The Lanuoma deposit, located in the Sanjiang Tethyan metallogenic domain, shows a characteristic assemblage of Pb-Zn-Sb mineralization, distinguished from those in other sediment-hosted base metal deposits of this region. The ore textures reveal two mineralization stages: the early stage is characterized by Zn mineralization with occurrences of porous pyrite (Py2) and yellowish-brown sphalerites (Sp1), and the late stage is characterized by Sb-Pb mineralization with occurrences of subhedral-euhedral pyrite (Py3), yellowish-white sphalerites (Sp2), sulfosalts consisting of boulangerite, zinkenite, sorbyite and plagionite and calcite veins. The framboidal pyrites (Py1) predate Pb-Zn-Sb mineralization. Py2 has higher Zn contents (16.97–621.67 ppm, mean: 181.17 ppm) than Py3 (Zn: 0.76–323.44 ppm, mean: 29.58 ppm) by up to one order of magnitude. The Se contents of Py2 (Se: 5.46–87.82 ppm, mean: 50.96 ppm) are also one order of magnitude higher than those of Py3 (Se: 1.64–10.99 ppm, mean: 4.35 ppm). Sp1 is characterized by one order of magnitude higher contents of Fe (381.99–9046.64, mean: 4875.50 ppm) and Se (4.02–72.51 ppm, mean: 34.70 ppm) than Sp2 (Fe: 287.53–584.02 ppm, mean: 416.75 ppm; Se: 2.89–10.80 ppm, mean: 6.20 ppm). However, the average content of Cd (4256.38 ppm) in Sp2 is almost twice that in Sp1 (2635.74 ppm). The higher Se contents in Py2 coupled with higher Se and Fe contents in Sp1 indicate that Py2 and Sp1 had higher precipitation temperatures than Py3 and Sp2. Sulfur isotope compositions of pyrites and sphalerites acquired by NANO-SIMS and LA-MC-ICP-MS suggest two origins: the sulfur of Py2 (δ³⁴S: −3.0 to 2.3‰), Sp1 (δ³⁴S: 0.2–0.9‰) and Sp2 (δ³⁴S: 0.7–2.5‰) was mainly of magmatic source, and sulfur reduced via thermochemical sulfate reduction participated in the formation of Py3 (δ³⁴S: 0.2–6.0‰) and S-Sb-Pb minerals intergrown with Py3. The sulfur isotope compositions of Py1 (δ³⁴S: −31.8 to −19.4‰) indicate a biogenic origin associated with bacterial sulfate reduction. A fluid mixing model is suggested to interpret the genesis of the Lanuoma Pb-Zn-Sb deposit: mixing of a reduced S-bearing fluid with a metalliferous basinal brine resulted in the precipitation of sulfides. Temperature was the most important factor controlling metal precipitation in the Lanuoma deposit.