制剂治疗胃肠胰神经内分泌肿瘤的进展[J]. 外科理论与实践, 2023, 28(03): 267-272.
[8]	孔韦奇, 何俊, 杨成广, 刘微薇, 徐英杰.嗜铬细胞瘤合并甲状腺乳头状癌（附1例报告）[J]. 外科理论与实践, 2023, 28(02): 162-165.
[9]	李为光, 孙蕴伟, 孙菁, 张本炎, 王华枫, 钱爱华.直径≤1 cm的直肠神经分泌肿瘤2种内镜治疗方法的比较[J]. 内科理论与实践, 2022, 17(04): 289-294.
[10]	王宏伟, 邓尧, 杜敏, 梁贇, 姜翀弋, 王巍.神经纤维瘤病1型（附1例报告）[J]. 外科理论与实践, 2019, 24(06): 540-542.
[11]	张俊, 姜毓, 沈柏用.胰腺神经内分泌肿瘤的治疗[J]. 外科理论与实践, 2019, 24(03): 208-211.
[12]	李旭东, 林晓珠, 房炜桓, 谢环环, 陈楠, 柴维敏, 严福华, 陈克敏.MRI图像纹理分析在胰腺神经内分泌肿瘤病理分级中的应用研究[J]. 诊断学理论与实践, 2017, 16(06): 601-606.
[13]	徐玮, 燕敏, 刘文韬,.胃肠道神经内分泌肿瘤诊疗进展[J]. 外科理论与实践, 2016, 21(05): 434-438.
[14]	姜毓, 金佳斌, 詹茜, 沈柏用,.胰腺神经内分泌肿瘤肝转移的治疗进展[J]. 外科理论与实践, 2016, 21(03): 273-276.
[15]	陈利文,.直肠神经内分泌肿瘤的诊断与治疗(附14例报告)[J]. 外科理论与实践, 2015, 20(06): 515-517.