The invention belongs to the technical field of plunger sleeve processing, and provides a plunger sleeve drilling and reaming positioning device and a plunger sleeve drilling and reaming processing method. the plunger sleeve drilling and reaming positioning device comprises a bottom plate, wherein a sliding positioning plate with a correction hole formed therein is slidably mounted on the bottom plate, first positioning holes are formed in the bottom plate, and second positioning holes are formed in the sliding positioning plate; one end of the sliding positioning plate is fixedly provided with a fixed supporting plate, the fixed supporting plate is rotatably provided with a first tip in which an index hole is formed, the first tip is sleeved with a positioning sleeve in which an index positioning hole is formed, the positioning sleeve is fixedly arranged on the fixed supporting plate, the other end of the sliding positioning plate is slidably provided with a sliding supporting plate adjusted by means of an adjusting mechanism, and a second tip is rotatably mounted on the sliding supporting plate; and the positioning device further comprises a positioning cross beam with a positionadjusting hole formed therein. The plunger sleeve drilling and reaming processing method is implemented by means of the plunger sleeve drilling and reaming positioning device. The plunger sleeve drilling and reaming positioning device is simple and convenient in processing operations, greatly improves the processing quality and the processing efficiency, effectively reduces or avoids the occurrence of waste workpieces, and significantly improves the product qualification rate.