Objective: To systematically evaluate the efficacy of ultrasound-guided percutaneous microwave ablation and thyroidectomy in the treatment of papillary thyroid microcarcinoma. Methods: The PubMed, Google scholar, Cochrane Library, Wanfang, CNKI databases were searched, and the clinical studies on ultrasound-guided percutaneous microwave ablation or thyroidectomy for the treatment of papillary thyroid micro- carcinoma were selected. The search time was from 2015 to2018, and Meta-analysis was performed on 4 articles that met the inclusion criteria. Results: After data extraction and statistical analysis, compared with the operation group, the microwave ablation group had shorter hospitalization time, less intra-operative blood loss and shorter operation time, and the differences were statistically significant. The comparison of postoperative complications showed that the incidence of transient recurrent laryngeal nerve palsy and transient hand and foot numbness in the ablation group was lower than that in the operation group, and the difference was statistically significant. There was no significant difference in the incidence of permanent complications between the two groups. Preoperative and postoperative thyroid hormone Meta-analysis results showed that microwave ablation had little effect on thyroid function. None of the patients included in the studies had recurrence or lymph node metastasis. Conclusion: Microwave ablation is an option for low-risk PTCs patients with definite diagnosis and clear stratification. Surgical treatment is the best choice for middle and high-risk patients with unclear preoperative diagnosis and inability to judge lymph node metastasis.