〔Abstract〕 Objective To explore the efficacy and safety of microwave ablation (MWA) combined with transhepatic artery intubation chemoembolization (TACE) in the treatment of patients with primary hepatic cancer (PHC) and portal vein tumor thrombus (PVTT). Methods 50 patients with PHC combined with PVTT who were admitted to Putian First Hospital from February 2016 to February 2021 were selected as the research objects. The random number table method was used to divide them into an observation group and a control group, with 25 cases in each group. The control group was treated with TACE, and the observation group was treated with MWA combined with TACE. The clinical efficacy, survival, adverse reactions and complication rates of patients the two groups of were compared. Results The objective remission rate of patients in the observation group was significantly higher than that in the control group, and the difference was statistically significant (P < 0.05). The patients of two groups all developed fever, vomiting, liver pain and other adverse reactions within 3 days after treatment. Patients in the observation group developed puncture site hematoma and gastrointestinal hemorrhage after treatment, while patients in the control group developed gastrointestinal hemorrhage and tumor after treatment. There was no hepatic abscess or oncolytic syndrome in the two groups with rupture and bleeding symptoms. There was no statistically significant difference in the incidence of adverse reactions and complications between the two groups (P > 0.05). Conclusion The treatment of MWA combined with TACE for PHC patients with PVTT can effectively improve the clinical efficacy and has sufficient medical safety during the treatment period.