Oddi括约肌为一受神经体液支配的复杂的调节装置，为一明显高压区。作为一种可变的阻力装置可调节胆汁由胆总管进入十二指肠，并防止十二指肠内容物反流。在胆道手术中应强调Oddi括约肌结构和功能的保护，更要严格掌握Oddi括约肌切开或成形术的指征。医源性胆总管末段损伤诊断与处理困难，关键是要预防其发生。一旦发生损伤，尽量要在手术中发现，早期处理。延迟发现者应遵循损伤控制手术的理念，不强求一次性解决问题。处理损伤的基本原则是实现胆汁、胰液、胃液的分流，减少消化液的漏出，充分引流腹膜后间隙，同时尽早进行肠内营养支持和抗感染及全身支持治疗。二期手术再考虑恢复胆道和胃肠道的连续性。

Two issues of biliary surgery can not be ignored：Protection of the sphincter of Oddi function and bile duct injury in last paragraph        LIU Yong-feng, LI Gui-chen. Department of General Surgery, the First Hospital of China Medical University, Shenyang110001, China
Corresponding author: LIU Yong-feng, E-mail:yfliu@mail.cmu.edu.cn
Abstract    Sphincter of Oddi (SO) is a complex neuromuscular structure located at the choledocho and pancreatoduodenal junction.  SO plays a major role in controlling the flow of bile from the common bile duct into the duodenum and  effectively prevents duodenobiliary reflux. The protection of the structure and function of SO should be emphasized in biliary surgery. Oddi sphincterotomy or angioplasty should be carried on strictly. It is very difficult for the diagnosis and treatment of the last part of common bile duct injury with iatrogenic reasons. The key point is to prevent its occurrence. Once the injury occurs, early treatment will be important. Damage control surgery has been proven to have the most benefits for delay found. The basic principles of the management for bile duct injury are the diversion of bile juice, pancreatic juice and gastric juice, reducing the leakage of digestive juices and adequate drainage of retroperitoneal space. Enteral nutrition, anti-infection and supportive therapy should be applied as soon as possible. Restoring the continuity of the biliary tract and gastrointestinal tract should be considered in the second stage operation.