For the treatment of congenital choledocholithiasis, in view of its frequent symptomatic episodes and the possibility of serious complications such as biliary perforation and biliary tract cancer during the course of the disease, in principle, surgery should be performed promptly after the diagnosis is clear. When choosing the timing of surgery for a specific patient, the timing of surgery and the necessary preoperative preparations vary greatly due to the different clinical and pathological types, whether it is in the acute attack stage, whether it is combined with poor liver function, whether it is combined with hyperpancreatic amylasemia, etc., which are introduced separately. 1, congenital biliary dilatation of cystic type and the common bile duct is obviously dilated in the shuttle type of children after a clear diagnosis of the child, should be appropriate preoperative preparations, timely surgery. 2. Children with acute attacks in the course of the disease will often have abdominal pain, nausea, vomiting, fever and other acute abdominal symptoms, as well as jaundice and other signs of biliary obstruction. In cystic cases, severe biliary tract infection, high fever, abdominal muscle tension, or even shock may be present, and the cyst may be severely infected, and an external cyst drain may be performed as an emergency. However, most of the cases, including cystic or clostridial type of acute attack is not a serious bacterial infection, but by the pancreatic fluid reflux pancreatic enzyme digestion caused by chemical inflammation, such patients after fasting, antispasmodic, anti-inflammatory and other treatments can be relieved, and is in remission when the cystectomy, pancreatic-biliary shunt radical surgery to be much safer. However, in individual cases, even if the above measures are taken for one week or even more than 10 days, the symptoms of abdominal pain and jaundice still can not be relieved, or even aggravated, surgery can also be performed in emergency. 3, acute attack combined with high pancreatic amylasemia and liver function damage in children Congenital biliary dilatation disease, especially shuttle type cases, in the course of the acute attack of 20% to 40% had manifested high pancreatic amylasemia, blood and urine can be detected in the pancreatic amylase increased significantly. A small number of cases may be combined with true pancreatitis, while most of them are the so-called “pseudo-pancreatitis” caused by the backflow of amylase from bile into blood in capillary bile ducts, in which the pancreatic lesions are relatively mild or even without obvious pathologic changes. At the same time, a considerable number of cases were combined with liver function impairment such as increased transaminases. These patients can improve after the above active preoperative preparation, and the problems of hyperpancreatic amylasemia and hepatic impairment usually disappear quickly after pancreatobiliary bypass and radical surgery. There is no need to delay or change the surgery to immediate emergency surgery because of the increase of hyperpancreatic amylasemia and liver function index. Children with biliary perforation Biliary perforation, which can also be expressed as cholestatic peritonitis, is a very common complication of congenital choledocholithiasis. It can occur in the cystic type when combined with infection and inflammation, but it is more common in the case of clostridial type, and many cases even have biliary peritonitis as the first symptom without prior knowledge of the patient with congenital choledocholithiasis. The child often presents with a sudden deterioration of general condition, marked abdominal distension, weak peripheral blood flow, and shortness of breath. The diagnosis is made by aspiration of bilious peritoneal fluid by laparotomy. Rapid rehydration, correction of water and electrolyte disorders, and other necessary preoperative preparations should be carried out, followed by an emergency caesarean section. Radical cystectomy is often not possible because of the severity of the exudate, edema, and adhesions at the site of inflammation and the critical condition of the child. If the site of perforation can be found, choledochal drainage can be performed from the perforation site location tube; if the specific site of perforation cannot be found, only abdominal drainage can be performed, and radical treatment can be performed in the future. If the perforation has just occurred and the inflammation in the cyst wall is mild and the child is in good general condition, the authors have had several successful cases of one-stage cystectomy and biliary reconstruction with pancreaticobiliary shunt.