摘要：输尿管狭窄的治疗方式主要取决于狭窄的部位及长度。对于无法通过输尿管端端吻合或离断式肾盂成形术 治疗的长段上、中段输尿管狭窄，目前常用的回肠代输尿管术、自体肾移植术均存在一定不足。近年来，泌尿外 科医师尝试使用口腔黏膜补片、肠道组织补片以及尿路组织补片等自体补片技术进行输尿管重建。口腔黏膜补片 是目前接受度最高的自体补片材料，阑尾补片、肾盂瓣等技术目前也有一些成功报道，这些研究初步验证了自体 补片技术的安全性与可行性，但每种补片材料存在其各自的优势和不足。论文通过对自体补片输尿管成形术的研 究进行综述，旨在总结该技术的研究进展及未来的发展方向。

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尹路,杨昆霖,熊盛炜,等. 自体补片技术在输尿管狭窄重建中的研究进展[J]. 泌尿外科杂志（电子版）,2021,13(2):64-68. DOI:10.3969/j.issn.1674-7410.2021.02.015.

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输尿管狭窄的治疗目标包括缓解临床症状和保 护患侧肾功能，其治疗方式主要受到狭窄部位及狭 窄段长度等因素的影响。对于狭窄段较长 （一般认 为>3 cm） 的上、中段输尿管狭窄，切除病变部位 后，两端健康的输尿管可能无法直接吻合。对于这 类患者，泌尿外科医师过去一般选用回肠代输尿管 术或自体肾移植术进行治疗，但这些术式可能导致 术后代谢紊乱、肠梗阻、肾静脉血栓或假性血管瘤 等并发症。既往有研究报道，回肠代输尿管术后并 发症发生率约在 30%[1,2] ，而自体肾移植术后严重并 发症发生率约在 15%~20%[3- 5] 。因此，此类患者的 治疗目前仍存在挑战。

为改善长段上、中段输尿管患者的治疗效果， 近年来泌尿外科医师开始尝试使用自体补片技术进 行输尿管重建。该技术一般通过纵行切开狭窄段或 后壁加强吻合的方式形成“输尿管板”，随后将自体组织补片吻合于输尿管缺损处完成重建 （图 1）。该 技术能够重建宽大通畅的输尿管管腔、保护输尿管 局部血供，同时避免了回肠代输尿管术、自体肾移 植术可能导致的术后并发症，因此是一种理想的治 疗方式。本文将回顾目前自体补片输尿管成形术的 研究进展，为临床治疗提供指导。

1 自体补片的组织类型及选用原则

2 自体补片的技术种类
    2.1 口腔黏膜补片输尿管成形术
    2.2 肠道组织补片输尿管成形术
    2.3 自体尿路组织补片输尿管成形术

3 自体补片技术采用的吻合方式

4 结语与展望

4 结语与展望 

自体补片输尿管成形术是一种理想的输尿管重 建方式，目前的相关研究已初步证实了该技术的安 全性与有效性。未来仍需进一步研究以明确补片类 型和吻合方式如何选择、补片技术适用的狭窄长度 范围等问题。

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