Objective: To evaluate the efficacy of gallbladder-preserving treatment via B-ultrasound-guided gallbladder puncture and dual-channel tube placement plus choledochoscopic lithotomy in treatment of acute calculous cholecystitis in high-risk elderly patients. Methods: The clinical data of 35 patients over 80 years of age with acute calculous cholecystitis admitted from January 2012 to December 2013 were retrospectively analyzed. Results: All the 35 patients underwent B-ultrasound-guided gallbladder puncture and dual-channel tube placement for lavage and decompression of the gallbladder and continued drainage, followed by choledochoscopic lithotomy via sinus tract with gallbladder preservation 6 to 8 weeks later. Ultrasound-guided gallbladder puncture and tube placement were successfully performed in all patients in one session, and bleeding occurred in one case after gallbladder puncture, which was controlled by hemostasis treatment. One case was converted to cholecystectomy due to incomplete sinus tract formation of the tube, and gallbladder-preserving cholecystolithotomy was successfully conducted in all the remaining 34 cases (34/35). Follow-up ranged for 4 to 24 months and stone recurrence was observed in one case (1/34). Conclusion: Dual-channel tube placement plus choledochoscopic gallbladder-preserving cholecystolithotomy for high-risk elderly patients with acute calculous cholecystitis is a simple treatment method with reliable efficacy, so its use is recommended.