Objective: To explore the therapeutic efficacy of percutaneous transhepatic one-stage lithotomy with a rigid choledochoscope in treatment of intrahepatic stones. Methods: Sixty-five patients with hepatolithiasis underwent direct puncture of hepatic duct under B-ultrasound guidance to establish a percutaneous tract, and then lithotomy with a rigid choledochoscope for extraction of the intrahepatic stones was performed after the tract diameter was expanded to 16 to 18 F. Results: Sixty patients were rendered stone free in one session of tract dilation; the procedure was abandoned in 2 cases because the angle between the right hepatic duct and the common bile duct was less than 90°; three cases underwent interventional embolization for post-procedure hemobilia; biliary stricture was seen in 39 cases, which was treated simultaneously according to the patients’ conditions. All patients were followed-up for 26 months, and recurrence rate of intrahepatic stones was 7.7% (5/65). Conclusion: Percutaneous transhepatic one-stage lithotomy with a rigid choledochoscope in treatment of hepatolithiasis is safe and effective, and it may reduce the stone recurrence because of synchronous stone removal and treatment of biliary stricture, so it is a preferable procedure that can avoid the use of the traditional method of operative treatment.