The present disclosure relates to a high-precision multilayer PCB and a 3D printing preparation method thereof. The method includes: S1, forming a 3D circuit layer on an upper surface of a substrate; S2, forming a
metal pillar at a preset position of the current 3D circuit layer by stacking; S3, forming an insulating layer on an upper surface of the current 3D circuit layer, and leading the corresponding
metal pillar out of the formed insulating layer in advance by drilling a hole in the insulating layer and filling the drilled hole with the nanoscale
metal slurry; S4, forming a pad layer on an upper surface of the current insulating layer and executing step S5 if the current insulating layer is a top layer; repeatedly executing steps S1 and S2 by using the current insulating layer as a new substrate and executing step S6 if not; S5, connecting the corresponding metal pillar or leading it out in advance and connecting to the pad layer, to complete the preparation of the multilayer PCB; and S6, connecting the corresponding metal pillar or leading it out in advance and connecting to the current 3D circuit layer, and returning to step S3. According to the present disclosure, the high-precision multilayer PCB with high interconnect precision can be prepared.