对于困难胆总管结石的治疗，内镜下乳头括约肌切开术联合内镜下乳头大球囊扩张术应作为首选方案。机械碎石术和胆道镜辅助碎石术是近乎等效的替代方案，具有几乎相同的清除率，应在条件允许的情况下使用。置入临时塑料支架是一种很好的选择，可以争取时间以探索后续治疗选项。
此外，基于小肠镜的ERCP、PTCS、或EUS-HG以及结石治疗，虽然是某些解剖异常病例的替代方法，但应在专科单位进行。
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