胆总管下段嵌顿结石的处理因其解剖特殊性而较为困难，术前准确判断及评估决定了其治疗方式。胆总管下段结石嵌顿并急性化脓性胆管炎，遵照损伤控制外科理念治疗的重点应是胆道引流迅速缓解胆道梗阻优于结石的处理。胆总管下段结石嵌顿的治疗包括腹腔镜胆囊切除术（LC）结合内镜括约肌切开术（EST）以及腹腔镜胆囊切除胆总管切开取石（LCBDE）辅助术中经胆道镜碎石，提倡LCBDE经胆道镜碎石，应避免胆胰肠结合部损伤及减少应用Oddi括约肌切开成形术治疗胆管下段嵌顿结石。

Treatment strategies and skills for incarcerated choledocholithiasis in distal common bile duct        LIU Jin-gang. Department of General Surgery，Shengjing Hospital，China Medical University，Shenyang 110004，China
Abstract    The treatment of the incarcerated choledocholithiasis in distal common bile duct is relatively more difficult to deal with for its anatomic particularities. The precise preoperative diagnosis and evaluation must be the determinant of the therapy method. With regard to incarcerated choledocholithiasis in distal common bile duct complicated with acute obstructive suppurative cholangitis，according to the controlled theory it should put the focus of treatment on the problem that the drainage of the bile duct for alleviation of biliary obstruction is superior to the management of the stones. Nowadays the therapy methods include the combination of LC and EST，or LCBDE assisted by choledochoscopic crushing technique and so on. The latter method should be advocated. Meanwhile, choledocho-pancreatico-duodenal junction injuries should be avoided and application of Oddi’s sphincteroplasty should be reduced as far as possible.