The karst landforms in northeastern Sichuan Basin are widely developed, but the understanding of the geological characteristics, controlling factors, and spatiotemporal evolution process of karst caves is still unclear. The research object of this study is the Panlongdong karst cave in the northeastern Sichuan Basin. An outcrop geological survey was carried out, 14C isotope dating of stalactite was performed, carbon and oxygen isotope analysis was completed, and the formation process was identified. The interior of this cave is covered with karst sediments, and its original rocks are the Permian Wujiaping and Changxing formations, with secondary dissolution that has developed. The rock types, geological structure (fault, joint), and climate are the main factors behind the formation of the Panlongdong karst cave. The sedimentation of biogenic reefs and carbonate rocks is a fundamental geological condition for the development of karst processes. The geological structures provide channels for the dissolution of atmospheric precipitation. From 43.5 ka.B.P., six continuous changes in climate have intensified the formation of karst landforms. Warm, humid, and cold dry climate conditions have repeatedly occurred, and carbonate rocks have experienced varying degrees of karstification under the influence of climate. Through the four stages of structural breakup and surface dissolution, secondary cranny dissolution, selective dissolution, and detachment of rock mass and karst sediment formation, the Panlongdong karst cave was ultimately formed. The formation process of the Panlongdong karst cave is of great significance for understanding the evolution of the paleoenvironment in the northeastern Sichuan Basin.