To study the diagnosis and treatment of primary liver cancer(PLC) with bile duct cancer thrombus (BDT). Methods:The clinical data of 21 patients with PLC and BDT admitted in the past 8 years were analyzed retrospectively . Results:The major clinical manifestations were the symptoms of primary liver cancer and obstructive jaundice. The correct diagnosis rate was 76.2% before operation. The diagnosis rate of Bus, CT, MRI, ERCP and PTC was 14.3%, 9.52%, 14.3%, 71.4% and 100% respectively. The operative procedures included hepatectomy with removal of BDT (n=10), hepatectomy combined with extrahepatic bile duct resection (n=5), thrombectomy through choledochotomy with TACE (n=3), removal of BDT with HAI (n=3). The 3,5year survival rate were 43.20% and 24.60% respectively. Conclusions:Multiexaminations should be applied in the diagnosis of PLC with BDT. The comprehensive therapy including surgery and other therapies must be adoptted for PLC with BDT.