Objective To investigate the efficacy of postoperative superficial X-ray radiotherapy for keloids. Methods From April 2016 to April 2017, a total of 172 patients who underwent surgical resection of keloids were enrolled (263 lesions), and were given postoperative superficial X-ray radiotherapy within 24 hours. Each patient got 5 Gy/fraction/day for 4 days. Effectiveness, adverse reactions and recurrence rates were observed and evaluated. Results The total effective rate of the superficial X-ray radiotherapy was 92.8% (244/263). According to the lesion area analysis, the total effective rate of face and neck area, trunk area and limb area was 94.6% (106/112), 91.5% (86/94), and 91.3% (52/57) respectively. No serious adverse reactions were observed. Conclusion Surgical resection combined with superficial X-ray radiotherapy is a safe and effective method for keloid treatment.