Bile duct stones are divided into extrahepatic bile duct and intrahepatic bile duct stones. Intrahepatic bile duct stones are one of the common diseases in China, mostly found in South China, Yangtze River basin and southeast coast, currently lack of curative treatment measures, easy to recur, and are a common and difficult to treat biliary disease in China. Most of the extrahepatic bile duct stones are caused by the discharge of small stones from the gallbladder into the bile duct, mostly cholesterol stones, and usually have a clear history of gallbladder stones. In addition, primary bile duct stones are caused by bile duct parasites, infection and obstruction, and are mostly bile pigment stones or mixed stones. Intrahepatic bile duct stones are stones in the bile ducts above the confluence of the hepatic ducts, which are located in the liver parenchyma and are difficult to treat. Intrahepatic bile duct stones are mainly associated with Schistosoma mansoni, bacterial infection of the biliary tract, and hereditary lithogenic bile. Most of the stones are bile pigment stones containing bacteria, which are often distributed in hepatic segments and lobes, and can also involve the left and right hepatic bile ducts, entering a vicious cycle of stone – obstruction – inflammation – accelerated stone formation, which is very difficult to deal with. Intrahepatic bile duct stones are often combined with stenosis of the intrahepatic bile duct, and stones enter the common bile duct and complicate extrahepatic bile duct stones. How are bile duct stones diagnosed? Abdominal pain, chills fever and jaundice are the typical clinical symptoms of acute cholangitis secondary to biliary stones. In severe cases, neurological symptoms and shock may occur, endangering the patient’s life. Most patients have a long medical history and the diagnosis is clear with ultrasound examination. The clinical manifestations of intrahepatic bile duct stones are varied, mainly intermittent right upper abdominal pain that may radiate to the back of the shoulder, history of acute cholangitis with repeated chills and fever, jaundice, significant pressure pain and percussion pain in the liver area, and manifestations of hepatomegaly, splenomegaly and portal hypertension in the late stage. How are bile duct stones treated? Surgical indications for extrahepatic bile duct stones are clear and the management is relatively simple. If the number of stones in the common bile duct is small and the diameter of stones is small, ERCP is suitable for minimally invasive treatment. Most scholars believe that surgery is still the most effective and thorough treatment for intrahepatic bile duct stones. The principles of treatment are to remove the lesion, remove the stone, correct the biliary stricture, release the bile duct stasis, clear the drainage, and prevent recurrence. Removal of obstruction caused by stones or strictures is the key to surgical treatment, and removal of the lesion and removal of stones are the core of surgical treatment. Intraoperative ultrasound localization, intraoperative cholangiography and intraoperative cholangioscopy are required to accurately determine the lesion and the extent of resection, to improve the efficiency of stone extraction and to reduce the residual stone rate. Surgical treatment of intrahepatic bile duct stones Currently, the main surgical treatment methods are: 1. Partial hepatectomy Regular resection of the diseased liver lobe (segment) to maximize the removal of lesions containing stones, stenosis and dilated bile ducts is the most effective treatment for intrahepatic bile duct stones. The extent of hepatic resection depends on the distribution of stones and the extent of destructive lesions, which is determined with the help of ultrasound, ERCP, MRCP and PTC. 2, hepatobiliary ductotomy and lithotomy is the basic and emergency means in the treatment of hepatobiliary stones surgery. This procedure is generally suitable for small number of stones and minor lesions of the involved hepatic ducts and liver, and the intraoperative combination of cholangioscopy solves the problem of blind stone extraction. It is particularly suitable in the management of emergency septic cholangitis. Since intrahepatic bile duct stones are often combined with hepatic bile duct stenosis, the stenosed bile duct is cut open to retrieve the stones, and bile duct jejunostomy after choledochoplasty solves the access of residual stones and recurrent stones. 4.Filled intrahepatic bile duct stones with diffuse irreversible damage to the liver and bile duct system have occurred, causing biliary cirrhosis, when liver function loss is difficult to maintain life, liver transplantation is required. Once intrahepatic bile duct stones are formed, they enter a vicious circle and are not treated well and are prone to recurrent attacks. The ancient medical philosophy of “treating the disease before it occurs” is particularly appropriate in the treatment of intrahepatic bile duct stones, which will gradually shift from passive symptomatic treatment to prevention of intrahepatic bile duct stone formation and recurrence as the focus of future treatment.