慢性输尿管梗阻的微创治疗进展与创新策略

Advances and innovative strategies in minimally invasive treatment of chronic ureteral obstruction

摘要

慢性输尿管梗阻是泌尿系统常见疾病之一。本文系统阐述慢性输尿管梗阻的病因分型、术前评估及术式选择，提出维持性治疗与治愈性治疗两种总体治疗策略，并对磁压榨输尿管吻合、无支架化与日间手术、机器人远程手术等前沿方向进行简要评述。在病因分型方面，提出基于病变部位（管腔内/管壁性/管腔外压迫）、病因（先天性/获得性）的分型；在术前评估方面，整合计算机断层扫描-尿路造影（CTU）、顺行/逆行尿路造影、磁共振尿路水成像及利尿肾图的多模态评估体系；在术式选择方面，涵盖腔内治疗及机器人/腹腔镜/开放尿路重建等技术；在手术选择方面，详述腔内切开、球囊扩张、放置输尿管支架、输尿管端端吻合、阑尾补片、口腔黏膜补片成形及肠代输尿管等个体化术式选择原则；在前沿与展望方面，对磁压榨吻合技术、组织工程与3D生物打印、机器深度学习影像组学等最新进展进行评述，旨在为临床提供一条可复制、可推广的微创治疗途径。

Abstract

Chronic ureteral obstruction is a common urological condition.This article systematically reviews the etiological classification，preoperative evaluation，and surgical management of CUO，and proposes two overarching therapeutic strategies-palliative and curative treatment.It also briefly discusses emerging approaches，including magnetic compression ureteral anastomosis，stentless procedures combined with day surgery，and robotic telesurgery.Regarding etiological classification，we propose a framework based on lesion site（intraluminal，mural，or extrinsic compression） and etiology（congenital or acquired）.For preoperative assessment，a multimodal evaluation system integrating CT urography，antegrade/retrograde pyelography，magnetic resonance urography，and diuretic renography is recommended.In terms of surgical strategy，options encompass endourological interventions as well asrobotic/laparoscopic urinary tract reconstruction.More specifically，individualized proceduralchoices are detailed，including endoureterotomy，combined balloon dilation strategies，ureteroureterostomy，appendiceal patch ureteroplasty，buccal mucosal graft ureteroplasty，and ilealureter substitution.Finally，we review the latest advances in magnetic compression anastomosis，tissue engineering and 3D bioprinting，and machine learning/deep learning-based radiomics，with the aim of establishing a replicable and generalizable minimally invasive treatment pathway for clinical practice.

关键词

慢性输尿管梗阻 / 微创治疗策略 / 输尿管镜 / 机器人手术

Key words

chronic ureteral obstruction / minimally invasive treatment / ureteroscopy / robotic surgery

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