Objective To investigate the safety and efficacy of splenectomy versus spleen-preservation surgery(endocystectomy or subtotal pericystectomy) in the treatment of primary splenic hydatid cysts,and to determine the optimal surgical procedure for this disease. Methods A retrospective analysis was performed for the clinical and pathological data of 29 patients with primary splenic hydatid cysts who were admitted to The First Affiliated Hospital of Xinjiang Medical University from April 2002 to June 2017 and underwent surgical treatment. According to the surgical procedure,the patients were divided into group A(splenectomy) and group B(endocystectomy or subtotal pericystectomy).The two groups were compared in terms of time of operation,intraoperative blood loss,time to first flatus after surgery,catheter indwelling time after surgery,length of postoperative hospital stay,hospital costs,residual complications,and recurrence. The t-test was used for comparison of continuous data between the two groups,and the chi-square test was used for comparison of categorical data between the two groups. Results Compared with group B,group A had a significantly longer time of operation(167. 50 ± 41. 85 min vs 125. 84 ± 28. 88 min,t = 3. 41,P = 0. 002) and a significantly higher intraoperative blood loss(189. 00 ± 50. 65 ml vs 113. 16 ± 59. 73 ml,t = 3. 15,P =0. 004). Group A had significantly longer catheter indwelling time after surgery and length of postoperative hospital stay than group B(catheter indwelling time: 5. 00 ± 2. 36 d vs 3. 16 ± 1. 34 d,t = 2. 70,P = 0. 012; length of postoperative hospital stay: 7. 90 ± 1. 91 d vs 5. 47 ±1. 61 d,t = 3. 42,P = 0. 004). There were no significant differences between the two groups in time to first flatus after surgery,hospital costs,and incidence rate of residual cavity effusion(all P > 0. 05). Conclusion Spleen-preserving surgery(endocystectomy and subtotal pericystectomy) is safer and more effective than splenectomy in the treatment of primary splenic hydatid cysts.