The invention discloses a nuclear power plant main pipeline hoisting adjustment tool, which comprises a support frame, a vertical adjustment mechanism, a horizontal adjustment mechanism and a hoisting guide mechanism. The vertical adjustment mechanism and the hoisting guide mechanism are respectively arranged on the support frame. The horizontal adjustment mechanism is mounted on the vertical adjustment mechanism. The hoisting guide mechanism lays a main pipeline on the horizontal adjustment mechanism. The vertical adjustment mechanism and the horizontal adjustment mechanism respectively adjust the vertical height and the horizontal position of the main pipeline till the main pipeline is adjusted to an accurate fit-up position. Compared with the prior art, the nuclear power plant main pipeline hoisting adjustment tool provided in the invention can adjust the main pipeline in the height direction and the horizontal direction simultaneously without a guide chain, thus effectively reducing the main pipe collision and other quality and safety risks in a main pipeline installation process, and simultaneously reducing the working time and intensity of workers.