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探讨经胆道镜Nd：YAG激光碎肝胆管术后残余结石的有效性与安全性。对22例肝胆管术后残余结石，常规内镜取石失败的患者实施经胆道镜导入Nd：YAG激光碎石治疗。通过T管窦道经胆道镜插入0.3mm光纤对准结石中心，生理盐水快速灌注冲洗胆道，Nd：YAG激光28～30W，以40J/s脉冲式重复照射。反复脉冲式发射直至击碎，用取石钳或网篮取出碎石。22例患者其中左肝内胆管11例，右肝内胆管8例，胆总管3例。结石2.0×2.0～1.0×1.0cm。碎石1次取净治愈者16例，2次取净治愈4例，2例为早先使用直径0.6mm光纤缺乏柔软性，无法到达残余结石所在部位而失败。经胆道镜Nd：YAG激光碎石治疗肝胆管术后残余结石安全有效。,Discussion of the effectiveness and safety of smashing postoperational residual hepatic calculi with Nd:YAG laser through bile duct endoscope. Methods: Twenty cases with postoperational residual hepatic calculi were treated with Nd:YAG laser through bile duct endoscope, which had failed in normal endoscope extraction of gallstones. Through bile duct endoscope by way of T sinus,a 0. 3mm optical fibre was focused on the center of gallstones.Repeated pulses of Nd:YAG laser with 28～30W at 40J/S radiated on the gallstones while normal saline irrigated the bile duct quickly. Repeated pulses continued until the gallstones were smashed, which were extracted by forceps or string bag. Results :The 22 cases included 11 with gallstones in the intal bile duct of the left liver lobe,8 in the intal bile duct of the right liver lobe and 3 in the common bile duct. The dimensions of the residual stones ranged from 2.0cm by 2. 0em to 1. 0em by 1. 0cm. There’re 16 cases cured without residual stones after one laser treatment and 4 cases cured without residual stones after two laser treatment while 2 cases were treated with failure due to the lack of flexibility of the 0. 6mm optical fiber,which could not reach the point where the residual stones had remained. Conclusions: The treatment has been proved effective and safe of postoperational residual hepatic calculi with Nd: YAG laser through bile duct endoscope