Objective To systematically evaluate the curative effect and security of radiofrequency ablation and surgery in the treatment of papillary thyroid microcarcinoma (PTMC). Materials and Methods Literatures that compared radiofrequency ablation and surgery in the treatment of PTMC from establishment to November 2021 were searched in databases including PubMed, Embase, The Cochrane Library, Web of Science, CNKI, Wan Fang, VIP and SinoMed. Two researchers independently screened out literature, extracted data in strict accordance with the inclusion and exclusion criteria and evaluated the quality of the included literatures. Revman5.4 was then used for meta-analysis. Results A total of 8 articles, involving 1932 patients were included, in which 972 cases were treated with radiofrequency ablation and 960 cases were treated with surgery. Results showed that the radiofrequency ablation group had fewer postoperative complications (RR=0.28,95％CI 0.12 to 0.63,P=0.002), less operation time (MD=-54.65,95％CI -65.83 to -43.46,P＜0.05), less blood loss in operation (MD=-25.15,95％CI -29.10 to -21.20,P＜0.05), shorter postoperative hospital stay (MD=-2.48,95％CI -3.00 to -1.95,P＜0.05). All the differences were statistically significant (P<0.05); The incidence of postoperative recurrence or metastasis in the radiofrequency ablation group was similar to that of surgery (RR=1.14，95％CI 0.52 to 2.51,P=0.74), and there was no statistically significant difference (P>0.05). Conclusion Ultrasound-guided radiofrequency ablation is superior to surgical procedures in many aspects, presenting a high clinical application value in the treatment of PTMC.