In recent years, the number of patients with gallstones has increased, and most patients can be treated well with laparoscopic and open surgery. However, the treatment of “complex intra- and extra-hepatic bile duct stones” is a difficult problem. After research and summary, according to the formation and clinical characteristics of this kind of stone, combined with decades of clinical and other research results at home and abroad, combining the features of open surgery, laparoscopic technology, ultrasound technology, we have developed today’s more minimally invasive and more effective stone extraction technology – percutaneous perforation bile duct stone removal, applied to The treatment of complex intra- and extra-hepatic bile duct stones and common bile duct or/and common hepatic duct stones has been very effective. The technique requires only a small incision of less than 5 mm in the abdominal wall to remove the stones from the internal and external bile ducts of the liver. The case is presented below. Huang Gang, Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Guangzhou Medical University, was admitted to the hospital on 2014-12-9 with “recurrent epigastric pain and jaundice for 1 month, aggravated by fever for 4 days”. The patient developed epigastric pain with paroxysmal colic, radiating to the lower back and right shoulder, accompanied by nausea and severe yellowing of the skin and sclera, after feeding in January. He was discharged after treatment with anti-infection and pain relief. 4 days ago, the above symptoms worsened with fever, temperature ranging from 38 to 39 degrees, nausea, no vomiting, and progressive deepening of urine color, and was again hospitalized in a local hospital without significant relief. The patient was found to have tuberculosis in 2010, which was cured after regular treatment, and underwent cholecystectomy + choledochotomy for gallbladder stones and bile duct stones in 2007, and again underwent choledochotomy for stones in 2010. Physical examination: surgical scar was seen in the upper abdomen, there was pressure pain in the middle abdomen, no rebound pain, liver was not reached under the ribs, and the rest was not abnormal. Auxiliary examination: 2014-11-7 CT of upper abdomen in a hospital in Yueyang suggested: multiple stones in intrahepatic bile duct and multiple stones in common bile duct. Admission diagnosis: 1. intra- and extra-hepatic bile duct stones and cholangitis. 2. post-biliary exploration and lithotripsy. 3. post-cholecystectomy. After admission, he was immediately given anti-infection and liver protection treatment, while preoperative tests were done: glutamate transaminase:61.9U/L, γ-glutamyl transpeptidase:382.2U/L, platelets:66*10^9/L, potassium:3.14mmol/L, abdominal CT: multiple stones in the right intrahepatic bile duct, combined with cholangitis possible; dilated intra- and extrahepatic bile ducts, common bile duct filled with stones. Hepatobiliary ultrasound: 1. postoperative absence of the left liver and stones in the right intrahepatic bile duct. 2. postoperative absence of the gallbladder. The upper part of the common bile duct was unexplored. After adequate preoperative preparation, “percutaneous hepatic puncture choledochoscopy and extraction of intra- and extra-hepatic bile duct stones” was performed under general anesthesia on 12-15. The left hepatic duct, common hepatic duct and common bile duct were full of stones, and the right anterior lobe, right posterior lobe and left internal lobe bile duct were full of stones, the largest stones were S4 and S6 1.5 cm, and the internal and external hepatic bile ducts were obviously dilated, the largest ones were 2-3 cm, and the left internal lobe bile duct was remarkable, with a diameter of about 2 cm. Cholangioscopic exploration revealed multiple yellow-brown stones in the intra- and extrahepatic bile ducts and a large number of stones in the intrahepatic bile duct, which were removed. The largest diameter of the common bile duct was about 1.5 cm, the bile was purulent white bile, more necrotic flocculent material was seen, and the right hepatic duct all the way to the lower end of the common bile duct was filled with stones. According to the choledochoscopic findings and ultrasound, the bile stones were removed from the intra- and extra-hepatic ducts and the opening of the lower common bile duct was checked to be clear. The operation went well and the patient returned to the ward after the operation. The patient has recovered since the postoperative visit.