Primary intrahepatic bile duct stones refer to stones that originate in the intrahepatic bile duct system, excluding stones that drain from the gallbladder and migrate up to the intrahepatic bile duct, and excluding stones that form secondary to biliary stasis and biliary inflammation caused by other biliary diseases such as injury bile duct stricture, bile duct cysts, and biliary anatomical variations. Diagnosis of intrahepatic bile duct stones usually relies on abdominal ultrasound or CT. Symptoms of intrahepatic bile duct stones are not obvious or atypical, mostly with right upper abdominal discomfort, or mild pain and stuffiness, and most people are found during abdominal ultrasound. A few patients with severe intrahepatic bile duct stones may show symptoms of cholangitis, i.e. chills, fever, jaundice or even shock, liver abscess, and may even develop into cirrhosis. Intrahepatic bile duct stones are mainly divided into two types: bile pigment stones and cholesterol stones, the majority of which are bile pigment stones. Most of the bile pigment stones are secondary to bile duct strictures and bacterial infections. The proportion of cholesterol stones is relatively small, accounting for only 5.8% to 13.1% of all intrahepatic bile duct stones, but there has been an increasing trend of cholesterol stones in recent years. Congenital or acquired metabolic abnormalities are involved in the development of cholesterol stones. Because of the acute angle of the confluence of the left hepatic duct with the common bile duct, the left liver is more likely to form and retain stones when biliary stenosis is present here. Asymptomatic intrahepatic bile duct stones may be found incidentally during an abdominal examination. When epigastric or right upper abdominal pain, jaundice and fever are present, it suggests that the patient has developed acute cholangitis. In severe cases, patients may develop purulent cholangitis or liver abscess or even biliary sepsis. Very few patients can develop thrombocytopenia and enhanced platelet function, leading to abnormalities in coagulation and fibrinolysis. Long-standing bile duct stones and biliary strictures can lead to distal bile duct dilatation and atrophy of the liver parenchyma. In some patients, intrahepatic bile duct stones can fall into the common bile duct causing obstructive jaundice, acute cholangitis or biliary pancreatitis. The incidence of bile duct cell carcinoma in patients with intrahepatic bile duct stones is 2.4%-10.0%, and the proportion of patients with bile duct cell carcinoma combined with intrahepatic bile duct stones is as high as 17.0%-27.0%. The treatment of intrahepatic bile duct stones needs to be individualized, and those with no symptoms and little harm generally do not need treatment. 1.Stones located in the terminal bile duct without clinical symptoms and without bile duct dilatation distal to the stone do not require treatment, and regular observation is sufficient. 2, simple choledochotomy for stone extraction T-tube drainage: intrahepatic bile duct stones have a high interpretation residual rate, and it is best to treat them in units with cholangioscopy, which can greatly reduce the interpretation residual rate after surgery, and also understand the presence of intrahepatic bile duct stenosis and take appropriate surgical approach, which can be removed through T-tube channel without further opening after surgery. 3, combined liver lobectomy, Japanese scholars believe that 90% of patients with symptomatic intrahepatic bile duct stones have combined liver atrophy, while the incidence of asymptomatic liver atrophy is only about 15%, especially in the left outer lobe of the liver, and the lower right posterior lobe. Many units only perform choledochotomy to retrieve stones without judging partial resection of the liver, resulting in reoperation causing greater trauma and medical costs to the patient, and even causing cancer. 4.The bile duct in the hilar part is enlarged to form bile duct jejunostomy, for intrahepatic bile duct stones must be judged whether there is bile duct stenosis, stenosis is not lifted, stone recurrence is inevitable, even the stones cannot be removed and symptoms cannot be relieved. 5. For patients with intrahepatic stones and hepatic insufficiency, mostly seen in those with dilated intrahepatic bile ducts and gallstones, liver transplantation is required. In conclusion, intrahepatic bile duct stones are complex and intractable benign diseases and should be treated by one or a combination of surgical procedures depending on the location and extent of the patient’s lesions. The exact removal of biliary obstruction and restoration of bile flow is the key to successful treatment. For patients with relatively limited lesions, regular hepatectomy is the most ideal treatment modality. Intraoperative and postoperative choledochoscopic exploration and stone extraction help to improve the stone retrieval rate. For patients with postoperative residual stones causing recurrent cholangitis, liver abscess, liver atrophy, or suspected cancer, reoperative treatment should be aggressively performed based on accurate evaluation.