Objective: To evaluate the efficacy of percutaneous transhepatic cholangial drainage (PTCD) plus biliary metal stent placement in palliative treatment of malignant biliary obstruction. Methods: The clinical data of 94 patients with malignant biliary obstruction admitted between January 2011 and June 2013, who underwent PTCD alone or in combination with biliary metal stent placement after failure of endoscopic retrograde cholangiopancreatography (ERCP) with stent placement, were retrospectively analyzed. Of the patients, 45 cases underwent PTCD treatment alone (PTCD group), and 49 cases underwent PTCD plus biliary metal stent placement (PTCD plus stent group). The degree of jaundice reduction, incidence of postoperative complications and survival between the two groups were compared. Results: The serum bilirubin levels at 5 d after operation showed no significant difference between the two groups (P>0.05), but were significantly lower at 7 and 14 d after operation in PTCD plus stent group than those in PTCD group (P<0.05); There was no significant difference in incidence of postoperative complications between the two groups (P>0.05); the 1-year postoperative survival in PTCD plus stent group was better than that in PTCD group (χ2=6.280, P=0.012). Conclusion: PTCD plus metal biliary stent placement is an effective palliative treatment for malignant biliary obstruction in patients with ERCP failure, moreover, it is superior to PTCD alone treatment.