Objective To investigate the incidence and risk factors of secondary abscess (SA) after ultrasound-guided percutaneous transhepatic gallbladder drainage (PTGD). Methods The clinical data of 410 patients underwent ultrasound-guided PTGD were analyzed retrospectively from January 2010 to December 2017 in Wuxi People"s Hospital Affiliated to Nanjing Medical University. Univariate and multivariate logistic regression analysis were used to evaluate the related risk factors. Results SA was found in 12 patients (2.93%, 12/410) underwent PTGD, and the success rate of second drainage due to SA was 100%. After the confounding factors such as benign disease obstruction, underlying disease, gallbladder size, ascites, coagulation, platelet, HbA1c, short-term drainage tube off/ pulled out were corrected, logistic regression analysis showed that short-term drainage tube off/ pulled out (OR=6.64, 95%Cl: 3.34～13.81, P =0.03) and HbA1C＞9.0% (OR=3.38, 95%Cl: 1.22～7.95, P=0.04) were the independent risk factors for postoperative SA. Conclusions SA is a rare complication of ultrasound-guided PTGD, and second drainage is an effective and safe method for the treatment of SA. The occurrence of SA after PTGD could be clinically reduced by strengthening the protection of drainage tube and applying hypoglycemic drugs.