長段輸尿管狹窄外科治療思考：不同自體組織成形術的優劣及微創與開放的抉擇

ABSTRACT：Ureteral stricture is a common urological condition，whose treatment mainly depends on the etiology，location，number，and length of the stricture.For complex long-segment ureteral stricture，the main surgical procedures include endourological treatment，flap pyeloplasty，ureterocalicostomy，buccal mucosal ureteroplasty，lingual mucosal ureteroplasty，bladder mucosal ureteroplasty，appendiceal ureteroplasty，bladder flap ureteroplasty，and ileal ureter substitution ureteroplasty.Although open and laparoscopic surgeries are still prevalent，robotic surgery is gaining popularity due to its minimally invasive nature and precision.Based on the latest clinical advances and diagnostic and therapeutic experience of our team，we will systematically introduce the new surgical techniques and methods for the treatment of long-segment ureteralstricture from a clinical practical perspective.In addition，we will discuss the advantages and disadvantages of different autologous tissue reconstruction techniques，as well as the choices between minimally invasive and open surgery.

摘要：輸尿管狹窄是泌尿外科常見疾病，治療方法主要取決于輸尿管狹窄的病因、位置、數目和長度等。長段輸尿管狹窄的主要治療術式包括輸尿管腔內治療、腎盂瓣輸尿管成形術、腎下盞輸尿管吻合術、頰黏膜輸尿管成形術、舌黏膜輸尿管成形術、膀胱黏膜輸尿管成形術、闌尾代輸尿管成形術、膀胱瓣代輸尿管成形術和回腸代輸尿管成形術。雖然開放手術和腹腔鏡手術仍然是常用的治療方法，但機器人輔助手術因其微創、精確的特點，在臨床上應用已越來越多。本文結合最新臨床進展及本團隊（鄭州大學第一附屬醫院泌尿外科）診療經驗，著重探討不同自體組織成形術的優劣及在微創與開放術式之間的抉擇，以期從臨床實用角度系統介紹長段輸尿管狹窄的各種外科治療新方法和新技術。

關鍵詞：長段輸尿管狹窄；腹腔鏡手術；機器人輔助手術；尿路重建；自體組織成形術

中圖分類號：R699" " " " 文獻標志碼：A" " " "DOI：10.3969/j.issn.1009-8291.2025.04.002

輸尿管狹窄是泌尿外科常見疾病，可能導致不同程度的腎積水，嚴重者會影響患側腎功能。輸尿管狹窄的病因主要包括先天性疾病、醫源性損傷、泌尿系結石、放療、腹膜后纖維化、外傷等。輸尿管狹窄的治療原則是完全切除狹窄段并進行尿路重建，同時減少吻合口張力并保護吻合口的血供，以解除輸尿管梗阻、緩解臨床癥狀并預防腎功能減退等并發癥。

在手術之前需要對患者的疾病情況進行仔細的評估和排查，對于選擇合理的手術方式至關重要。……