Objective: To assess the clinical efficacy of percutaneous transhepatic cholangiodrainage (PTCD) under ultrasonic and X-ray guidance in management of malignant obstructive jaundice. Methods: The data of 46 patients with malignant obstructive jaundice undergoing PTCD under combined ultrasonic and X-ray guidance were retrospectively analyzed. Results: PTCD was successfully performed in 44 patients (95.65%), of whom, puncture and catheter introduction was completed in one session in 41 cases (93.2%), and in two sessions in 3 cases (6.81%). The daily postoperative drainage volume was 100-800 mL, and from the first day after PTCD, the jaundice of the patients began to show regression in varying degrees and their symptoms were gradually alleviated. At one week after PTCD, the serum levels of total bilirubin, direct bilirubin, alanine transaminase, aspartate transaminase and alkaline phosphatase of the patients were all decreased significantly compared with their preoperative values (all P<0.05). Biliary tract infection occurred in 2 cases and slight bleeding of the biliary tract occurred in 3 cases after PTCD, which were resolved by symptomatic treatments, and no other serious complications occurred. Conclusion: PTCD under combined ultrasonic and X-ray guidance has the advantages of being safe and convenient with few complications, and is an effective treatment method for malignant obstructive jaundice.