From 1998.10 to 2012.11, 24 cases of fibrous plate resection and residual cavity disinfection and closure of septic chest assisted by thoracoscopic techniques were performed in the Department of Thoracic Surgery of our hospital, including 16 cases of septic chest after pneumonia, 6 cases of lobectomy or additional lung segments, and 2 cases after total pneumonectomy. There were 16 cases of early stage pneumothorax and 8 cases of late stage pneumothorax. The experience in the management of this group of cases is now discussed in the light of the literature review. Clinical data Early septic chest – 16 cases of fibrous plate resection of septic chest assisted by thoracoscopic technique: preoperatively, the location of the thoracic incision was selected according to chest X-ray and CT film and intraoperative thoracic trial penetration to determine the location of the thoracic incision, and the first incision was made in the lowest position of the fluid-encapsulated cavity as far as possible, and then the remaining two incision locations were selected under thoracoscopic guidance. Surgical operation: under the guidance of thoracoscopy, the pleural fluid and pus are aspirated, the fibrous separation and pus moss are removed, the lung is expanded after flushing the residual cavity with a large amount of saline, and the fibrous plate is peeled according to the extent of pleural fibrous plate formation. Fibrous plate removal requires the use of long curved vascular forceps through this hole directly into the thoracic cavity, first tearing a point of the fibrous plate to the normal lung surface, and then strip and sheet tearing around this point until the lung is basically reopened. It is very important to choose a good location for the first incision of the surgery. Late septic chest – disinfection and closure of the residual cavity with the assistance of thoracoscopic techniques in 8 cases: preoperative selection and positioning according to chest X-ray and CT film, making an incision as low as possible in the septic cavity, aspirating the pus accumulated in the chest cavity under the guidance of thoracoscopy, removing the fibrous partition, pus moss and necrotic tissue, flushing the residual cavity with a large amount of saline and then expanding the lung, selecting the lowest site A closed chest drainage tube was placed through the incision or through the thoracoscopic orifice. After surgery, the chest cavity was irrigated with polyketide iodine for 2/day and bacteriological culture was done for 1/day. Eight cases of chronic pustulothorax were removed after 3 consecutive negative bacteriological cultures and the last pegylated iodine irrigation. 8 cases of chronic pustulothorax were treated with other procedures, including Eloesser flap and Clagett’s procedure chest wall opening in 2 cases each, and fibrous plate resection of pustulothorax assisted by thoracoscopic technique at an earlier stage of chronic pustulothorax in 4 cases. Five cases were cured after this operation, and three cases were finally cured by limited thoracotomy, and the total hospital stay was 9-43 days, with an average of 16 days. Discussion Inadequate treatment of pustulothorax in early stage can turn into chronic pustulothorax after 3-4 weeks, and the treatment is very tedious as granulation tissue and fibrous tissue on the pleural surface mechanize to form fibrous plate like changes and lead to restricted lung expansion and thoracic deformity. Most patients, especially those with primary pneumonia or other non-physical infections, can be controlled and eventually cured through open chest or thoracoscopic debridement combined with fibrous plate removal surgery; however, there are still some patients with complicated conditions that require thoracoplasty to eliminate the abscess cavity or adopt chest wall opening surgery. Thoracic wall opening surgery is suitable for cases where conventional drainage, debridement, and debridement procedures have failed and the patient cannot tolerate thoracoplasty, especially in patients with bronchopleural fistula (BPF) secondary to lobar or segmental lung surgery. Bronchopleural fistula is likely to occur in 2-10% of lung resections, 80-100% of which are secondary to pneumothorax, with an average mortality rate of 5-25%. The Clagett’s procedure is the classical chest wall window procedure with good clinical results (evidence 3b), and Weissberg suggests that the size of the chest wall window is directly related to the time required to irrigate and disinfect the pleura. Clagett resected only an 8-cm section of the 7th rib in the patient’s posterior lateral chest wall, whereas Virkkula et al. resected two 15- to 20-cm ribs to enlarge the chest wall window and irrigated the chest cavity with 0.25% neomycin saline alternating with 1:1000 Neosporin, changing the dressing day by day. It can lead to complete disappearance of infection in 1/3 (8/24) of patients with abscess chest in 10 days to 4 months, while the wound is then closed without reoperation. The pleural remnant cavity gradually shrinks with time, and when the chest wall window needs to be closed, even with a vascularized muscle flap or limited thoracic revision, the operation is small and the postoperative interference with respiratory and circulatory function is mild. Thoracoscopic surgery is mildly traumatic, with good visual field, and can be well tolerated by patients who have been sick and weak for a long time, and can thoroughly aspirate fluid and pus, remove fibrous separation, pus moss and necrotic tissue, peel off the pleural fiber plate, reduce the dead cavity, promote lung reopening, greatly shorten the treatment course, and maximize the protection of lung function, which is suitable for the early and middle stages of pneumothorax, especially for pneumothorax with primary pneumonia. Thoracoscopic surgery has been accepted by more and more thoracic surgeons for debridement of abscess chest and removal of pus moss and intrathoracic foreign bodies under direct vision, and stripping the lung fiber plate to allow unobstructed drainage. However, systemic nutritional therapy and maintenance of positive nitrogen balance during treatment remain important measures for successful surgery and shortening the course of the disease. Patients are in poor general condition due to experiencing acute suppurative septic chest infection, so active into improving systemic condition; preoperative comprehensive examination of heart, lung, liver, kidney function, plasma protein, coagulation mechanism, etc.; choosing effective antibiotics to actively control infection, etc. should not be neglected. For septic chest secondary to chest trauma, including chest trauma, lobe or segmental lung resection combined with bronchopleural fistula, or even bronchoesophageal fistula, it is also necessary to eliminate the source of contamination first, and on this basis, give adequate drainage, debridement and nutritional support to achieve good therapeutic effect, so the treatment of BPF is very important. In this regard, thoracoscopic surgical treatment has some limitations, although for abscesses secondary to BPF, there are reports of thoracoscopic-assisted surgical treatment if the fistula is less than 3 mm; there are also reports of successful treatment by glueing and chemical cauterization, but most cases still require However, most cases still require open-chest surgical debridement and filling treatment with tissues such as muscle flaps or omentum.