Primary pneumothorax occurs in lean adolescents, while secondary pneumothorax occurs in middle-aged and elderly patients with moderate-to-severe chronic obstructive pulmonary disease (COPD) and large pulmonary alveoli. Refractory pneumothorax refers to persistent bronchopleural fistula, the duration of persistent air leakage is not clearly defined yet, and most clinicians believe that the disease can be diagnosed when persistent air leakage still exists after closed chest drainage treatment and exceeds 2 weeks. In this case, the patient must be hospitalized for a long time, which will cause great hindrance to work and life. The treatment measures for refractory pneumothorax mainly include medical pleural adhesion treatment and thoracic surgery. However, in clinical practice, many patients are often unable to undergo thoracic surgery due to severe underlying cardiopulmonary disease and poor systemic condition, etc. Based on the above status quo, clinicians have explored a safer bronchoscopic interventional technique, namely unidirectional valve implantation, in recent years. The basic principle of unidirectional valve implantation in the treatment of refractory pneumothorax is to block the bronchus at the site of pneumothorax in one direction to stop the air leakage from the fistula and thus accelerate its healing. Recently, we successfully performed a case of unidirectional bronchial valve implantation for refractory pneumothorax, and in July 2015, we admitted a 56-year-old patient with severe chronic obstructive pulmonary disease combined with pneumothorax. A finger-thick (28F) chest drain was placed in the right anterior chest wall of the patient, and continuous closed drainage treatment failed to heal for nearly 2 months, and the patient still felt dyspnea, shortness of breath and chest tightness in semi-recumbent position, which greatly affected his quality of life. Several years ago, the patient had been treated surgically for right spontaneous pneumothorax, but after this attack, he had difficulty tolerating surgery and general anesthesia due to extremely poor cardiopulmonary function. The patient was found to have multiple pulmonary alveoli on both sides of the lung by chest CT examination, and the alveoli were fused with each other. He was treated with hypertonic glucose pleural adhesions several times without improvement. After admission, we decided to perform transbronchoscopic unidirectional valve implantation to trap and close the air-leaking lung segments, thus achieving the goal of curing the pneumothorax. For this patient, we made careful preoperative preparations and the surgery was scheduled. However, during the operation, it was found that the patient had significant persistent air leakage and collateral ventilation in the upper lobe, middle lobe and part of the bronchi of the lower lobe of the right lung. Under the guidance of Prof. Li Qiang, the head of the department, and Prof. Zhou Xin, a total of five unidirectional valve (EBV) of different sizes were implanted in the four bronchi of the upper lobe and part of the bronchi of the lower lobe of the right lung. The operation lasted 2 hours and was well tolerated under local anesthesia. The chest drain was removed more than 1 week after the operation and the patient was able to get out of bed and walk around. It is reported that this minimally invasive interventional technique for the treatment of refractory pneumothorax has been little studied in domestic and foreign clinics, and the implantation of five unidirectional flaps of different sizes in a single operation is the leading one in China, which reflects the strong professional level and pioneering and innovative spirit of the Department of Respiratory Medicine of our hospital. At present, we have routinely carried out this new technique of bronchoscopic intervention for patients with severe emphysema and refractory pneumothorax in the elderly. Compared with surgical lung decompression surgery, this minimally invasive treatment technique can improve lung function, exercise capacity and quality of life in patients with non-homogeneous emphysema, with fewer complications and faster postoperative recovery.