胆总管末端嵌顿性结石是常见的急腹症，处理不当易造成胆胰肠结合部的损伤。术前磁共振胰胆管造影（MRCP）可了解结石嵌顿的部位、肝内外胆管的扩张程度以及是否合并胆囊结石、肝内胆管结石和乳头周围憩室，有利于选择适宜的治疗方案。应根据病人的全身情况、胆囊炎的严重程度以及技术条件，依据个体化的原则，选择创伤小、操作方便、并发症少的治疗措施，优先考虑内镜治疗。对于合并梗阻性化脓性胆管炎、胰腺炎病人应采取控制性手术原则，先解除胆胰管梗阻，不强调一次取净结石。

Management of stone impacted at distal common bile duct        WANG Jian, ZHANG Xi-wen, WANG Hao-lu. Department of General Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
Corresponding author：WANG Jian, E-mail: dr_wangjian@yahoo.com.cn
Abstract    Stone impacted at distal common bile duct is common and inappropriate treatment would result in a high rate of injury in choledocho-pancreatico-duodenal junction. Magnetic resonance cholangiopancreatography (MRCP) shows advantages in managements selecting, which can reveal where the stone impacted, how extent the bile duct dilated, and whether cholecystolithiasis, intrahepatic lithiasis or periampullary diverticula accompanied. Different treatments should be determined by patient’s condition such as general condition, severity of cholecystitis and specification. The principle of choice in treatment is to minimize the wound and decrease the rate of complication. So endoscopy is preferable. Damage control surgery to relieve the biliary obstruction should be firstly considered in patients with acute obstructive suppurative cholangitis or pancreatitis. There is no need to remove the stone completely at once.