Since the emergence of video-assisted thoracoscopic surgery (VATS) in the early 1990s, VATS has gradually begun to be widely used as a mature procedure. From December 1996 to December 2006, 856 patients with spontaneous pneumothorax and traumatic hemopneumothorax underwent VATS in our hospital and achieved satisfactory results. 1. Clinical data Among the 856 patients, 756 were male and 100 were female. The age was 146-7-80 years old, with an average age of 36.6 years. There were 636 cases of spontaneous pneumothorax, including 422 cases of recurrent attack and 214 cases of first attack. There were 220 cases of traumatic hemopneumothorax, including 92 cases of crush injury, 90 cases of sharp knife injury, 20 cases of blunt chest injury, and 18 cases of mixed injury. There were 452 cases on the right side, 364 cases on the left side, and 40 cases on both sides. There were 103 cases of combined rib fracture, 48 cases of pulmonary herpes, 10 cases of pulmonary laceration, 5 cases of tension pneumothorax, and 134 cases with shock symptoms. 2.Methods Patients were treated with intravenous compound general anesthesia, double-lumen tube tracheal intubation, unilateral surgery in the lateral position on the healthy side, and bilateral surgery in the supine position during the same period. After successful anesthesia, the chest surgical field was routinely disinfected, and in most patients, a 1-cm incision was made in the 6th intercostal space in the mid-axillary line of the affected side, and a 10-mm thoracoscopic trocar was inserted, and the thoracoscope was inserted through the trocar to examine the whole thoracic cavity in turn and identify the lesion site. The 10-mm Trocar is placed in the anterior axillary line of the 3rd or 4th intercostal space, and the electrocoagulator, titanium clamp and suction device are fed in. During the operation, electrocoagulation was cut off when adhesions were encountered to increase the exposure. After the lung atrophy is satisfied, the lesion site is explored and the corresponding operation is performed as needed. If pulmonary herpes can be closed at the base with titanium clamps or ligated with a trap. If the base of the lung herpes is wide, multiple titanium clips can be used to intermittently clamp the lung tissue from the edge of the normal lung tissue at the base of the herpes. In addition to clamping the pulmonary blister, the patient with hemopneumothorax should have the clot removed from the chest cavity, and the bleeding should be stopped by electrocoagulation and titanium clamps. After surgery, closed chest drains were placed through the original incision in the 6th intercostal axillary line. The lungs were blown to inflate before extubation. 3. Results Among 856 patients, 853 cases were operated successfully, and 3 cases had difficulty in completing VATS and were converted to open chest. Among them, one case had severe pleural adhesions, one case had multiple lung lacerations and was near the hilum, and one case had traumatic hemopneumothorax with pericardial laceration and right atrial injury. Thoracoscopic treatment of the pleural vessel wall was performed in 41 cases, and the lung was sutured in 15 cases. The patients’ vital signs were stable during surgery, without arrhythmias and obvious blood pressure fluctuations. There was basically no intraoperative bleeding, and the operation lasted 45-180 minutes, with an average operation time of 86 minutes. The chest drainage tube was placed for 24-48 hours, with 20-100 ml of drainage fluid, and the patients were basically able to get out of bed and take care of themselves after extubation, and were discharged from the hospital in 3-8 days, with an average hospital stay of 6.8 days. The patients were instructed to follow up half a month to 1 month, and the follow-up was 2-24 months. All patients were able to move their upper limbs freely, and no death or complications occurred. 4.Discussion Television thoracoscopic surgery has been widely used abroad for more than 10 kinds of surgeries such as spontaneous pneumothorax, sympathectomy, benign and malignant lung tumors, benign and malignant esophageal tumors, thoracic trauma and cardiac surgery [1], and its application in China is now expanding and gradually popularized.VATS treatment of hemopneumothorax has the advantages of short time, small trauma, fast recovery and few complications, and is a safe and effective It is a safe and effective treatment method with minimal invasion. 4.1 VATS can treat chest wall, lung and intercostal vascular injuries at one time. The direct vision of thoracoscopy can help to aspirate the blood in the chest cavity, thoroughly remove blood clots and foreign bodies in the chest cavity, accurately determine the site, scope and extent of chest wall vascular, rib and lung injuries, especially the depth of lung injuries can be checked with separating forceps, etc., and the surgical approach can be decided in time and the bleeding of chest wall vessels can be quickly treated with electrocoagulation, titanium clips, sutures, or Endo-GIA clamps to close the bleeding and laceration of the lung. The lung can also be repaired or lobectomized with a small thoracoscopic incision. For multiple multi-segment rib fractures, wire suspension external fixation is feasible, which can rapidly restore the appearance and function of the chest wall and effectively improve respiration and circulation. 4.2 VATS should be performed as early as possible for spontaneous pneumothorax, usually the third episode of recurrent pneumothorax and persistent pulmonary air leak >7 days should be treated by VATS, which can avoid intrathoracic adhesions and increase the difficulty of surgery, and prevent the waste of medical resources. Endoscopic sutured incisional resection should be preferred for the management of pulmonary herpes, and for multiple pulmonary herpes and herpetic emphysema, small incisions for pulmonary herpectomy or lobectomy should be appropriately adjunctive for both definitive efficacy and reduced surgical costs. Careful intraoperative exploration, exact management of pulmonary herpes and adequate pleural fixation are the keys to prevent recurrence after VATS. 4.3 Intraoperative experience of the relevant techniques: (1) Use of additional small incisions: Both spontaneous and traumatic hemopneumothorax with shock symptoms indicate a large amount of intra-thoracic bleeding and varying degrees of intra-thoracic clots, and additional small chest incisions can be considered when VATS is performed on such patients. The use of conventional thoracic surgical instruments in the small incision can not only remove the intrathoracic clot completely, making the operation safer and faster, but also avoid the occurrence of unexpected situations. (2) Management of pulmonary bullae: There are many ways to manage pulmonary bullae in VATS, and electrocoagulation, laser, argon knife to remove coagulated bullae, traps and endoscopic incisional sutures have been reported [2]. We attempted to use titanium clips intermittently to close the herpes completely at the base of the herpes, effectively preventing localized herpetic air leakage and recurrence. When the lung is resuscitated and has sufficient resistance, it is especially applied to multiple pulmonary hernias, which can better preserve the lung tissue. (3) Application of pleural adhesions: In postoperative patients with pneumothorax and hemopneumothorax, pleural cavity adhesions are required to reduce the chance of recurrence. daniel [3] applied talcum powder direct spray method to close the pleural cavity up to 100%. In our group, 1% iodophor was used to apply mural and dirty pleural surfaces (mainly the 1st-5th rib area) and lobe spaces to produce chemical inflammation and close the pleural cavity, and there were no recurrence cases and other adverse effects after follow-up. 4.4 VATS can thoroughly remove the accumulated blood, blood clot and foreign body from the pleural cavity, reduce the irritation to the pleural cavity, and reduce the mechanization of blood clot and the occurrence of abscess chest. After the operation, the trauma was checked for bleeding and microscopic extraction of Trocar in sequence, and the puncture hole was checked for bleeding to reduce the occurrence of secondary bleeding. After lung repair, injection of water to expand the lung to check for air leakage is an essential step to prevent the occurrence of postoperative pneumothorax. The placement of drainage management want position can effectively prevent complications such as pleural effusion. Postoperative management of the airway should be strengthened, and patients with poor pulmonary function can extend the duration of mechanical ventilation and return to the ICU with a tube. closed chest drains are mostly extubated in 48 hours and up to 3-5 days. After VATS surgery, patients recovered much faster and had fewer complications than those who underwent open-heart surgery. There was no case of complication in this group. VATS for traumatic hemopneumothorax and spontaneous pneumothorax has the advantages of thorough cleaning, small trauma, fast recovery and few complications, and is a safe and effective, minimally invasive treatment method for hemopneumothorax, especially for traumatic hemopneumothorax with intra-thoracic injuries and bleeding sites, which can be diagnosed and treated in a timely and accurate manner, making intra-thoracic surgery simple.