OBJECTIVE: To explore the clinical significance of thoracoscopic treatment of pediatric pyothorax. DATA AND METHODS: Fifteen cases of pediatric pyothorax treated by thoracoscopic surgery in our hospital from January 2009 to March 2011 were retrospectively analyzed, 7 males and 8 females, with an average age of 3.3 years (10 months to 10 years and 11 months). The site of onset was left side in 6 cases and right side in 9 cases. All were secondary to pulmonary infection. Pus culture was Staphylococcus aureus or Streptococcus pneumoniae. With the healthy side lying down, 2~3 Trocars were selected for surgery, and a thoracoscope was placed in the mid-axillary line of the 7th intercostal space on the affected side, and two Trocars were placed in the anterior axillary line or posterior axillary line of the 4th or 5th intercostal space as the operation holes. The pus was aspirated, necrotic tissue, fibrin membrane and pus were removed with endoscopic grasping forceps, bronchopleural fistula was repaired with suture, the chest cavity was flushed with large amount of warm saline, and after the lungs were completely reexpanded to observe that there was no air leakage, 1~2 closed chest drainage tubes were left in place. RESULTS: All 15 cases in this group were successfully operated by thoracoscopy, and there was no case of intermediate open thoracotomy. Using 2 Trocar in 9 cases and 3 Trocar in 6 cases, the average operation time was 160.5 minutes (60~210 minutes); the average blood loss was 33.7 ml (20~200 ml), and only 1 case of child was transfused intraoperatively; the average time of keeping closed chest drain after operation was 5.7 days (4~14 days); the average time of postoperative body temperature returning to normal was 3.6 days (1 day~ 13 days); the average number of days of postoperative hospitalization was (8.8 days 3~18 days); there was no case of applying painkillers in the postoperative period. 15 cases suffered from no complications such as pneumothorax, hemothorax, and celiac chest. CONCLUSION: Thoracoscopic surgery has the advantages of less trauma, adequate drainage, simultaneous stripping of thickened pleura, fast recovery and fewer complications, which is the development trend of pediatric pyothorax treatment.