objective To investigate the severe postoperative complications of percutaneous microwave ablation for the treatment of recurrent Hepatocellular Carcinoma（HCC）. Methods The perioperative and followup data of percutaneous microwave ablation (PMWA) for the treatment of recurrence of HCC between 2014 to 2016 were analyzed, respectively. Results 128 patients with 164 recurrence recurrent HCC tumors were treated with PMWA (183 ablations). There were 10 cases of severe complications (7.81%), including 1 (0.78%) in mortality. The other sever complications included 3 cases of liver insufficiency (2.34%), 2 cases with symptomatic pleural effusion (1.56%), 2 cases of liver hemorrhage (1.56%), 1 case of liver abscess (0.78%) and 1 case of tumor seeding (0. 78%).Tumor diameter and tumor number were associated with a higher severe complication rate (both P＜0.05). Conclusion PMWA can be used as the preferred treatment for recurrence HCC. Careful selection of patients and special precautions are necessary to reduce the occurrence of severe postoperative complications.