Pleural effusion is a pathological change of tuberculous pleurisy, which is an inflammation of the pleura caused by the entry of tubercle bacilli and their metabolites into the pleural cavity of an organism that is in a highly allergic state. When the body is in a highly allergic state and the tuberculosis bacilli and their metabolites invade the pleura, exudative pleurisy is caused. In the early stage of pleural inflammation, pleural congestion, edema and leukocyte infiltration predominate, then lymphocytes turn into the majority, pleural endothelial cells are shed, fibrin exudates from its surface, followed by paddle fluid 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, which is usually plasmacythematic, occasionally bloody or purulent. Tuberculous pleural effusion accounts for 5% of pleural effusions. There are many ways to deal with pleural effusions, either by thoracentesis with intrapleural medication or by cannula closed puncture with simple chest drainage. However, once the encapsulated effusion is formed, the conventional treatment is not effective. The application of total thoracoscopy for the treatment of tuberculous pleural effusion has become a conventional treatment, and its clinical effect is significantly better than other treatments, which we have also experienced. 1, the timing of surgery: the majority of patients with tuberculous pleural effusion can choose television thoracoscopic treatment, and the efficacy is better. However, the treatment effect varies greatly from one period of onset to another, and the variability of healing is also great. We found that patients with onset between 3-6 weeks and more than 3 weeks of standardized anti-tuberculosis treatment and disappearance of symptoms of tuberculosis toxicity have good clinical results with the choice of surgery. Among the five cases in which patients in our group had a lot of postoperative drainage and could not be extubated early, except for one case in which thoracic duct injury was considered, all of them were patients with an irregular antituberculosis treatment within 2 weeks of onset and a strong positive combination bacteriocin test. In our group, a total of 6 patients with postoperative pulmonary air leak and thoracic cavity infection were all patients with onset of disease more than 2 months ago, heavy thoracic adhesions, large amount of caseous material, difficulty in stripping the pleural fiber plate, poor pulmonary reopening, and inability to effectively fill the thoracic cavity. Therefore, we believe that if the preoperative diagnosis is clear and abscess thorax and tumor can be excluded, anti-tuberculosis treatment should be standardized for 3 weeks, the symptoms of tuberculosis toxicity disappear, and the onset of disease in 3-6 weeks is the best time to choose total thoracoscopic treatment. In contrast, patients with pleural hypertrophy and obvious calcification are more difficult to apply thoracoscopic treatment. We performed thoracoscopic treatment in 23 patients with pleural hypertrophy and obvious calcification, only 5 cases were completed under full thoracoscopy, and the remaining 18 cases were selected for adjuvant small incision or intermediate open-heart surgery. 2. Surgical operation hole selection: By comparing 100 patients who chose full thoracoscopic treatment, it was found that 28 cases were operated by single-incision hole, of which 25 cases had onset within 6 weeks and 3 cases had onset within 6 months. In contrast, 21 cases were operated by triple incision, all of which had onset of disease for more than 6 months. For the selection of incision we think that according to the preoperative CT positioning, the lowest part of the effusion, especially the encapsulated effusion, should be chosen as the observation and operation hole, and the single hole operation can be done as much as possible, and with the increase of cases, some encapsulated effusion with heavy thoracic adhesions can also be done in the single hole. When cutting the second and third holes should be done under thoracoscopic observation to prevent serious air leakage due to lung injury, do not do three holes at the same time, but open the third hole when two holes are difficult to operate, which can also reduce lung injury. When choosing the operation hole, give full consideration to the need for auxiliary small incision or intermediate open chest incision selection. 3, dirty layer pleural fiber plate and lung air leak treatment: preoperative disease duration is long, pleural hypertrophy is obvious, patients with pleural calcification, pleural fiber plate stripping difficulties, a place can be found for the breakthrough, often sharp stripping at the interlobular lung and then blunt stripping with a suction device. Once a pulmonary air leak is caused, a small amount of postoperative drainage can heal, and in large amounts, the pleura can be sutured thoracoscopically. When pleural fibrous plate stripping is particularly difficult, an adjuvant small incision or intermediate open thoracotomy can be chosen. However, we found that in order to reduce side injuries, we should not forcibly peel off the pleural fibrous plate, and through repeated chest irrigation and placement of drainage, postoperative pleural hypertrophy, thoracic collapse, and mediastinal movement can also make the residual cavity disappear, and even if a small amount of residual cavity remains, as long as the postoperative anti-tuberculosis treatment is adequate, standardized, and effective, the healing can be good. In conclusion, for tuberculous pleural effusion, both preoperative and postoperative anti-tuberculosis treatment is very important, and no matter what kind of treatment method is adopted, anti-tuberculosis treatment is the key to determine the prognosis. Therefore, when we treat tuberculous pleural effusion in the clinic, for patients who have no symptoms of tuberculosis poisoning after early anti-tuberculosis treatment or patients with long-onset encapsulated effusion, choosing total thoracoscopy is a simple, minimally invasive and effective method.