Clinical experience in the diagnosis and treatment of cholelithiasis ultrasound diagnosis of cholelithiasis: gallstones are shown as strong echogenic clusters with acoustic shadow during ultrasound examination, gallbladder stones can move with body position change, stones that will not change with body position are called attached stones, 2mm size stones can be detected, gallbladder tumors or polyps are inhomogeneous strong echogenic or hypoechoic, not accompanied by acoustic shadow, and there is no mobility. Ultrasound diagnosis of bile duct dilatation: normal common bile duct diameter is 0.6-0.8 cm, common hepatic duct is 0.4-0.6 cm. gallbladder length is 8-12 cm, diameter of bile duct is 0.1-0,4 cm, thickness of gallbladder wall is <3 mm. ultrasound diagnosis of gallbladder atrophy is not always correct and multiple examinations are needed. Extrahepatic bile ducts of >5mm in the upper segment and >10mm in the lower segment can be diagnosed as dilated bile ducts. normal intrahepatic bile ducts are not shown on ultrasound. 1. Points to note in the diagnosis of cholelithiasis: (1) Mild symptomatic cholelithiasis must be differentiated from gastritis, gastric cancer, viral hepatitis, pancreatic cancer, etc. There have also been cases of misdiagnosis of symptoms arising from sclerosing spondylitis as intrahepatic bile duct and common bile duct stone surgery, which did not achieve symptom relief after surgery and caused medical disputes. In acute attacks, it must be differentiated from gastric perforation and acute appendicitis; (2) When diagnosing acute attacks of cholelithiasis, blood and urine amylase determination must be done to avoid missing the diagnosis of complicated biliary pancreatitis. (3) When diagnosing isolated intrahepatic bile duct stones by ultrasound, it should be differentiated from calcification. Intrahepatic bile duct stones show mass-like, striated or dendritic strong echogenicity under ultrasound. Chronic inflammation of the bile ducts around the gallstones with fibrosis causes echogenic disturbance of the nearby liver parenchyma and distal bile duct dilatation. (4) The accuracy of ultrasound examination of gallbladder stones is more than 95%, and CT or MRI examination of gallbladder stones is only for reference, and spiral CT or MRI examination is needed when the lower bile duct stones are missed due to gas interference in the duodenal bulb. (5) Magnetic resonance cholangiopancreatography (MRCP) uses the principle of meiotic water imaging to make the parenchyma invisible and the bile and pancreatic fluid in the bile ducts invisible. MRCP is different from ERCP in that it can show pancreaticobiliary duct lesions above the narrow obstructed segment; (6) gallbladder stones and gallbladder cancer. There is a significant correlation between the two, with about 74%-92% of patients with gallbladder cancer having gallbladder stones in combination. Similarly, patients with long-term intrahepatic bile duct stone attacks may have the possibility of bile duct cancer. Patients with clinical bile duct cancer may present as intrahepatic bile duct stones with biliary tract infection or intrahepatic bile duct stones with liver abscess, which are not easily detected by preoperative ultrasound and CT examination, or may be missed due to prolonged contrast enhancement. The diagnosis is not yet clear. In case of elderly patients, CA199 rising significantly, thick bile or bloody bile, or postoperative biliary tract infection that cannot be explained by residual stone and cannot be controlled, the diagnosis of cholangiocarcinoma should be highly suspected and confirmed by repeated liver biopsy, bile duct drainage secretion to find cancer cells or CT review; (7) primary or secondary choledocholithiasis in the liver or gallbladder or secondary to congenital common bile duct cyst; (8) gallstone intestinal obstruction (duodenal or (9) gallbladder stones can form cholecystoduodenal fistula, gallbladder colonic impotence, gallbladder common bile duct fistula (Mirizzi S); (10) intrahepatic bile duct stones can cause sepsis, hepatic abscess, acute obstructive purulent cholangitis, biliary pleural fistula, biliary bronchial fistula; (11) biliary-heart syndrome. This refers to gallstone colic causing cardiac rhythm disturbance or cardiac dysfunction, or cardiac arrest during intraoperative exploration of the biliary tract. The presence of geriatric diseases such as {blood pressure, coronary heart disease diabetes, hyperlipidemia, atherosclerosis, etc. in elderly patients with cholelithiasis; (12) gallbladder polyps and cholelithiasis Gallbladder augmentation lesions include inflammatory polyps, cholesterol polyps, adenomas, adenomyoma and gallbladder cancer. Among them, cholesterol polyps are the most common. The diagnosis of gallbladder augmentation lesions is more precise than that of gallbladder polyps. Gallbladder cholesterol polyps are often multiple calcifications that first form wall stones and then become multiple gallbladder stones or full-blown stones when they are dislodged. If the gallbladder bulge lesion >0.8cm or rapid increase in size within a short period of time, gallbladder removal is appropriate. (1) The principles of gallstone treatment are: extraction of stones, removal of lesions, and smooth flow of bile; (2) Indications for biliary surgery and selection of the timing of surgery. (2) the indications for biliary surgery and the timing of surgery (indications for common bile duct exploration and one-stage suture of common bile duct; laparoscopy, choledochoscopy and duodenoscopy for the treatment of cholelithiasis); (3) prevention and treatment of residual biliary stones; (4) types of biliary injury, prevention and repair; (5) treatment of cholelithiasis combined with diabetes; (6) treatment of cholelithiasis combined with cirrhosis.