Objective To explore the therapeutic strategy and clinical value of intraoperative chole-dochoscopy and electrohydraulic lithotripsy for refractory intrahepatic bile duct stones.Methods Liver pa-renchyma,intrahepatic bile duct and bile duct stones were explored under direct vision and intraoperative choledochoscope in 1 1 cases of refractory intrahepatic bile duct stones.Electrohydraulic lithotripsy and lithot-omy were performed to remove the stones and protect the liver parenchyma.If the stones could not be re-moved once,a secondary lithotripsy and lithotomy was performed through the fistula tract.Results All re-fractory calculi were crushed after one or two procedures and the clearance rate were 100%.No complica-tions occurred.Ten patients were followed up from 1 to 3 years except one.Three cases revealed recurrent stone during follow-up due to withdrawal of ursodeoxycholic acid capsules in 1 to 2 years.Seven others showed no stone recurrence within follow-up time.Conclusion Intraoperative choledochoscopy and electro-hydraulic lithotripsy is an easy technique and can effectively protect the liver parenchyma.The life quality of patients can be improved with low surgical risk and postoperative complications.