上尿路尿路上皮癌（UTUC）是一类相对少见但侵袭性较强的尿路上皮恶性肿瘤，传统以根治性肾输尿管切除术作为主要治疗方式。然而，该术式不可避免地造成肾单位丢失，增加慢性肾脏病及相关并发症发生风险。随着影像学、内镜技术和风险分层体系的不断完善发展，保肾治疗逐步从"被动替代方案"发展为在特定人群中具有循证依据的治疗策略。近年来，在内镜消融、节段切除等传统保肾方式基础上，围手术期系统治疗（尤其是抗体偶联药物联合免疫治疗）与局部治疗相结合的新型综合策略不断出现，为部分高危UTUC患者实现肿瘤控制与肾功能保留提供了新的可能。本文结合国内外关于UTUC保肾治疗进展的研究，对UTUC保肾治疗的风险分层、主要技术方式、最新进展及局限性进行系统论述。

Upper tract urothelial carcinoma (UTUC) is a relatively uncommon but highly aggressive malignancy of the urothelial tract. Radical nephroureterectomy has traditionally been regarded as the standard treatment. However, this procedure inevitably results in loss of functional renal units and is associated with an increased risk of chronic kidney disease and related complications. With continuous advances in imaging modalities, endoscopic technologies, and risk stratification systems, kidney-sparing treatment has gradually evolved from a "passive alternative" into an evidence-based therapeutic strategy for selected patient populations. In recent years, beyond conventional kidney-sparing approaches such as endoscopic ablation and segmental resection, novel multimodal strategies integrating perioperative systemic therapy-particularly antibody-drug conjugates combined with immunotherapy-with local treatment have emerged. These approaches offer new possibilities for achieving oncologic control while preserving renal function in selected patients with high-risk UTUC. This review summarizes current domestic and international evidence on kidney-sparing management of UTUC, with a focus on risk stratification, major technical approaches, recent advances, and existing limitations.