Choledochal stones are usually found in the lower part of the common bile duct and can be divided into primary and secondary choledochal stones according to their origin. Most of the common bile duct stones are formed in the bile duct, called primary stones, and their formation is closely related to biliary tract infection and bile stasis, mostly bile pigment stones. Stones from the gallbladder or intrahepatic bile ducts that have fallen into the bile ducts are called secondary stones, with cholesterol stones being the most common. Clinical manifestations The clinical manifestations of common bile duct stones are complex and varied, mainly related to the degree of obstruction of the common bile duct caused by the stones. (1) In patients without severe biliary obstruction, there is no obvious discomfort, and elevated transpeptidase and alkaline phosphatase may be seen in laboratory tests. (2) Complete obstruction of the bile duct by stones may cause bile duct dilatation and bile stasis, which may lead to impaired liver function in severe cases. (3) Secondary infection may cause abdominal pain, fever and jaundice, which is clinically referred to as acute cholangitis. Severe cases can cause circulatory and psychiatric changes, threatening the patient’s life, clinically known as acute obstructive suppurative cholangitis. (1) Laboratory tests: Blood count: white blood cells are an indicator to help determine the degree of infection, and transketolase and alkaline phosphatase are elevated to indicate the presence of biliary obstruction. MRCP: It can clearly show the bile duct dilatation, and the stone shows filling defect. Treatment Common bile duct stones should be treated actively regardless of the presence or absence of symptoms. （With the development of laparoscopic technology and endoscopic sphincterotomy for stone extraction, traditional open surgery is now less commonly used. (2) Endoscopic sphincterotomy lithotomy: Endoscopic sphincterotomy lithotomy has the advantages of small trauma and fast recovery, especially for patients with acute obstructive pyogenic cholangitis in critical condition and elderly patients. However, this treatment method will destroy the integrity of the oddi sphincter and is prone to recurrent episodes of reflux cholangitis after surgery. (3) Laparoscopic combined with choledochoscopic choledochotomy and stone extraction treatment: With the development of laparoscopic technology in recent years, laparoscopic combined with choledochoscopic choledochotomy and stone extraction treatment has gradually become the preferred treatment for common bile duct stones. Laparoscopic surgery is less traumatic, faster recovery, and preserves the integrity of the oddi sphincter, avoiding the disadvantage of endoscopic treatment prone to reflux cholangitis. It should be preferred when technology and equipment allow.