Abstract: Objective　To investigate the feasibility of laparoscopic follicular puncture plus letrozole in the treatment of precocious pseudopuberty caused by functional autonomous ovarian cysts with a significantly higher estrogen level. Method The clinical data of functional autonomic ovarian cysts combined with precocious pseudopuberty in a child were retrospective analyzed. Results　A 3.5-year-old girl suffered from early breast development and intermittent small amount of vaginal bleeding for one year. Her bone age and height were significantly higher than those of normal children of the same age and gender, and estrogen level was continuously increased. In order to clarify the etiology and reduce the estrogen level rapidly, laparoscopic exploration was performed. During the operation, the pathological results of the ovary showed fibrous cyst wall with a few granular cells lining. Then follicle puncture was performed because multiple follicular cysts of the ovary were considered. The estrogen level decreased rapidly after operation. The estrogen E2 level was 121 pg/mL 20 days after the operation and letrozole was given orally at 1.25 mg/d. During the 50-month follow-up, the estrogen level fluctuated between 6~51 pg/mL, and the growth rate of height gradually returned to normal level, with delayed bone age development and normal function of liver and kidney. Conclusion　Laparoscopic follicular puncture plus letrozole is an alternative method for the treatment of precocious pseudopuberty caused by functional ovarian cysts with a significantly higher estrogen level.