Objective: To evaluate the clinical safety and efficacy of Ti-Ni alloy stent placement through colonoscopy combined with X-ray assistance for advanced colorectal cancer with acute bowel obstruction. Methods: Thirty-five patients with advanced colorectal cancer and acute bowel obstruction underwent palliative treatment by permanent stent placement (stent group), and 35 patients with the same conditions who were subjected to traditional colostomy served as control group. The success rate of operation and clinical effects of the two groups of patients were compared. Results: In stent group, success rate of stent placement was 100%, incidence of postoperative complications was 8.57% (postoperative intestinal perforation in one case and stent obstruction in two cases), patients began ambulation immediately after operation, without creating an artificial anus, and the survival rate was 94.2 % during 1-year followed-up. In control group, the surgical success rate was 100%, incidence of postoperative complications was 31.42% (postoperative pulmonary infection in 5 cases, wound infection in 5 cases, and abdominal infection in 1 case), and the survival rate was 97.1% during 1-year followed-up. The intestinal obstruction was completely resolved in patients of either group after operation, but in stent group compared with control group, the intestinal obstruction was quickly relieved, quality of life was improved, expense was reduced and incidence of complications was decreased and all differences had statistical significance (all P<0.05). Conclusion: Ti-Ni alloy stent placement by colonoscopy combined with X-ray assistance is a safe and effective palliative treatment for advanced colorectal cancer with acute bowel obstruction, with the advantages for patients having less suffering and better quality of life, and it also confers to patients a similar survival time as surgical treatment.