High-efficiency　video　compression　technology　is　of　primary　importance　to　the　storage　and　transmission　of　digital　medical　video　in　modern　medical　communication　systems.　To　further　improve　the　compression　performance　of　medical　ultrasound　video,　two　innovative　technologies　based　on　diagnostic　region-of-interest　(ROI)　extraction　using　the　high　efficiency　video　coding　(H.265/HEVC)　standard　are　presented　in　this　paper.　First,　an　effective　ROI　extraction　algorithm　based　on　image　textural　features　is　proposed　to　strengthen　the　applicability　of　ROI　detection　results　in　the　H.265/HEVC　quad-tree　coding　structure.　Second,　a　hierarchical　coding　method　based　on　transform　coefficient　adjustment　and　a　quantization　parameter　(QP)　selection　process　is　designed　to　implement　the　otherness　encoding　for　ROIs　and　non-ROIs.　Experimental　results　demonstrate　that　the　proposed　optimization　strategy　significantly　improves　the　coding　performance　by　achieving　a　BD-BR　reduction　of　13.52%　and　a　BD-PSNR　gain　of　1.16　dB　on　average　compared　to　H.　265/HEVC　(HM15.0).　The　proposed　medical　video　coding　algorithm　is　expected　to　satisfy　low　bit-rate　compression　requirements　for　modern　medical　communication　systems.