Image-guided therapy, combined with imaging and therapeutic action, forms an attractive system because it can induce outstanding effects at focused locations. However, the conventional liposomes-based system cannot figure in therapeutic or imaging roles themselves, thereby causing the disadvantage of their biological unavailability as a theragnosis tool. Herein, the structure-inherent near-infrared bilayer nanovesicles are fabricated with amphiphilic heptamethine cyanine dye, PEG conjugated heptamethine cyanine dye, and gemcitabine (NEPCG) is developed for the novel photoacoustic image-guided chemo-thermotherapy system. The organic structure-inherent near-infrared bilayer nanovesicles are self-assembled and exhibit a liposome-like bilayer structure. Furthermore, NEPCG showed the high photoacoustic signal (PA) due to the specific accumulation in the tumor site. Delivered NEPCG than displayed concurrent chemotherapy and photothermal therapy (PTT) effects against cancer, triggered by PA imaging with minimal side effects. In vitro and in vivo experiments show that NEPCG can be used as outstanding contrast agents and completely obliterate the tumor without reoccurrence under laser irradiation. Therefore, this work presents the potential for the realization of unprecedented structure-inherent near-infrared bilayer nanovesicles as highly accurate and effective theragnostic tools in clinical fields.