Spontaneous hemopneumothorax is a relatively rare thoracic surgical emergency, the condition is dangerous, timely diagnosis and early treatment is the key to reduce mortality and complications. The causes of bleeding in spontaneous hemopneumothorax are mainly divided into three categories: 1, lung tissue atrophy during pneumothorax, resulting in bleeding from small blood vessel tearing in the adhesion zone between the dirty and wall pleura, the formation of this adhesion zone is related to recurrent episodes of previous pneumothorax and inflammatory reaction in the thoracic cavity, which is also the most common cause of spontaneous hemopneumothorax; 2, bleeding from rupture of small blood vessels located in the wall of the pulmonary blister when the pulmonary blister ruptures; 3, bleeding from rupture of small blood vessels between the pulmonary blister and the wall pleura The presence of congenital ectopic blood vessel rupture bleeding. When a normal blood vessel ruptures, the severed end can contract and curl to promote coagulation, while the small blood vessels leading to spontaneous hemopneumothorax lack the ability to contract and curl after rupture due to the lack of smooth muscle fibers or mucus degeneration in the wall, and at the same time the lung tissue is compressed and atrophied during pneumothorax, which cannot play the role of compression and hemostasis on the bleeding site, so the bleeding is not easy to stop by itself and requires early surgical intervention and treatment. The clinical manifestations of patients with spontaneous hemopneumothorax are mainly chest pain and dyspnea in the early stage, which cannot be easily distinguished from the general pneumothorax symptoms. With the gradual increase of bleeding, hypovolemic shock manifestations, such as dizziness, palpitations, and decreased blood pressure, may appear. Since the human body can physiologically compensate by increasing cardiac output, constricting peripheral capillaries and increasing renal reabsorption when the effective circulating blood volume decreases, the shock symptoms are not typical in the early stage of the patient’s illness, and the hemoglobin level can be maintained in the normal range, which does not reflect the real blood loss of the patient. Therefore, combining with medical history, observing the dynamic changes of blood pressure and hemoglobin concentration of patients, performing closed chest drainage early after clear diagnosis, and observing the changes of chest drainage flow per unit time can determine the severity of the disease timely and accurately. Some patients with spontaneous pneumothorax can be accompanied by exudation in the pleural cavity, which also appears as liquid pneumothorax on imaging, but the amount of fluid accumulation is less than that of spontaneous hemopneumothorax, usually less than 400 ml, and can be clearly identified after closed drainage of the chest cavity. For spontaneous hemopneumothorax, treatment measures include thoracentesis, closed drainage of the chest and surgery. Thoracentesis requires repeated air and fluid extraction, which is likely to cause damage to intercostal vascular nerves and lung tissues, long treatment period, and difficult to drain the accumulated blood. It is now recognized that patients with spontaneous hemopneumothorax who meet the following conditions should be treated surgically: 1, the patient has hypovolemic shock manifestations, with systolic blood pressure less than 90 mmHg; 2, there is active bleeding in the thoracic cavity after closed chest drainage, and the volume of chest drainage is greater than 100 ml per hour; 3, the continuous air leakage after closed chest drainage is greater than 7 days; 4, the blood accumulation in the thoracic cavity occurs mechanization, fibrous plate formation, resulting in restrictive ventilation disorder. However, it is controversial whether surgical treatment should also be actively taken for other patients. Some scholars believe that adequate chest drainage, blood transfusion, and application of hemostatic drugs can avoid the blow of surgical trauma, and for the purpose of adequate drainage, a thick drainage tube with a diameter greater than 1 cm should be used to drain the accumulated blood, and a second drainage tube to drain the gas should also be placed in the upper part of the chest cavity, i.e., the double-tube method of drainage. The limitation of the location of the drainage tube in the treatment of spontaneous hemopneumothorax is that it is difficult to achieve satisfactory drainage of both gas and blood in the chest cavity, and the retention of multiple drainage tubes will aggravate the pain and discomfort of patients, and it is difficult to completely remove the clot in the chest cavity by simple drainage, which will cause restrictive ventilation obstruction once the fibrous plate is formed by mechanization; for the lesion of pulmonary herpes is not treated, the long time The air leakage makes the chest drainage tube stay longer, increasing the chance of chest infection and high recurrence rate of pneumothorax in the future. According to the literature, patients with spontaneous hemopneumothorax are mostly young people between 20 and 40 years old, in good general health, without serious concomitant diseases, and with a long expected survival period in the future. To ensure the quality of life of patients in the future, surgical treatment should be actively taken at an early stage to effectively stop the bleeding under direct vision, reduce the amount of blood transfusion, and shorten the hospitalization period; thoroughly remove the accumulated blood in the chest cavity to avoid the formation of fibrous plates, and promote the lung tissue Complete blood collection in the chest cavity should be removed to avoid the formation of fibrous plate and to promote lung tissue reopening to restore lung function; at the same time, the lesion of pulmonary blister should be removed to reduce the possibility of pneumothorax recurrence. The current surgical approach for spontaneous hemopneumothorax uses the television thoracoscopic technique (VATS). TV thoracoscopy can effectively reduce the blow of surgical trauma. Compared with traditional open-heart surgery, TV thoracoscopic surgery has light postoperative pain, short hospitalization period, fast recovery of lung function, and meets cosmetic requirements.