Medical ultrasound image is an important basis for doctors to diagnose human tissue lesions. The speckle noise inherent in medical ultrasound images is easy to cause the destruction of texture information, which affects the doctor′s judgment on tissues and organs. Therefore, the denoising process of medical ultrasonic images has attracted much attention. In view of the limitation that the current medical ultrasound image denoising algorithm cannot maintain image texture, a fractional differential weighted guided filtering algorithm was proposed. Firstly, the speckle noise was converted into additive noise by logarithmic transformation. Combined with fractional differential algorithm, the texture factor was designed according to the correlation between pixel and edge texture, and the texture factor was used to improve the guided image filtering. Finally, the processing result of the medical ultrasound image was generated by the improved guided image filtering. In this paper, the ultrasound images of pig stomach and pig trachea were tested. Experimental results indicate that compared with the guided image filtering, the proposed method respectively gets 20.1% and 3.3% advancement for Structural Similarity Index Measurement and Cumulative Probability of Blur Detection. It can satisfy the proposed algorithm can effectively preserve the edge texture structure of the image while removing speckle noise.