Objective To explore the relevant factors affecting the occurrence of biliary complications in patients after removing residual stones from intrahepatic and extrahepatic bile ducts through T­tube fistula，and to construct a predictive model. Method A retrospective analysis was conducted on 194 patients who underwent intrahepatic and extrahepatic bile duct stone removal through T ­tube fistula in our hospital from January 2018 to July 2020. Based on the incidence of postoperative biliary complications such as biliary bleeding， abdominal pain， and vomiting， the patients were divided into a non­complication group （n = 132） and a complication group （n = 62）. Relevant data of the patients were collected， and independent influencing factors for the occurrence of related complications were analyzed using univariate and multivariate logistic regression analysis. Another 92 patients who underwent intrahepatic and extrahepatic bile duct stone removal through T­tube fistula in our hospital from August 2020 to August 2022 were selected as external validation. The predictive value of the risk prediction model was evaluated by the receiver operating characteristic curve （ROC）， and the Goodness of fit of the model was judged by the Hosmer Lemeshow test. Results Among the 194 patients who underwent intrahepatic and extrahepatic bile duct stone removal through T­tube fistula，132 did not experience complications， while 62 experienced complications， including 57 cases of abdominal pain， vomiting， biliary tract infection， and 5 cases of biliary bleeding. The results of univariate analysis showed significant differences between the two groups of patients in preoperative albumin， surgical time， bile properties， intraoperative bleeding volume， and bile multidrug­resistant bacterial infection （P<0.05）； No significant difference was noted in age，sex，BMI，course of disease，preoperative total bilirubin， preoperative white blood cells， hypertension， diabetes， hepatitis B，surgeon experience and bile duct diameter in the two groups （P > 0.05）. The results of multivariate analysis showed that preoperative albumin， surgical time， bile properties， intraoperative bleeding， and infection with multidrug­resistant bile bacteria were all independent influencing factors for postoperative complications in patients（P<0.05）；Risk prediction model：Logit （P）=8.564­0.438 ×（Preoperative albumin）+0.092 ×（Surgical time）+2.038 ×（Bile traits）+1.253 ×（intraoperative bleeding volume）1.179 ×（Multi drug resistant bacterial infection），the area under the ROC curve （AUC） of the risk warning model was 0.890（95% CI： 0.875 ~ 0.951），the sensitivity was 89.8%，and the specificity was78.2%. The Hosmer Lime show fitting test showed that，χ² = 10.109，P = 0.57，the model had good fitting validity and high predictive value. The sensitivity of external validation of the model was 85.2%， specificity was 84.6%， and overall accuracy was 84.8%. Conclusion Preoperative albumin， surgical time， bile properties， intraoperative bleeding， and infection with multidrug­resistant bile bacteria were independent influencing factors for postoperative complications in patients. Therefore，constructing a risk prediction model based on these factors has certain predictive power.