胆总管结石的微创治疗理念正从单纯的“结石清除”向“功能保全”转型，其核心在于保护Oddi括约肌（SO）的结构与功能完整性。本文系统阐述了SO保护技术的革新与临床实践进展。①超细胆道镜经胆囊管取石术（LTCBDE）：利用直径2.0~2.8 mm胆道镜，经胆囊管自然通道实现“零切开”取石，尤其适用于胆管纤细（≤0.5 cm）的患者，能有效规避SO损伤，降低术后胰腺炎风险。​②胆管一期缝合术（联合或不联合临时内支架引流）：避免了传统T管长期留置的相关并发症，显著缩短了住院时间。​③内镜下乳头球囊扩张术（EPBD）：通过可逆性扩张替代内镜下括约肌切开术（EST）的永久性切开，最大程度地保留SO抗反流功能，尤其适用于凝血功能障碍或EST高风险解剖（如十二指肠憩室）的患者。​④三镜联合技术（腹腔镜、胆道镜、十二指肠镜）：整合了多种微创优势，旨在实现“一站式”结石清除与功能保全。本文进一步提出了基于患者特征（青年、高龄、高危）与结石特性的分层决策模型，以指导个体化治疗选择。当前面临的挑战包括术中SO功能实时监测手段的缺失和长期疗效数据的不足。未来，融合人工智能监测、再生医学及机器人技术的“智能胆道外科”范式，将是实现根治性治疗与生理功能保全终极目标的发展方向。

The concept of minimally invasive treatment for choledocholithiasis is transitioning from simple “stone clearance” to “functional preservation”, with its core lying in protecting the structural and functional integrity of the Oddi sphincter (SO). This article systematically explains the innovations and clinical practice progress of SO protection techniques. ①Ultra-fine choledochoscope transcystolithotomy (LTCBDE): Using a choledochoscope with a diameter of 2.0–2.8 mm, zero-incision stone extraction has been achieved through the natural channel of the cystic duct. It is particularly suitable for patients with slender bile ducts (≤0.5 cm), which can effectively avoid SO injury and reduce the risk of postoperative pancreatitis. ② Primary bile duct suture: (with or without temporary internal stent drainage) to avoid complications associated with long-term indwelling of traditional T-tubes and significantly shortens the length of hospital stay. ③ Endoscopic papillary balloon dilation (EPBD): Replacing the permanent incision of EST with reversible dilation, it maximally preserves the anti-reflux function of SO. It is particularly suitable for patients with coagulation dysfunction or high-risk anatomy for EST (such as duodenal diverticulum). ④ Combined the three-mirror technique: (laparoscope, choledochoscope, duodenoscope) to integrate the advantages of multiple minimally invasive approaches, aiming to achieve “one-stop” stone clearance and functional preservation. This article further proposes a stratified decision-making model based on patient characteristics (young, elderly, high-risk) and stone features to guide individualized treatment selection. Current challenges include the lack of real-time intraoperative SO function monitoring methods and insufficient long-term efficacy data. In the future, the “intelligent biliary surgery” paradigm integrating AI intelligent monitoring, regenerative medicine and robotic technology will be the development direction to achieve the ultimate goal of radical treatment and physiological function preservation.