Objective:To study the most appropriate approach to treat Acute cholangitis of severe type (ACST) by endoscopy,laparoscopy and integrated endoscopy and laparoscopy. Methods:Two hundreds and twenty-four patients with ACST were received miniinvasive surgical treatment in Tianjin Nankai Hospital from March 2000 to March 2006.The endoscopic nasobiliary drainage (ENBD) was firstly performed. The cases were selected to perform remove pathogeny of ACST by means of endoscopy,laparoscopy or combined them，according to respectively patient's individualized conditions after acutecare phase. Results:Among 224 ACST patients,urgent ENBD was successfully performed in 219 (97.8%).Among 183 cholelithiasises，selectived endoscopy treated 122 cases，and the success rate was 95.1%.Laparoscopic common bile duct exploration（LCBDE）treated 41 cases，and the success rate was 97.6%.Twentythree cases received the scheme of selectived endoscopic retrograde biliary drainage（ERBD），and the success rate was 100%.Four cases with common bile duct stones didn’t complete treatment of urgent ENBD,who received emergent laparoscopic common bile duct exploration and Ttube drainage，and the success rate was 100%.Among 41 biliary strictures，36 of them accepted endoscopic biliary dilatation and 5 of them accepted open radical operation. Conclusion:For patients with ACST,combined endoscopy and laparoscopy treat is safe and effective.