A guided trilateral filtering ultrasonic image speckle noise removal method comprises the steps of calculating the space domain distance weight of a guided image through a Gaussian function, and setting the standard deviation of the guided image to be increased along with increase of noise intensity; carrying out Histogram fitting on a local area of the guide image, and selecting a Fisher-Tippettprobability density function selected as a fitting function; Estimating a distribution parameter of the Tippett probability density function by adopting a maximum likelihood method, and calculating adistribution similarity weight according to the estimated parameter; calculating Pixel value difference weight of a guide image by using an exponential function, and setting a scale parameter of the guide image as an estimated Fisher-; Wherein the Tippett distribution parameters are in direct proportion change; And carrying out local iterative filtering on the ultrasonic image by using the three calculated weights, and carrying out iterative convergence to obtain the ultrasonic image with speckle noise removed. According to the method, the filtering weight value is calculated through three aspects of information of the spatial domain distance, the pixel value difference and the distribution similarity, speckle noise can be effectively reduced, meanwhile, detail and edge information of theimage can be better reserved, and therefore visual interpretation of the ultrasonic image is enhanced.