In 1993, the World Health Organization (WHO) issued the “Declaration of Global Tuberculosis Emergency”, which shows the importance and urgency of preventing and treating tuberculosis. Currently, rifampicin is the main treatment regimen used, and 95% of patients with primary TB can be completely cured. The recurrence rate of tuberculosis does not exceed 5% within 5 years after stopping the drug. However, there are still many loopholes in the strict supervision and full management of tuberculosis prevention and treatment, and many patients still lose the opportunity of primary treatment, thus turning into retreatment, or even becoming refractory or severe tuberculosis. On the other hand, many TB patients start with bronchial tuberculosis and even develop atelectasis and recurrent respiratory infections; some TB patients develop secondary bronchiectasis or Aspergillus infection, which is complicated by recurrent coughing up blood or even hemoptysis, often requiring surgery to solve the problem. According to the literature, 2% – 5% of TB patients need surgery, and the number of TB patients requiring surgery is still alarming from the national or Henan Province. From 1989 to the present, our thoracic surgery department has treated nearly 3,000 cases of tuberculosis patients with a success rate of more than 98% and a complication rate of less than 3%. Therefore, we believe that surgery is one of the effective means of treatment for some patients with refractory, severe tuberculosis with serious complications and multidrug-resistant tuberculosis. Surgical treatment of pulmonary tuberculosis has been carried out in China for nearly 70 years. In the 1960s, there were many surgical treatments for pulmonary tuberculosis, which were summarized into two categories: atrophy therapy and resection therapy. With the development and production of new anti-tuberculosis drugs and widespread clinical application, the continuous progress of medical technology, the improvement and innovation of surgical methods and the modernization of medical equipment, the indications for tuberculosis surgery and surgical methods have changed dramatically. I. Operating room indications (a) Cavitary tuberculosis: Patients with cavitary tuberculosis cavities that do not close for a long time, or cavities that are sometimes large and sometimes small, with persistent or intermittent positive sputum, especially those with drug-resistant tuberculosis, who have been treated by primary medical treatment or retreatment with standard chemotherapy for more than one year should be treated surgically first. This is of positive preventive significance to eliminate the source of infection and prevent the spread of tuberculosis. In addition, thick-walled cavities surrounded by thick fibrous tissue are difficult for TB drugs to reach the effective site; or huge cavities with tension cavities and diameter greater than 3 cm caused by poor drainage due to bronchial lesions, cavities in the lower lobe or near the hilum, and cavities that have been repeatedly disseminated and improved by retreatment should be considered for early pneumonectomy to eliminate the source of infection and prevent the emergence of TB complications. (B) Cavernous tuberculosis secondary to Aspergillus: sputum is mostly negative for tuberculosis, but recurrent small or large hemoptysis often occurs, and drug therapy is ineffective. (iii) One lobe or one side of the destroyed lung: The lung often has extensive fibrous caseous lesions and is often accompanied by bronchodilation and scattered multiple small cavities, such a lung has basically lost respiratory function, and there is much sputum and hemoptysis. If the initial treatment or irregular treatment exceeds six months, if the sputum is positive or the clinical symptoms are obvious, and there is no obvious active tuberculosis lesion in the contralateral lung, and the pulmonary function and general condition permit, lobectomy or whole lung resection should be performed according to the extent of lesion. (d) Bronchial stenosis caused by tuberculous bronchiectasis or endobronchial tuberculosis: If repeated hemoptysis, infection or positive sputum and pulmonary atelectasis, surgical resection of the diseased lung is required. For lesions in the upper lung without clinical symptoms, observation is possible, but for lesions in the middle lobe and both lower lungs, we believe that the indications for surgery should be relaxed. (v) Tuberculosis spheres and large cheese foci: The pathological changes are mainly encapsulated case-like necrotic tissue or tuberculous granulation tissue. If the diameter is greater than 3 cm, no change in the regular chemotherapy, and the patient requests surgery, it can be a relative surgical indication for surgery. If central lysis of the lesion occurs during clinical observation, or if tumor cannot be excluded, or if sputum is positive, early surgery should be performed. For those with small diameter, asymptomatic and sputum-negative lesions, surgery may be dispensed with if conditions are available for regular follow-up examinations. (f) Tuberculosis combined with hemoptysis: Patients with hemoptysis accumulating more than 600 ml in 24 hours or more than 200 ml at a time and with signs of asphyxia and shock should be operated early if the site of bleeding is clear, cardiopulmonary function permits and conservative treatment is poor. (vii) Pulmonary tuberculosis combined with pus or pneumothorax: early drainage should be performed, and if the effect is not obvious, open-chest negotiation or pleural fiber plate stripping should be performed. The standard posterior-lateral incision was used in the past for intra-thoracic surgery due to the serious adhesions in the thoracic cavity, and the incision was as long as 30 cm, which not only affected the aesthetics, but also caused great trauma and slow recovery after surgery. In recent years, with the development of minimally invasive surgery and the update of surgeon’s concept, we basically adopt small incision surgery, which not only does not need to remove ribs, but also sometimes does not even need to disconnect the chest wall muscles. Complications are low. Pulmonary resection methods used to be based on segmental, lobar, compound or total lung resection, but with the widespread use of strong and effective second- and third-generation antituberculosis drugs, tuberculosis lesion removal and cavity folding and suturing have been widely used. This procedure is a new surgical method to remove the main lesion, which is qualified to make up for the shortage of lobectomy and total pneumonectomy in pulmonary surgery. It not only expands the indications for surgery, but also fights for surgical opportunities for patients with multiple intrapulmonary lesions and pulmonary hypoplasia. Previously, patients with multiple intrapulmonary cavities (two lobes or both sides) and low lung function who could hardly afford lobectomy and compound resection could only be treated conservatively with a single approach, i.e., wasting medical resources and increasing the probability of repeated disease transmission. In recent years, our hospital has performed more than one hundred cases of unilateral multiple pulmonary cavities or bilateral multiple pulmonary cavities with simultaneous or staged lesion removal and cavity folding and suturing, all of which have achieved satisfactory results. It is characterized by less trauma, faster recovery, fewer complications and the ability to preserve more healthy lung tissue. In addition, we emphasize that the key to successful surgical treatment of tuberculosis is, in addition to mastering strict surgical indications, never forget that surgical treatment is only one part of a comprehensive tuberculosis treatment. Surgery itself often cannot eliminate all sources of disease or TB bacteria, so special attention should be paid to anti-tuberculosis systemic therapy before and after surgery to improve the cure rate and prevent or reduce postoperative complications and recurrence.