复杂型胆总管结石的内镜治疗策略

胆总管结石常导致急性胆道梗阻、胆管炎和胰腺炎。内镜下取石术已成为胆管结石的主要治疗方法。使用内镜下常规取石技术可治疗大部分结石，但对于约占10%~15%的复杂型胆总管结石的治疗尚需结合内镜下碎石术，笔者系统回顾和总结目前可用于复杂型胆总管结石的内镜治疗选择方式如内镜下球囊乳头扩张术、内镜引导下碎石术和内镜超声引导下胆道取石术等，以期对难治性胆总管结石临床治疗提供内镜诊疗建议和依据。 

Strategies for endoscopic management of complex choledocholithiasis

Common bile duct stones often lead to acute biliary obstruction, cholangitis and pancreatitis. Endoscopic stone extraction has become the main treatment for bile duct stones. Most of the common bile duct stones can be removed by the conventional endoscopic method, but there are still 10% to 15% of the complex choledocholithiasis that need the combined treatment of endoscopic lithotripsy. The authors review and summarize the current endoscopic management options for complex choledocholithiasis, such as endoscopic balloon papillary dilatation, endoscopic guided lithotripsy and endoscopic ultrasound-guided choledocholithotomy, so as to provide endoscopic diagnosis and treatment suggestions and basis for the clinical treatment of refractory choledocholithiasis.