摘要：机器人输尿管重建手术 （robotic ureteral reconstruction，RUR） 已成为治疗输尿管狭窄的一种有效手 段，其具备疗效好、发病率低和恢复快的优点。根据输尿管狭窄的长度和位置，可选择不同的术式进行输尿管修 复，常用的术式主要包括：输尿管-输尿管吻合术、肾盂成形术、口腔黏膜输尿管成形术、肾盂瓣输尿管成形 术、阑尾补片技术、阑尾管状替代技术、输尿管膀胱再植术、回肠代输尿管术及自体肾移植技术。RUR还可结 合近红外荧光成像技术及三维图像导航技术等，提高手术的安全性及有效性。由于目前针对 RUR的研究多为单 中心、小样本的研究，未来仍需开展针对RUR的大样本、多中心和长随访时长的研究。

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杨昆霖，李新飞，李志华，等. 机器人输尿管重建手术治疗成人输尿管狭窄的现状[J]. 泌尿外科杂志（电子版）,2023,15(1):1-6. DOI:10.20020/j.CNKI.1674-7410.2023.01.01

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输尿管狭窄疾病分为良性和恶性，其中，良性 输尿管狭窄主要包括先天性输尿管狭窄以及泌尿系 结石、医源性损伤、外伤、放疗和缺血引起的后天 性输尿管狭窄。良性输尿管狭窄治疗的目的是疏通 输尿管管腔、缓解症状，并预防肾功能损害。治疗 方案主要包括内镜治疗和手术重建。当输尿管狭窄 难以通过内镜处理时，可进行手术重建[1-2] 。 输尿管重建手术的路径通常分为开放、腹腔镜 和机器人手术[1- 2] 。手术技术主要包括切除及吻合， 使用自体移植物，或带蒂的自体瓣，以及完全替代 或自体肾移植，使用不同的技术取决于输尿管狭窄 的位置和长度 （图 1）。 开放手术往往存在切口较大、出血较多、术后 疼痛剧烈和住院时间长等缺点[3-5] 。虽然腹腔镜手术 是一种替代选择，可提供与开放手术类似的治疗结 果和较少的围术期并发症及更短的住院时长[6-7] ，但 其学习曲线较长，初学者不宜掌握[8] 。相较前两者而 言，机器人辅助腹腔镜手术具有独特的优势，可在v> 狭小的空间进行复杂而精细的操作，而且学习曲线 较短[8] ，许多研究报道机器人输尿管重建 （robotic ureteral reconstruction，RUR） 是一种安全有效的输 尿管修复手段，手术成功率高，并发症发生率低[9-15] 。 然而，既往许多关于 RUR的数据报道通常样本 量小、随访时间短。近 5年来，关于 RUR 的研究较 多，患者样本量增大，随访时间较长[3-5,7,9-15] 。本文 重点回顾 RUR 治疗输尿管良性狭窄的手术技术、并 发症和结果，以供临床医生参考。

1 RUR 的修复策略

2 RUR的常见术式

    2.1机器人输尿管—输尿管吻合术

    2.2机器人肾盂成形术

    2.3机器人颊黏膜输尿管成形术

    2.4机器人舌黏膜输尿管成形术

    2.5机器人肾盂瓣技术

    2.6机器人阑尾补片技术

    2.7机器人阑尾管状替代技术

    2.8机器人输尿管膀胱再植术

    2.9机器人回肠代输尿管术

    2.10机器人辅助自体肾移植术

3 小结及展望

随着机器人手术系统的进一步普及，RUR已逐步成为输尿管修复与重建领域的重要手段。本文结合文献回顾和笔者中心经验，对RUR治疗输尿管狭窄的现状进行了总结。目前RUR的大多数研究为个案或病例系列报道，未针对RUR进行系统性综述及分析，因而缺乏有力的循证医学证据。

总的来说，RUR目前已成为治疗成人输尿管狭窄的一种有效手段，相较于开放及腹腔镜手术，RUR具有较少的手术时间和术中出血等优势。然而，现阶段RUR技术主要在三级医学中心开展，许多关于RUR的研究来自单中心，且受限于小样本和较短随访时长的影响，尚未形成等级较高的临床证据，仍需针对RUR的大样本、多中心、随访时长的研究。加之输尿管修复手术种类繁多、技术较复杂、手术机器人尚未普及等，RUR的标准化推广短期内仍存一定难度。未来随着手术机器人的进一步普及，RUR技术将会进一步惠及更多的输尿管狭窄患者。

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