Intrahepatic gallstones, also known as hepatic choledocholithiasis, are a common and difficult-to-treat biliary tract disease. Asymptomatic bile duct stones can be left untreated with regular observation and follow-up; those with recurrent clinical symptoms should be treated surgically. Common pathological changes of intrahepatic bile duct stones include obstruction of hepatic bile ducts, which can lead to cirrhosis and portal hypertension; intrahepatic cholangitis, which can lead to recurrent cholangitis, liver abscess, infectious shock, biliary bleeding in case of acute infections; and cancerous transformation of the bile ducts due to long-term stimulation of the bile ducts by the stones and inflammation, which can lead to intrahepatic cholangiocarcinoma. The most common surgical method is choledochotomy and lithotripsy, in which the narrowest part of the bile duct is cut open and the stones are removed as much as possible. If the stone cannot be removed, biliary anastomosis can be considered. If recurrent infections cause localized liver atrophy, fibrosis and loss of function, hepatectomy can be chosen to remove the diseased portion of the liver, including stones and infected foci, which avoids the possibility of recurrence of stones and prevents cancerous transformation of the diseased portion of the liver, and is also a positive method of treating intrahepatic gallstones. It is important to note that if you are diagnosed with intrahepatic gallstones, once the above symptoms appear, you should actively seek medical attention and choose the best treatment after your condition has been clarified by a medical professional, so as to reap the best prognosis.