In obstructive jaundice, obstruction of the biliary tract in the hepatic portal is a condition that seriously affects the quality of life of the patient and is a difficult area to treat. So in this way, all lies in the particular situation of its obstruction site. The biliary tract is morphologically like a large tree from its formation in the liver to its confluence into the common bile duct and its drainage to the duodenum. The direction of bile flow is from the intrahepatic bile duct (“branch”) to the common bile duct (“trunk”) and then to the duodenum. Bile duct obstruction in the porta hepatis corresponds to the obstruction of a large number of “branches” converging into a “trunk”. Often, a single lesion causes bilateral or even complex obstruction of multiple bile ducts. This poses a great difficulty for drainage surgery; achieving simultaneous drainage of multiple obstructed bile ducts is a therapeutic challenge. Outside of open surgery, the only common minimally invasive surgical treatment options are PTCD or ERCP, in this case, how to choose? The reason why this topic is brought up is that recently several consecutive patients with hepatoportal biliary obstruction had no relief or even worsened obstruction after ERCP placement of several endobronchial ducts (called stents by some doctors) and were switched to PTCD treatment. Because of the adverse effect on PTCD, the original endotracheal tube was removed within a short period of time after another duodenoscopy. The circumstantial treatment process wastes both the treatment time and even misses the best time for treatment, causing cholangitis, and is also economically wasteful. Why is drainage sometimes so poor after ERCP treatment of biliary obstruction in the hepatic portal? And even sometimes aggravate the disease? It is mainly because of the specific site of obstruction. Sometimes it is difficult to ensure the proper position (through the obstruction site to the dilated bile ducts in the liver), and the position is not deep enough to achieve unobstructed drainage. If multiple internal ducts are concentrated in the common hepatic duct and common bile duct, they cannot achieve bile drainage in the intrahepatic bile duct, and then they become foreign bodies in the common bile duct, causing more serious obstruction in the bile duct, and in some patients, the condition is aggravated after treatment. Compared with ERCP, which is a difficult reverse operation from the “trunk” to the “branch” direction, the operation direction of PTCD is from the “branch” to the “trunk” direction. “In terms of imaging, with the help of contrast agent, the local image clarity far exceeds the fluoroscopic effect of ERCP, and the clear image is the fundamental guarantee of accurate stent or drainage tube placement. Through the PTCD route, no matter the drainage tube or stent is placed, its inner diameter is far more than the internal culvert tube, and the patency rate of drainage is guaranteed. In addition, the drainage tubes are of various calibers and can be replaced with new ones in just ten minutes after they become old. The PTCD route allows for easy bilateral or multiple bile duct drainage. For some specific benign lesions (such as bile-intestinal anastomotic strictures), via the PTCD route, treatments such as balloon dilation can also be performed, with the possibility of completely curing the local strictures.? In summary, if obstructive jaundice is caused by bile duct obstruction in the hilar region, regardless of the cause, a reasonable choice should be made between the PTCD route or ERCP route when choosing a biliary drainage method, in order to control the disease as soon as possible, avoid taking a detour in the treatment, absolutely avoid the embarrassment of unnecessary “placement and short-term removal”, and avoid unnecessary financial The patient should be carefully selected among the PTCD or ERCP routes in order to control the disease as soon as possible, to avoid the treatment detour, to avoid the embarrassment of unnecessary “placement and short-term removal”, and to avoid unnecessary financial expenses.