上尿路尿路上皮癌保肾策略新进展

doi:10.3877/cma.j.issn.1674-3253.2026.04.001

上尿路尿路上皮癌（UTUC）是一种泌尿系统相对少见的恶性肿瘤，具有发病隐匿、侵袭性强和复发率高等特点。根治性肾输尿管切除术作为标准治疗已有数十年，能有效避免肿瘤复发或远处转移。但对于高龄、孤立肾、双侧肿瘤以及肾功能不全的患者，术后肾功能显著下降，并限制了采用铂类药物化疗的应用。近年来，随着影像学诊断、内镜技术及机器人手术等领域的发展，保肾治疗在特定患者群体中展现出良好的应用前景。本文结合国际指南更新和最新临床研究证据，对UTUC保肾治疗的相关研究进展进行论述。

关键词: 上尿路尿路上皮癌, 保肾, 内镜, 节段性输尿管切除, 系统治疗

Upper tract urothelial carcinoma (UTUC) is a relatively rare malignant tumor in the urinary system, characterized by a latent onset, strong invasiveness, and high recurrence rate. Radical nephroureterectomy has been the standard treatment for this condition for several decades, effectively preventing tumor recurrence or distant metastasis. However, for elderly patients, solitary kidneys, bilateral tumors, and those with renal insufficiency, postoperative renal function significantly declines, limiting the application of platinum-based chemotherapy. In recent years, with the development of imaging diagnosis, endoscopic techniques, and robotic surgery, nephron-sparing treatment has shown promising application prospects in specific patient groups. This article reviews the research progress of nephron-sparing treatment for UTUC based on updated international guidelines and the latest clinical research evidence.

Key words: Upper tract urothelial carcinoma, Nephron-sparing, Endoscopy, Segmental ureterectomy, Systemic therapy

表1 上尿路尿路上皮癌（UTUC）保肾治疗方式比较

治疗方式	适应证	肿瘤学结局	主要并发症
输尿管软镜消融	低危、单发、直径<2 cm	5年CSS 89%，5年OS 70%^[11]；复发率30%~40%^[18]	输尿管狭窄、尿路感染
经皮肾镜	肾下盏较大肿瘤；软镜难及部位	5年OS 40%；复发率：低级别37%、高级别63%^[19]	穿刺通道种植、出血、感染
节段性输尿管切除	远段/中段输尿管肿瘤	5年CSS和OS对比RNU无明显差异^[21]；膀胱内复发风险升高21%^[20]	吻合口狭窄、尿漏
自体肾移植	孤立肾、双侧病变	随访44个月无复发^[24]	血管吻合口出血，输尿管缺血性狭窄
腔内药物治疗	低级别UTUC无法完全切除	CR率59%；DOR 48个月^[26,27]；中位复发时间13个月^[27]	输尿管狭窄、尿路感染

表1 上尿路尿路上皮癌（UTUC）保肾治疗方式比较

治疗方式	适应证	肿瘤学结局	主要并发症
输尿管软镜消融	低危、单发、直径<2 cm	5年CSS 89%，5年OS 70%^[11]；复发率30%~40%^[18]	输尿管狭窄、尿路感染
经皮肾镜	肾下盏较大肿瘤；软镜难及部位	5年OS 40%；复发率：低级别37%、高级别63%^[19]	穿刺通道种植、出血、感染
节段性输尿管切除	远段/中段输尿管肿瘤	5年CSS和OS对比RNU无明显差异^[21]；膀胱内复发风险升高21%^[20]	吻合口狭窄、尿漏
自体肾移植	孤立肾、双侧病变	随访44个月无复发^[24]	血管吻合口出血，输尿管缺血性狭窄
腔内药物治疗	低级别UTUC无法完全切除	CR率59%；DOR 48个月^[26,27]；中位复发时间13个月^[27]	输尿管狭窄、尿路感染

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