Spontaneous pneumothorax is a disease that seriously affects respiratory and circulatory functions, mostly occurs in thin and tall young men, but also in elderly patients with chronic lung diseases, mostly due to rupture of large alveoli, mostly in the apical part of the lung, which may be related to anthropogenesis and pulmonary hematology. Clinically, most patients with spontaneous pneumothorax can be cured by conservative treatment such as rest, thoracentesis and aspiration or closed chest drainage, but conservatively treated spontaneous pneumothorax is prone to recurrence. For the treatment of recurrent spontaneous pneumothorax, the current view mostly advocates surgery. There is very little chance that a ruptured alveolus can be repaired and closed by itself. Surgery is recommended for any of the following: ① recurrent ipsilateral spontaneous pneumothorax; ② repeated puncture is ineffective or closed drainage of the chest cavity for more than 3 days is still leaking, and the lung expansion is incomplete; ③ with spontaneous hemothorax and active bleeding; ④ with lung lesions, especially suspected tumors. Emphysema and advanced age are not contraindications to surgery, but adequate preoperative preparation and proper postoperative care should be done. For limited pneumothorax, the air can be pumped by puncture, and the change of air volume should be reviewed. If repeated puncture is not effective, closed drainage should be performed locally, and negative pressure suction should be applied for poor lung dilation. In recent years, due to the development and popularization of thoracoscopic technology and the emergence of ENDO-GIA, resection of large alveoli can be done under thoracoscopy, which is simple, less traumatic and faster recovery.