Abstract: Objective To investigate the effectiveness and safety of ultrasound guided microwave ablation (MVA) in the treatment of hepatocellular carcinoma (HCC) adjacent to hepatic hilum of the liver. Methods A total of 140 HCC patients (157 nodules) who were treated in the ultrasound department of Chinese PLA General Hospital from May 2015 to May 2017 were enrolled. They were randomly divided into observation group and control group. In the control group, 70 patients (80 nodules) were treated by MVA combined with artificial ascites, while another 70 patients (77 nodules) in the observation group were treated with ethanol injection assisted by artificial ascites. There was no statistical difference in the general data between the two groups (P> 0.05). The overall technical success rate, complete ablation rate, postoperative complications, and local progression rate at 3 months, 6 months and 12 months after operation were observed in two groups. Results In the observation group, the overall technical success rate was 97.14%, the complete ablation rate was 96.10%, the local tumor progression rate of 3, 6 and 12 months was 1.30%, 2.60%, 6.50%respectively and the main postoperative complications were local pain, fever and nausea or vomiting. In the control group, the overall technical success rate was 95.71%, the complete ablation rate was 90%, the local tumor progression rate of 3, 6 and 12 months was 2.5%, 8.75%, 13.75%, respectively, and the postoperative complications included local pain, fever and nausea or vomiting. There was no significant difference in total ablation rate and local progression rate at 3 months between the two groups (P> 0.05), while the complete ablation rate and the local progression rate at 6 and 12 months in the observation group was higher than that of the control group (P=0.025, P=0.04, P=0.033, respectively). Conclusion Local microwave ablation is safe and effective for patients with hepatocellular carcinoma adjacent to hepatic hilum. During the ablation process, the assistive technology of artificial ascites plus ethanol injection for treatment can effectively improve the complete ablation rate, and reduce the rate of local tumor progression.