Abstract:Fecal microbiota transplantation (FMT), as an important biological strategy for reconstructing intestinal microecology, has evolved from an empirical therapy for recurrent Clostridioides difficile infection to a promising intervention for a wide range of intestinal and extraintestinal diseases, including inflammatory bowel disease, functional gastrointestinal disorders, chronic liver diseases, and neuropsychiatric disorders. FMT is currently transitioning toward an era of precision, standardization, and mechanism-oriented microecological therapy. Based on major advances in FMT research over the past decade and the extensive clinical experience of our team, this review systematically summarizes the developmental trajectory of FMT from "empirical treatment-standardized practice-precision intervention". Key issues and challenges are discussed, including donor screening and quality control, gut microbiome detection, donor-recipient matching, optimization of treatment timing and therapeutic courses, selection of transplantation routes, establishment of efficacy evaluation systems, and long-term follow-up management. In addition, recent progress in emerging fields such as the gut-organ axis, live biotherapeutic products, and bacteriophage therapy is highlighted. Future development of FMT will increasingly rely on multi-omics technologies, artificial intelligence-assisted matching strategies, and functional microbiota analysis, thereby promoting the transformation of FMT from an empirical intervention into a precise, controllable, and reproducible microecological therapeutic modality.