Objective:To investigate the therapeutic characteristics and efficacy of televised thoracoscopic surgery versus standard dissection for the treatment of pulmonary herpes. Methods From May 1995 to August 1998, a total of 68 patients with symptomatic non-pneumothoracic pulmonary herpes underwent thoracoscopic resection of pulmonary herpes, and a total of 31 patients with pulmonary herpes underwent dissection of pulmonary herpes during the same period from 1994 to 1998. The surgical trauma, bleeding, postoperative pain and long-term outcome of the cases in the two groups were compared. Results The VAT group showed significant differences in intraoperative bleeding, postoperative pleural fluid volume, postoperative dose of dulcolax pain relief, postoperative symptom improvement and prevention of postoperative pneumothorax attacks compared with the open group. Conclusion VAT surgery is less invasive, less bleeding, and has a lower rate of postoperative pneumothorax attacks than dissection in the treatment of pulmonary maculoplasm. Pulmonary herpes are commonly found in patients with chronic obstructive pulmonary disease. With the enlargement of pulmonary blisters, patients may experience progressively more active shortness of breath, chest tightness, and, in severe cases, pneumothorax attacks. Since the introduction of VATS, more and more patients and surgeons are willing to accept this less invasive surgical procedure. From May 1995 to August 1998, a total of 68 patients with symptomatic non-pneumothoracic pulmonary herpes underwent VAT surgery, and a total of 31 patients with pulmonary herpes underwent dissection from 1994 to August 1998. We compared these two groups of patients regarding surgical invasiveness, bleeding volume, chest tube residence time, postoperative pain and long-term outcome as follows. Data and methods:General data Inclusion criteria:Patients with respiratory symptoms, unilateral or bilateral pulmonary herpes suggested by chest radiography, and no pneumothorax attack at that time.68 cases in the VAT group were 63 men and 5 women, aged from 31 to 72 years old, with a mean age of 52.5 years. There were 35 cases with chronic cough, 17 cases with chest tightness, 31 cases with shortness of breath after activity, and 25 cases with previous pneumothorax episodes. 16 cases of left-sided pulmonary herpes, 27 cases of right-sided pulmonary herpes, and 25 cases of bilateral pulmonary herpes were found on X-ray or CT examination, suggesting a combination of 34 cases of old pulmonary tuberculosis in the apical part of the lung. There were 29 cases of pulmonary herpes larger than 1/4 of one side of the chest cavity and 7 cases larger than 1/2. In the dissected chest group, there were 31 cases, 27 men and 4 women, aged 28-69 years, average 47.3 years, with chronic cough in 12 cases, chest tightness in 11 cases, shortness of breath after activity in 15 cases, pneumothorax episodes in 13 cases, X-ray examination suggesting pulmonary herpes on the left side in 9 cases, on the right side in 13 cases, bilaterally in 9 cases, old combination in the apical part of the lung in 17 cases, pulmonary herpes larger than 1/4 of one side of the chest cavity in 15 cases, larger than 1/ 2 thoracic cavity in 2 cases. Surgical methods:Both groups of patients were anesthetized with double-lumen tracheal intubation complex. In the open-chest group, a conventional posterior lateral standard dissecting incision was made and the chest was entered at the 4th or 5th intercostal space, and after free exposure of the pulmonary herpes, the giant pulmonary herpes was excised by clamping at the bottom, with crossed mattress sutures at the cut edge or continuous double sutures with acrylic thread, ligation or suturing of the scattered narrow pulmonary herpes, and wedge-shaped excision of the wide base pulmonary herpes. There are three types of surgical incisions in the VAT group: A: conventional three-incision approach, i.e., thoracoscopy at the 7th intercostal space in the mid-axillary line, a 2-cm incision in the 3rd or 4th intercostal space in the anterior chest, and a small 0.5-cm incision in the posterior chest wall in the same intercostal space as the thoracoscopic incision. This type of incision is mainly used for patients with large pulmonary herpes and few adhesions.B: Combined with a triple incision using a needle thoracoscope, that is, except for the incision into the thoracoscope, which is 2 cm, the other two incisions are 0.5 cm incisions. This type of incision is mainly used in younger patients without adhesions who have slightly smaller pulmonary blisters.C: A three-incision approach with an auxiliary 3- to 5-cm incision in the anterior chest. This type of incision is mainly used in patients with old union and more extensive adhesions. Pulmonary maculoplasty was performed using endoscopic cutting anastomotic staple occlusion with silk 8-string sutures, and in patients with severe emphysema the edges of the sutures were sprayed with bio-closure gel and talcum powder after chest wall friction. Results:There were no surgical deaths in either group. There were 3 cases of postoperative complications in the dissected chest group, 1 case of gastrointestinal bleeding, 1 case of postoperative bleeding with reopening of the chest to stop the bleeding, and 1 case of ventricular arrhythmia. 5 cases of postoperative complications in the VAT group, including 2 cases of ventricular arrhythmia, 1 case of mild cerebral infarction without sequelae, and 1 case of diplopia pulmonary edema after resection of the right giant pulmonary blister, which recovered by mechanical ventilation for 2 days. The other case had poor pulmonary reopening and was discharged after surgery with VAT surgery to release the adhesions and continuous negative pressure suction after surgery, and the lung was completely expanded.