This paper proposes a medical image denoising method based on two-dimensional adaptive compact variational mode decomposition (2D-ACVMD). First, a binary support function is introduced into 2D-VMD in order to enhance its spatial compactness. The optimal decomposition mode number K and the penalty factor α can be determined by the moving average power spectrum method and the genetic algorithm, respectively. Then, the decomposed high-frequency noise component is removed, and the other modes are reconstructed to obtain the denoised image. According to the experimental results, this method can effectively remove the noise interference, retain the original edge and detail features, and the PSNR and SSIM obtained are higher than the previous methods.