总结基于膜解剖的3D腹腔镜下舌黏膜补片输尿管成形术治疗输尿管中长段狭窄的安全性与临床疗效。

回顾性分析2021年7月至2025年2月，暨南大学附属第六医院收治的共8例行3D腹腔镜舌黏膜输尿管成形术治疗输尿管中长段狭窄患者的临床资料，统计并分析围手术期情况及随访资料。男性5例，女性3例，中位年龄47.5（19~55）岁。中位输尿管狭窄长度4.25（3.0~7.0）cm。中位术前血清肌酐84.7（56.2~141.1）μmol/L。8例患者均采用基于膜解剖的3D腹腔镜单一体位的舌黏膜输尿管成形手术，术后定期随访。

8例手术由同一名拥有20年临床经验的泌尿外科医生完成，手术成功率为100%。中位手术时间240（227~410）min；中位出血量20（5~30）mL；获取舌黏膜补片长度为4.5（4.0~7.0）cm，宽度为1.5 cm。中位术后住院时间8（7~15）d。术中及术后均无高级别并发症（Clavien-Dindo Ⅲ~Ⅳ）发生。术后中位随访时间9（6~30）个月。术后６个月中位血清肌酐76.9（53.3~121.3）μmol/L；末次随访中位血清肌酐73.4（52.4~128.7）μmol/L。随访过程中，7例腰痛患者中，症状完全缓解5例，较术前显著减轻2例。2例出现尿路感染（Clavien-Dindo Ⅱ），经敏感抗生素治疗后痊愈。7例出现舌部取材部位短暂性轻度麻木，末次随访时仅1例残留症状（Clavien-Dindo Ⅰ）；5例发生轻度舌体运动障碍，经康复训练后恢复。1例出现腹腔引流管切口乙级愈合（Clavien-Dindo Ⅱ），经局部清创换药后完全愈合。末次随访仅1例血清肌酐轻度升高（升高7.9 μmol/L，升高幅度<15.0%），7例肾功能较术前好转（血清肌酐下降2.2~64.5 μmol/L）。所有患者随访期间肾功能波动幅度<10%（除1例患者下降幅度约55%），无患者需透析治疗或出现急性肾损伤。

基于3D腹腔镜及膜解剖的分离技术有助于游离并显露狭窄的输尿管，减少出血和副损伤，舌黏膜补片输尿管成形术可有效解除输尿管中长段梗阻，且无严重并发症发生，具有较好的可行性和安全性，但仍需更多临床数据来进一步验证其疗效与安全性。

To summarize the safety and clinical efficacy of 3D laparoscopic lingual mucosa graft ureteroplasty for the treatment of mid-to-long-segment ureteral strictures based on membrane anatomy.

The clinical data of 8 patients who underwent 3D laparoscopic lingual mucosal ureteroplasty for the treatment of mid-to-long-segment ureteral strictures at the Sixth Affiliated Hospital of Jinan University between July 2021 and February 2025 were retrospectively analyzed. The cohort comprised 5 males and 3 females, with a median age of 47.5 (range: 19-55) years. The median ureteral stricture length was 4.25 (range: 3.0-7.0) cm. The median preoperative serum creatinine level was 84.7(range: 56.2-141.1) μmol/L. All 8 patients underwent membrane anatomy-based 3D laparoscopic lingual mucosal ureteroplasty in a single surgical position. Regular follow-up was conducted postoperatively.

All procedures were performed by the same urologist with 20 years of clinical experience, achieving a success rate of 100%. The median operative time was 240 (range: 227-410) min, the median estimated blood loss was 20 (range: 5-30) mL. The harvested lingual mucosal graft had a median length of 4.5 (range: 4.0-7.0) cm and width of 1.5 cm. The median postoperative hospital stay was 8 (range: 7-15) d. No high-grade complications (Clavien-Dindo Ⅲ-IV) occurred during or after surgery. The median follow-up time was 9 (range: 6-30) months. The median serum creatinine level at 6 months postoperation was 76.9 (range: 53.3-121.3) μmol/L; at the last follow-up, it was 73.4 (range: 52.4-128.7) μmol/L. Among the 7 patients with preoperative flank pain, 5 experienced complete resolution and 2 reported significant improvement. Two patients developed urinary tract infections (Clavien-Dindo Ⅱ), which resolved after targeted antibiotic therapy. Seven patients experienced transient mild numbness at the lingual donor site (Clavien-Dindo I), with only 1 case persisting at the final follow-up. Five patients developed mild tongue movement impairment, all of which resolved after rehabilitation training. One patient had a grade B wound healing at the drainage site (Clavien-Dindo Ⅱ), which healed completely after local debridement and dressing changes. At the final follow-up, only 1 patient showed a mild increase in serum creatinine (an increase of 7.9 μmol/L, <15.0%). In the remaining 7 patients, renal function improved compared to preoperative levels (mean decrease in serum creatinine range 2.2-64.5 μmol/L). During follow-up, the fluctuation in renal function was <10% in all patients (except for 1 patient with a decrease of approximately 55%). No patient required dialysis or developed acute kidney injury.

The use of 3D laparoscopy combined with membrane anatomy-based dissection facilitates the mobilization and exposure of the strictured ureter, reducing bleeding and collateral injury. Lingual mucosal graft ureteroplasty based on membrane anatomy effectively relieves mid-to-long-segment ureteral obstruction without serious complications, demonstrating good feasibility and safety. However, further clinical data is needed to validate its efficacy and safety.