Hepatobiliary stones are a common occurrence in China, accounting for 15%-30% of gallstone cases, and have become a major problem in hepatobiliary surgical treatment because of their high incidence, recurrence and reoperation rates. Traditional open biliary exploration, applying bile duct probes to remove stones, has a residual stone rate of more than 30% (4). Modern surgery has significantly decreased the rate of residual biliary stones due to the combined application of choledochoscopy combined with fluid electro-lithotripsy, but once residual stones are removed, the reoperation rate also remains high. Percutaneous T-tube sinusoidal choledochoscopic exploration for stone extraction is a simple and easy method to remove the maximum number of residual stones in the bile duct, which greatly reduces the reoperation rate. The patient’s pain is reduced. Indications All patients with an indwelling T-tube after biliary exploration. Two months after open biliary exploration and three months after laparoscopic biliary exploration. Those without severe coagulation disorders can undergo percutaneous T-tube sinusoidal stone extraction. Tips for stone extraction Before stone extraction, a waterproof membrane should be taped around the T-tube sinus tract, and the waterproof membrane should have a water catch bag. Because the choledochoscope requires a certain amount of water pressure to hold up the sinus tract to be explored, water will also leak out of the T-tube sinus tract, and if the waterproof film is not prepared with a water catching bag, the patient will be very immersed in water and very uncomfortable. After the T-tube is removed, the choledochoscope is placed. The choledochoscope needs to enter along the sinus tract in a homeopathic way, not forcefully and strongly, otherwise it will hurt the mirror body, the choledochoscope is very delicate, and the mirror body is easily broken near the lens; explore the biliary tract, first up and then down, first right and then left; the angle of the lower biliary tract is sometimes too large and not easy to explore, so you must be patient and look for it; when retrieving the stone in the mesh basket, the front end of the mesh basket should exceed the stone, and the front end of the mesh basket should be on the wall of the biliary tract, so that the mesh basket can be opened to the maximum. Pull the basket back and forth, adjust the direction, put the stone into the net, tighten the net blue, and take out the stone; probe the bile duct, if it is all sediment-like stones, you can add pressure to flush the water, most stones can come out with water, if the stone is <1cm and not embedded, you can take it out directly through the basket, if the stone is embedded or the stone is >1cm in diameter, you can use a liquid electric lithotripter to break the stone and then take it out in pieces. If the stone is embedded or the stone is >1cm in diameter, the stone can be removed in pieces by using a lithotripter. Before the stone is broken, the stone should not be removed directly by using the mesh basket, so that the stone can easily be stuck in the sinus tract and the mesh basket cannot be removed or the mesh basket can be damaged. The electrode should be about 5mm away from the lens, otherwise it will hurt the lens, try to avoid hitting the bile duct wall, the process of hitting can cause bleeding in the bile duct wall and affect the field of view; too many stones should not be taken out at once, you can try to break the stones first, and then take them after three to five days; the time for taking stones should not be too long, usually 3000ml of flushing water is the standard. Otherwise, the sinus tract will be obviously edematous, which is not conducive to stone removal and hurts the sinus tract; insert a catheter of the same diameter as the original T-tube at the same depth as the original T-tube at the end of stone removal. Postoperative precautions Postoperative antibiotic treatment is not required, and the patient can leave the hospital after 4 hours of observation. A few patients will have abdominal pain and diarrhea. This is mainly due to the low temperature of saline applied during the operation. It causes spasm of small intestine. Our experience heats saline to about 37°C, so that postoperative pain will be basically avoided. Postoperative diarrhea is mainly due to too much saline and too fast. The amount and speed of water can be reduced as much as possible. The main cause of fever is due to a combination of infection in the biliary tract or too high flushing pressure. In such patients, catheters should be left in place until the fever subsides, and antibiotic therapy should be applied. The incidence of biliary bleeding is low, mainly due to violence during lithotripsy, but also in some patients due to lithotripsy equipment. It is usually self-clotting. In a few patients with large bleeding, norepinephrine 8 mg can be applied after flushing with 100 ml of ice saline and then clamping the T-tube. Observe the patient for routine blood changes. If bleeding is still persistent, DSA can be considered. Indications for open surgery Large number of stones in the liver; patient with recurrent fever, atrophy of the liver lobe, significant stenosis of the intrahepatic bile duct, and inability to remove stones; suspicion of cancer in the bile duct. We adopt open surgery for treatment. Patients with a large number of intrahepatic stones require repeated and multiple stone extraction, which is unbearable for most patients and cannot be exhausted. In combination with lobe atrophy and significant intrahepatic stenosis, lobectomy is required to remove the stones and relieve the patient’s symptoms. Repeated inflammatory stimulation of the intrahepatic bile ducts can cause cancer, and such patients require surgery.