3D生物打印技术在泌尿系统主要器官组织工程中的研究进展

Research Progress of 3D Bioprinting in Tissue Engineering of Major Urinary Organs

摘要: 泌尿系统疾病涉及肾脏、输尿管、膀胱和尿道等多个器官，常伴有结构缺损、屏障破坏、尿液传导障碍、储排尿功能异常及局部瘢痕化等问题。传统治疗手段在维持生命、恢复尿路连续性和改善症状方面仍具有基础地位，但在供体短缺、免疫排斥、供区损伤、组织适配性不足和远期功能恢复有限等方面存在局限。3D生物打印融合医学影像建模、计算机辅助设计、生物材料、细胞打印和组织工程技术，能够按照预设空间结构沉积细胞、生物墨水及生物活性因子，为泌尿系统组织修复、类器官构建、疾病模型和个体化治疗评价提供新的技术路径。本文围绕肾脏、膀胱、尿道和输尿管等主要器官，系统综述3D生物打印在泌尿系统组织工程中的研究进展，重点讨论诱导多能干细胞来源肾脏类器官、可灌注肾小管模型、器官特异性脱细胞外基质生物墨水、膀胱分层支架、尿道狭窄修复和输尿管长段缺损替代等方向。现有研究显示，该领域已由早期支架成型逐步转向细胞微环境调控、器官特异性功能模拟和患者个体化模型建立；但完整功能性泌尿器官打印尚未实现，血管化、神经化、功能成熟、长期安全性和标准化评价仍是制约临床转化的关键瓶颈。短中期内，肾脏方向更适合服务于体外疾病模型和药物筛选，尿道、输尿管及膀胱局部修复则可能成为较早开展临床前转化验证的应用场景。

Abstract: Diseases of the urinary system involve multiple organs, including the kidney, ureter, bladder and urethra, and are frequently associated with tissue defects, barrier dysfunction, impaired urine transport, abnormal storage and voiding function, infection and fibrosis. Conventional therapies, including dialysis, transplantation, reconstructive surgery and autologous tissue substitution, remain clinically indispensable but are limited by donor shortage, immune rejection, donor-site morbidity, anatomical mismatch and insufficient long-term functional recovery. Three-dimensional bioprinting integrates medical image-based modeling, computer-aided design, biomaterials, cell deposition and tissue engineering, allowing spatially controlled fabrication of cells, bioinks and bioactive cues. This review summarizes current progress in 3D bioprinting for major urinary organs, with emphasis on induced pluripotent stem cell-derived kidney organoids, perfusable renal tubule models, organ-specific decellularized extracellular matrix bioinks, layered bladder scaffolds, urethral stricture repair and ureteral reconstruction. Current evidence suggests that urological bioprinting has shifted from scaffold fabrication toward regulation of cellular microenvironments, organ-specific functional modeling and personalized platforms. However, printing of fully functional urinary organs remains a long-term goal, and clinical translation is still limited by vascularization, innervation, functional maturation, long-term safety and standardized evaluation. In the near to medium term, kidney bioprinting may be more suitable for in vitro disease modeling and drug screening, whereas localized bladder repair and personalized tubular grafts for the urethra and ureter may represent more feasible translational directions.