Objective To compare the effectiveness of Guided laser ablation guided by ultrasound and surgical resection as an initial treatment for patients with small hepatocellular carcinoma(HCC).Methods Between May 2011 and June 2014, 100 patients with small HCC were divided at random into two groups :A group (n=50)and B group (n=50) to undergo surgical resection or Guided laser ablation guided by ultrasound respectively .Results After 1 months of treatment, the effective cure rate of A group and B group were 100%. During 3 years of follow-up, the recurrence rate was 16% in A group, B group, the tumor recurrence rate was 36%, two groups of tumor recurrence rate was statistically significant (P < 0.05). A group of pain, fever, abdominal bleeding, infection and the incidence of postoperative complications was significantly higher than the complication rate of group B (P<0.05). The difference between the A group and B group the survival rate of 1 years, 2 years, 3 years is not significant. Conclusion Guided by ultrasound guided laser ablation and open surgical resection of small hepatocellular carcinoma has advantages, in the case of hospital medical conditions permit, the former can be partly replaced by the latter.