目的： 探讨内镜逆行胰胆管造影术（endoscopic retrograde cholangiopancreatography, ERCP）联合SpyGlass DS直视液电碎石治疗困难胆总管结石的有效性及安全性。方法： 纳入2020年1月—2022年2月在杭州市第一人民医院行SpyGlass DS直视下液电碎石治疗的35例困难胆总管结石病人临床资料,分析碎石成功率、取石成功率、一次取石成功率以及术后并发症发生率、术后住院时间和ERCP操作时间。结果： 34例（97.1%）SpyGlass DS直视液电碎石成功。1例液电碎石不完全,改为体外震波碎石。ERCP操作时间（77±13.1） min。所有病人最终均取石成功。29例（82.9%）一次取石成功。2例（5.7%）分别出现术后急性胆管炎、急性胰腺炎并发症。术后住院时间（6.3±3.7） d。结论： ERCP联合SpyGlass DS直视液电碎石治疗困难胆总管结石安全可行。

Objective To investigate the efficacy and safety of endosocopic retrograde cholangiopancreatography (ERCP) combined with SpyGlass DS direct visualization electrohydraulic lithotripsy in the treatment of difficult bile duct stones. Methods A total of 35 patients with difficult bile duct stones in Hangzhou First People′s Hospital undergoing SpyGlass DS direct visualization electrohydraulic lithotripsy from January 2020 to February 2022 were enrolled. Clinical data were collected to analyze the success rate of lithotripsy, stone clearance, and single-session stone clearance with post ERCP complication rate, hospital stay after ERCP, and ERCP time. Results There were 34 (97.1%) patients with successful SpyGlass DS lithotripsy, One patient underwent incomplete electrohydraulic lithotripsy supplemented with extracorporeal shock wave lithotripsy. ERCP time was(77±13.1) min. All patients achieved stone clearance and single-session stone clearance was achieved in 29(82.9%) patients. Two patients with acute cholangitis and acute pancreatitis were found respectively and ERCP complication 5.7%. Hospital stay after ERCP was(6.3±3.7) days. Conclusions ERCP combined with SpyGlass DS-guided electrohydraulic lithotripsy would be safe and feasible in the treatment of difficult bile duct stones.