Tuberculous pleurisy is a common tuberculous disease, characterized by unilateral or bilateral pleural fluid accumulation of different degrees, which accounts for about half of the pleural fluid in China. However, there are still some patients who cannot be controlled by repeated fluid extraction and drainage and effective anti-tuberculosis treatment, so that the effusion is separated, presented with multiple small cavities and wrapped changes, and the pleural fluid is difficult to be absorbed, forming refractory tuberculous pleurisy. In the past, most of these patients were given intrapleural drugs, and when the pleural hypertrophy was eventually transformed into abscess chest, the pleura could only be peeled off by opening the chest, which caused great damage and unsatisfactory healing. We started to treat refractory tuberculous pleurisy with thoracoscopy or small adjuvant incision under general anesthesia in January 2011. Thirty patients who underwent thoracoscopic treatment during hospitalization from January 2011 to January 2014 were selected. The inclusion criteria were: duration of disease less than 2 months, repeated punctures and poor drainage with closed chest drains, and chest CT confirmed significant pleural thickening with pleural fluid separation. There were 16 male cases. Female 14 cases: age 16-58 years, mean (39±12) years. The patients were diagnosed with tuberculous pleural effusion according to the criteria established by the Chinese Medical Association Branch of Tuberculosis and given anti-tuberculosis ( 2HRZE/4HR) and prednisone according to the protocol of the National Collaborative Group for Short Course Chemotherapy of Tuberculosis, and the duration of the disease was <1 month. The formation of a fibrous plate affecting pulmonary resuscitation was confirmed by CT of the dividing chest. The surgical methods are summarized as follows: I. Surgical methods: All were performed by general anesthesia with double-lumen tracheal intubation, in the healthy-side position, and different positions were selected according to preoperative ultrasound localization, combined with X-ray films. Generally, we choose to make an incision between the 7th and 8th intercostal area between the anterior axillary line and the posterior axillary line, with a length of 1.5 cm, firstly, to attract some of the pleural fluid or cheese-like material, place the thoracoscope, perform a single-hole operation to deal with the fluid to separate and open the pleural fluid package, separate the pleural adhesion zone, peel the fiberboard Then, according to the situation during the operation, we can cut the second or third operation hole, and the instruments can be interchanged according to the operation, and insert the electrocoagulation hook The pleura was seen to be congested and edematous, with a large amount of fibrinous membrane attached, partly purulent changes and a large amount of adhesion zone formation and pleural hypertrophy, carefully peel off the pleural adhesion zone, open the separation and peel off the block friction, remove the exuded fibrinous membrane, aspirate the pleural fluid, peel off the pleural fibrous plate as much as possible during the operation, place closed drainage of the chest cavity, inject flushing fluid into the chest cavity and ventilate the affected side and then see the air leak on the surface of the lung tissue. Large air leaks were given lumpectomy sutures and small air leaks did not need to be treated, and the lungs on the affected side were observed for reopening after surgery. One drainage tube was placed at the first incision. The treatment effect of the group was analyzed by analyzing the intervention process, efficacy, and follow-up of the grouped patients. II RESULTS: The surgeries were completed successfully without serious complications and perioperative deaths, and the operative operating time ranged from 40 to 160 min, with an average of ( 65.5±26.2) min Intraoperative bleeding ranged from 50 to 200 ml, and none of them were transfused. Postoperative closed chest drainage tube placement time ranged from 4 to 9 d, with a mean of ( 4.5±1.7) d . The patients with thoracoscopic surgery were significantly relieved of dyspnea and chest tightness after surgery, and after active anti-tuberculosis treatment, the hospitalization period was shortened and the overall treatment cost was reduced compared with that of patients with surgically refractory tuberculous pleurisy, which reduced the economic burden of patients. After postoperative follow-up from 3 months to 2 years, we learned that the patients recovered well, the recurrence rate was very low, there was no history of recurrence of pleural effusion, all the compressed lungs were reopened ideally, the CT showed that the average pleural thickness was 1.23±0.10 mm, the thoracic deformity was aggravated in only one case, the rest of the rib space was relaxed and widened, and the intercostal nerve compression pain was relieved or disappeared. When the body is in a highly allergic state, tuberculosis bacilli and their metabolites invade the pleura, causing exudative pleurisy. In the early stage of pleural inflammation, pleural congestion and edema and leukocyte infiltration predominate, followed by lymphocytes becoming the majority, pleural endothelial cells falling off, and their surface There is fibrin exudation, followed by plasma exudation, forming pleural effusion, and the pleura is often formed by tuberculous nodules. The lesions are mostly unilateral, and there is a variable amount of exudate in the pleural cavity, usually plasma, occasionally blood or purulent. [1] At present, most domestic tuberculous pleural effusions are treated with repeated fluid extraction on the basis of effective anti-tuberculosis, sometimes with appropriate amount of glucocorticoids to reduce exudation. There are also methods of intrapleural injection of urokinase aimed at promoting the absorption of pleural fluid, and most of them can make the pleural fluid disappear and be cured by systemic anti-nuclear and timely fluid extraction, etc. Some patients have a large number of fibrin-like adhesions forming a parcel due to the limitation of pleural adhesions, and the pleural fluid should not be extracted due to pleural hypertrophy and the formation of encapsulated pleural fluid mainly due to the exuded large amount of fibrinogen forming fibrin ( fibrin The formation of encapsulated pleural effusion is mainly due to the formation of fibrin (fibrin) from a large amount of exuded fibrinogen, which covers the pleura, followed by fibrin mechanization and fibrous adhesions forming encapsulated pleural effusion, which is difficult to disappear clinically. Moreover, due to the prolonged course of the disease, the progressive aggravation of pleural adhesion thickening causes lung volume reduction, thoracic collapse, and pulmonary function involvement One study found that about 54% of patients with tuberculous pleurisy develop diffuse pleural hypertrophy, and pleural thickening is a unique risk factor for pulmonary function. Although some patients may later undergo fibrous plate debridement, the procedure is highly contingent, and the extent and scope of fibrous plate debridement is difficult to guarantee. Early intervention through thoracoscopy in the treatment of tuberculous pleurisy has significantly relieved postoperative dyspnea and chest tightness, shortened the period of hospitalization and anti-tuberculosis medication, greatly reduced the recurrence rate, achieved satisfactory results in terms of preventing pleural thickening and eliminating residual pleural fluid, effectively reduced the formation of tuberculous pustules in patients, prevented the need to perform more invasive pleural dissection and other procedures in the future, and also reduced The patient's economic burden was also reduced.