Hepatobiliary stone disease refers 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 bile duct anatomical variations. Most hepatobiliary duct stones are bile pigment stones. Cholesterol stones originating from the intrahepatic bile ducts may also be seen clinically. The etiology of hepatobiliary stone disease is not fully understood. The formation of liver stones is associated with chronic inflammation of the biliary tract, bacterial infection, biliary ascariasis, biliary stasis, and malnutrition. Chronic inflammation in the bile ducts is an important factor in stone formation, and bile stasis is a necessary condition for stone formation. Stagnant bile flow and chronic inflammation of the biliary tract are most likely to form intrahepatic bile duct stones. The basic pathological changes of hepatobiliary stone disease are biliary obstruction, biliary tract infection and destruction of the liver parenchyma. The hepatic bile ducts in the affected area are dilated, with circumferential or segmental narrowing of the bile ducts; thickening of the duct walls, hyperplasia of the bile duct walls and surrounding fibrous tissues, and chronic inflammatory cell infiltration; massive inflammatory cell infiltration and fibroblast proliferation in the confluent area, accompanied by damage to the liver parenchyma and, in severe cases, fibrotic atrophy and loss of function of liver segments or lobes. The combination of biliary tract infection can cause a series of serious complications such as biliary sepsis, liver abscess, subphrenic abscess, biliary bronchial fistula and biliary hemorrhage. About 2.0% to 9.0% of cases of hepatobiliary stones can be complicated by hepatobiliary cancer in the later stages of the disease. The clinical manifestations of hepatobiliary duct stone disease: The course of hepatobiliary duct stone disease is long and complex, and many serious complications can occur, so its clinical manifestations are complex and varied. The basic clinical manifestations of hepatic bile duct stone disease can be divided into 3 main types: Quiet type: patients have no obvious symptoms or mild symptoms, only vague epigastric pain and discomfort, and are often detected during physical examination. Obstructive type: manifests as intermittent jaundice, persistent pain and discomfort in the liver and chest and abdomen, decreased digestive function and other biliary obstruction symptoms. Bilateral hepatic bile duct stones with hepatic bile duct stenosis may present with persistent jaundice. Cholangitis type: It presents with recurrent episodes of acute purulent cholangitis. In acute attacks, epigastric paroxysmal colic or persistent distension, chills, fever, jaundice, right upper abdominal pressure pain, percussion pain in the liver area, hepatomegaly with tenderness, etc. In severe cases, sepsis may be present: peripheral blood leukocytes and neutrophils are significantly elevated, serum transaminases are sharply elevated, serum bilirubin, alkaline phosphatase and glutamyl transpeptidase are elevated. When acute hepatic cholangitis is combined with obstruction of one hepatic duct stone, jaundice may be absent or mild, serum bilirubin may be at normal level or mildly elevated, and the interictal period may be asymptomatic or obstructive. When various serious complications occur, liver abscess, biliary hemorrhage, biliary cirrhosis, portal hypertension and hepatobiliary duct cancer may appear. The diagnosis of hepatic bile duct stones relies on imaging examinations, such as ultrasound Doppler, CT or MRI, ERCP, PTC, etc., which can clarify the diagnosis. Treatment principles of hepatobiliary duct stone disease: Hepatobiliary duct stones with obvious clinical symptoms need to be treated. There is no unanimous opinion on whether treatment is needed for quiescent stones with insignificant symptoms. In view of the fact that with the progression of the disease and the development of the lesion, most cases will develop significant symptoms and the possibility of malignant transformation of the involved hepatic ducts, active surgical treatment or percutaneous transhepatic choledochoscopic stone extraction is also advocated for the treatment of static stones. The treatment of hepatic bile duct stones mainly relies on surgery, and the principles are to remove the lesion, remove the stone, correct the stricture, unblock the drainage, and prevent recurrence. There are various surgical and non-surgical treatment methods for the complex intra- and extra-hepatic biliary tract and liver lesions of hepatic bile duct stone disease.