Objective To investigate the differences of efficacy and adverse reactions between drug-loaded microsphere embolization and traditional surgical methods for primary hepatic carcinoma （PHC）. Methods A total of 122 PHC patients admitted to Fenyang Hospital of Shanxi Province from January 2020 to December 2022 were selected as the study subjects,and were randomly divided into an embolization group （n=61, embolization with drug-loaded microsphere） and a control group （n=61, with traditional surgery） according to random number table. General data,treatment conditions,serum indexes, neutrophil-lymphocyte ratio, adverse reactions and short-term efficacy were compared between the two groups. Results There were no significant differences in the number of tumors （single）, size, serum γ-glutamyl transpeptidase or α-fetoprotein （AFP） between the two groups at 1,2 and 3 months after treatment （P>0.05）. The alkaline phosphatase （ALP） of the embolization group was slightly lower than that of the control group at 1,2 and 3 months after treatment （P<0.05）. The ratio of neutrophils to lymphocytes of the embolization group 3 months after treatment was higher than that of 1 month after treatment （P<0.05）. The ratio of neutrophils to lymphocytes of the control group was higher than that in the control group at 2 and 3 months after treatment （P<0.05）. The ratio of neutrophils to lymphocytes of the embolization group was higher than that of the control group at 1,2 and 3 months after treatment （P<0.05）. The total incidence of adverse reactions in the embolization group within 3 months after treatment was lower than that in the control group （P<0.05）. The ratio of RR and DCR in the embolization group was higher than that in the control group （P<0.05）. Conclusions Drug-loaded microsphere embolization and traditional surgical methods can both achieve significant therapeutic effects in PHC, but the former significantly improves immune function and has a lower incidence of adverse reactions and better short-term efficacy.