胆总管探查是胆道外科常用的基本手术方法，胆总管下段分为胰腺段和十二指肠壁内段，在进入十二指肠前，胆管以一定的角度向右后下倾斜，并与十二指肠间形成一个（40.5±4.6）°夹角，胆管长（1.67±0.52）cm，仅有部分结缔组织覆盖。由于胆总管下段解剖结构的特殊性，加之胆总管末端结石嵌顿、胆管狭窄等病理改变，容易导致胆总管下段探查、取石时发生医源性损伤，引起严重并发症。根据解剖特点及合并脏器损伤情况，胆总管下段损伤大体可分为4型，单纯性胆管损伤、合并胰腺损伤、合并十二指肠损伤及合并胰腺十二指肠损伤，因此了解胆总管下段的解剖特点及损伤分型，采用正确的探查方法及预防、处理措施显得十分重要。

The relationship between anatomic characteristics and injury type of distal common bile duct        TANG Zhao-hui，HEI Zhen-yu，WENG Ming-zhe，et al. Department of General Surgery， XinHua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine，Shanghai 200092，China
Corresponding author：TANG Zhao-hui, E-mail：tangzhaohui@yahoo.com
Abstract    Exploration of the common bile duct is the basic operational methods of bile duct surgery. The distal common bile duct is divided into two parts：section within pancreas and section within duodenal wall. Before entering duodenum，the common bile duct lean to back lower place forming a angle between bile duct and duodenal wall equaling about （40.5±4.6）°. Its length is about （1.67±0.52）cm with limited cover of connective tissue. It’s easy to suffer from iatrogenic injury and cause severe complication during exploration of common bile duct in the distal section for its special anatomy, the high occurrences of calculous obstruction and bile duct stricture. The injury of distal common bile duct includes 4 types such as simple bile duct injury，bile duct injury combined with pancreas trauma，bile duct injury combined with duodenal trauma，bile duct injury combined with pancreas and duodenal trauma. Therefore，it is of vital importance to know the special anatomy of distal common bile duct and injury type，and adopt right exploration method.