局段金属输尿管支架的临床应用进展、热点、争议与未来展望

doi:10.19723/j.issn.1671-167X.2026.04.001

摘要/Abstract

摘要：

输尿管狭窄是导致上尿路梗阻及进行性肾功能损害的常见泌尿系统疾病。近年来，局段金属输尿管支架凭借其长效留置与可靠引流优势，已逐渐成为输尿管狭窄的重要维持性治疗手段。然而，由于狭窄病因的高度异质性，不同类型支架在适应证精准选择、手术植入规范以及远期并发症的防治策略上仍存在显著争议与认知局限。本文结合国内外最新循证医学证据与本中心大样本诊疗经验，系统梳理了局段金属支架在各类输尿管狭窄中的临床应用现状，对目前临床存在的主要争议问题进行深入剖析，并针对各类导致支架失效的并发症提出临床处置策略。

关键词: 输尿管狭窄, 输尿管支架, 维持性治疗, 覆膜金属输尿管支架, 温控记忆合金输尿管支架

Abstract:

Ureteral stricture (US) is a common urological disease with complex etiologies, including benign and malignant lesions, iatrogenic injuries, and idiopathic factors. Without timely intervention, it can lead to upper urinary tract obstruction and progressive, irreversible renal impairment. Traditional re-constructive surgeries are often limited by high technical demands, significant surgical risks, and strict requirements for patient fitness. To address these challenges, segmental metallic ureteral stents (SMUSs) have gained prominence in recent years. Featuring a non-full-length design for targeted support, excellent radial strength, and a large caliber, SMUSs provide reliable drainage and allow for long-term retention. They effectively overcome the common drawbacks of traditional double-J stents, such as frequent encrustation, the need for regular replacement, and severe bladder irritation. Consequently, SMUSs have become a vital maintenance therapy for patients with malignant obstructions or those unsuitable for re-constructive surgery. Moreover, they have shown curative potential by providing long-term efficacy for certain benign strictures. However, due to the high heterogeneity of stricture etiologies, significant controversies and knowledge gaps remain in clinical practice. These mainly pertain to the precise selection of stent types for specific indications, the standardization of surgical implantation, optimal indwelling durations, and strategies for preventing and managing long-term complications. Drawing upon the latest global evidence-based medicine and large-sample follow-up data from our center, this article systematically reviews the clinical application and efficacy differences of SMUSs across malignant, benign, and radiotherapy-induced ureteral strictures. We provide an in-depth analysis of major ongoing clinical controversies and propose practical management strategies for complications leading to stent failure, including stent obstruction, migration, encrustation, recurrent infections, and high-risk ureteral fistulas.

Key words: Ureteral stricture, Ureteral stent, Maintenance therapy, Covered metallic ureteral stent, Thermo-expandable metallic ureteral stent

中图分类号:

R693

胡浩, 边小龙, 徐涛. 局段金属输尿管支架的临床应用进展、热点、争议与未来展望[J]. 北京大学学报（医学版）, 2026, 58(4): 679-685.

Hao HU, Xiaolong BIAN, Tao XU. Clinical application progress, hot topics, controversies and future prospects of segmental metallic ureteral stents[J]. Journal of Peking University (Health Sciences), 2026, 58(4): 679-685.

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