Objective：To explore the diagnosis, surgical treatment and outcome of hepatocellular carcinoma(HCC) with tumor thrombus in bile duct (BDT).
Methods：The clinical data of  16 patients with hepatocellular carcinoma and tumor thrombus in bile duct treated in Henan Tumor Hospital from June 2006 to December 2008 were retrospectively analyzed.
Results：All 16 patients received surgical treatment. The operative procedures included left hemihepatectomy combined with tumor thrombectomy through choledochotomy (n=2), right hemihepatectomy with tumor thrombectomy through choledochotomy (n=3), segmental hepatectomy with  tumor thrombectomy through choledochotomy (n=4), left hemihepatectomy combined with hepatic hilar duct    resection and bilioenteric anastomosis (n=1), left lateral and right anterior segment ectomy combined with tumor thrombectomy through choledochotomy and potal vein  tumor thrombectomy (n=1), extended left hemihepatectomy with removal of tumor thrombus in left bile duct (n=1), right hemihepatectomy with removal of tumor thrombus in right bile duct (n=1), and Ⅴ, Ⅵ  segmentectomy with removal of left bile duct  tumor thrombus (n=1),  and tumor thrombectomy through choledochotomy (n=2).  In 1 patient,  bile leakage occurred and it healed after continuous drainage for 34 days. There were no other serious complications and no perioperative death. All patients were followed up; the average survival time was 23.6（4-63）months. Six patients have survived well now and 1 patient survived for over 5 years.
Conclusions：Patients with hepatocellular carcinoma and tumor thrombus of bile duct can obtain a good outcome after definitive diagnosis and aggressive surgical treatment.