The low-medium temperature Zn-Pb deposits in the Sichuan-Yunnan-Guizhou (SYG) metallogenic region contain not only Pb and Zn but also abundant critical metals such as Ge, Ga, and In. The majority of previous studies focus on the genesis of Pb and Zn metals, and the research on Ge, Ga and In in the SYG region has become a topic in recent years due to economic importance of these metals. In this review, the distribution, occurrence, and enrichment mechanism of Ge, Ga, and In in Zn-Pb deposits in the SYG region is summarized. Sphalerite is the main host mineral of Ge, Ga, and In, with contents of up to ∼1300 ppm, ∼600 ppm, and ∼1191 ppm, respectively. Pyrite from the Fule Zn-Pb deposit is also rich in Ge (up to 340 ppm), which may be due to involvement of magmatic components in the ore-forming fluids. Germanium, Ga, and In mainly appear in the form of isomorphism in sphalerite. Independent minerals of Ge such as ruizhongite (Ag2□)Pb3Ge2S8), are only found in the Wusihe Zn-Pb deposit. Copper is the main coupling ions for substitution of Ge, Ga, and In in sphalerite. However, the positive correlation of Ge with Pb, Mn and Ag in the sphalerite of Huodehong, Shaojiwan, Shanshulin, and Qingshan Zn-Pb deposits may indicate other means of substitution or existence of nanometer Ge minerals with similar composition to the ruizhongite. The substitution mechanisms of Ge and Ga vary with layers in the zoned sphalerite from the Nayongzhi Zn-Pb deposit, possibly indicating that physical or chemical variations in fluids will affect the substitution ways of Ge and Ga in sphalerite.The growth direction and crystal structure of ZnS also exert control over the contents of Ge, Ga, and In. The enrichment degree of Ge, Ga, and In changes between (110) and (111) crystal planes, and the wurtzite structure is beneficial to the infiltration of large ions (Ge, Ga, and In). Compared to sphalerite with euhedral texture, colloform sphalerite is conducive to the enrichment of Ge. For zoned sphalerite such as the rhythmic banding and the conventional zone, the former lacks zoning of Ge, Ga and In but the latter shows elemental zonation and Ge is enriched in the black domains. The correlation between the contents of Ge, Ga, and possible In in sphalerite and Pb or Zn isotopes of sulfides indicates the significant contribution of basement rocks for the enrichment of these metals. During the mineralization process, Ge tends to be enriched in dark or early sphalerite, including the Daliangzi, Tianbaoshan, Huize, Nayongzhi, Fule, Fuli, Wusihe, and Maoping deposits, which may be due to the variations in temperature or fluid evolution. The opposite variation trend of Ge and Ga with sphalerite color or stage in the Daliangzi, Nayongzhi, Maoping, Shaojiwan, and Wusihe Zn-Pb deposits indicates that Ge and Ga may behave differently during precipitation of sphalerite.