目的：探讨通过ＰＴＣＤ内外引流对恶性阻塞性黄疸的治疗价值以及操作方法的改进。材料和方法：１８例恶性阻塞性黄疸，其中肝门部胆管癌１１例，肝门部肝癌４例，胰头癌２例，肝门部胆管癌合并胰头癌１例。治疗前血清总胆红素值８５．０～７８７．８μｍｏｌ／ｌ。采用Ｂ超引导下经皮经肝穿刺肝内胆管，透视下留置引流管，治疗后随访３～２２个月。结果：血清总胆红素值１１３～４３７９μｍｏｌ／Ｌ，平均下降１９８７μｍｏｌ／Ｌ，无严重并发症出现。结论：超声与透视相结合是ＰＴＣＤ成功的关键。超声引导下左侧肝内胆管穿刺的难易度和安全性优于右侧，尤其在有腹水的病例。ＰＴＣＤ是治疗恶性阻塞性黄疸的安全有效的方法 Objective: To explore the treatment of malignant obstructive jaundice by PTCD internal and external drainage and the improvement of operation method. MATERIALS AND METHODS: Eighteen patients with malignant obstructive jaundice, including 11 cases of hilar cholangiocarcinoma, 4 cases of hilar hepatocellular carcinoma, 2 cases of pancreatic head carcinoma and 1 case of hilar cholangiocarcinoma with pancreatic head cancer. Serum total bilirubin before treatment was 85.0 ~ 787.8μmol / l. Percutaneous transhepatic transhepatic bile duct under the guidance of B-ultrasound and indwelling drainage tube under fluoroscopy were followed up for 3 to 22 months. Results: Serum total bilirubin values ​​ranged from 113 to 4379μmol / L, with an average decrease of 1987μmol / L. No serious complications occurred. Conclusion: The combination of ultrasound and fluoroscopy is the key to PTCD success. Ultrasound-guided left intrahepatic bile duct puncture easier and more secure than the right, especially in cases of ascites. PTCD is a safe and effective method for the treatment of malignant obstructive jaundice