Objective To investigate the efficacy, feasibility and safety of the one-step ultrasound-guided percutaneous transhepatic cholangiographic drainage (PTCD) in treatment of bile duct obstruction in aged patients (>60 years old). Methods Clinical data of 147 old patients who underwent one-step PTCD with bile duct obstruction in our department from December 2012 to August 2015 were collected and retrospectively analyzed. The operation time, cost, duration of the disease, incidence of complications, preoperative and postoperative levels of serum total bilirubin (STB), were analyzed. The success rate of one-step puncture, and the incidence of complications were compared in different groups of gender, age, duration of the disease, preoperative STB level, preoperative diameter of bile duct and the causes of obstruction. Results There were 127 (86.4%) cases undergoing successful one-step PTCD. No significant difference was seen in the success rate of operation among the patients of different genders and with different causes of obstruction, but obvious differences were observed in patients at different ages and with different duration of disease, preoperative STB level, and preoperative diameter of bile duct (P<0.05). There were 17 patients experiencing postoperative complications, and significant differences were seen among those of different STB level and of benign and malignant obstruction (P<0.05). Conclusion One-step PTCD is a safe and effective treatment for bile duct obstruction in aged patients. Its success rate of puncture is associated with the duration of disease, severity and cause of bile duct obstruction. The incidence of complications is closely related to the preoperative level of STB and causes of obstruction.