There are various treatment methods for spontaneous pneumothorax, including conservative treatment, pleural puncture and aspiration, closed pleural drainage, pleural atresia, and surgery. Different treatment methods should be selected according to the condition, emphasizing individualization. (i) Oxygen inhalation The absorption rate of pleural cavity pneumothorax under oxygen inhalation is 3~4 times higher than that without oxygen inhalation (the absorption rate of pneumothorax without oxygen is about 1.25% per day), and the increase of absorption rate is more obvious when the volume of pneumothorax is large. Because oxygen inhalation increases the gas pressure gradient between the pleural cavity and the tissue, it promotes the absorption of nitrogen as well as other gases in the chest cavity. In addition, the occurrence of pneumothorax may be accompanied by ventilation/perfusion ratio imbalance, anatomical shunt and dead space, and the ventilation/perfusion ratio may temporarily deteriorate after drainage, and it takes 30~90 min to improve, which emphasizes the necessity of oxygen inhalation therapy. Therefore, oxygen inhalation should be the basic measure of pneumothorax treatment, and the usual amount of oxygen inhalation is 3L/min. (2) Simple observation Small amount of pneumothorax with <20% and no respiratory distress can be simply observed until it is absorbed by itself. To promote the absorption of pneumothorax, short-wave diathermy is an effective treatment option for small amount of spontaneous pneumothorax. This method can increase the local tissue temperature and blood flow, and the increased capillary blood flow in the pleura can promote the absorption of air in the pleura. On the other hand, according to molecular biology, the pressure of a gas is proportional to its temperature, so the thermal supply of the chest cavity causes an increase in the temperature of the intrapleural air, which in turn increases the intrapleural pressure, and can increase the pressure difference between the chest cavity and the thoracic capillaries, promoting gas absorption. Studies have shown that the average absorption rate of gas in the chest cavity can be increased by 2 times, shortening the course of treatment. Usually, ultrashort wave diathermy is used, 25 min per session, 1/d, 6 times as a course of treatment. (iii) Simple aspiration If the pneumothorax volume is greater than 20%, or although the pneumothorax volume is less than 20% but the patient has obvious symptoms, or if the absorption of pneumothorax is delayed after rest and observation, thoracentesis aspiration should be performed. After local disinfection and anesthesia, a small-sized catheter is placed in the second intercostal space in the midclavicular line, connected to a tee connector, and pumping is performed until gas cannot be pumped out or when sudden coughing occurs. Pumping connected to the pneumothorax machine can be performed with chest pressure measurement, and the amount of pumping is accurately recorded and stopped when the pleural cavity pressure drops to -2~-4cmh2o. The catheter is removed at the end of the operation. The advantage of this procedure is its simplicity and low cost. The disadvantage is that it does not prevent recurrence of pneumothorax. Chest tube treatment should be placed for those who fail in suction treatment. (iv) Closed chest tube drainage Closed chest tube drainage is simple and easy to perform, and is suitable for patients with primary spontaneous pneumothorax (psp) and most secondary spontaneous pneumothorax (ssp) who have failed by simple suction therapy, and is the most common method for treating various pneumothoraxes. After placing the chest tube, it can be connected with double bottle closure for continuous drainage. if it is ssp, especially secondary to COPD, the negative pressure can be gradually applied 20~30min after surgery, usually 3~17cmh2o, even up to 25cmh2o. the specific negative pressure size should be decided according to the implementation effect. Observe the air bubbles to determine the air leakage, stop suctioning after the bubbles disappear and close the tube for 24 h. If there is no pneumothorax on chest X-ray review, observe for 1 day and discharge. If pneumothorax still exists after 5~7 days of drainage, surgery or treatment by thoracoscopic spraying of talcum powder can be performed. It is also believed that persistent air leak after drainage >48h, regardless of psp or ssp, prolonged chest tube drainage and suction time is also difficult to make the air leak stop. Therefore, if the air leak does not stop after 48~72h of chest tube drainage, more aggressive treatment measures should be taken. (E) Pleural sclerotherapy (pleural adhesion) The recurrence rate of pneumothorax is high in women, long and thin men and smokers. In recent years, transthoracic injection of chemical drugs after cessation of gas leak and lung reopening is advocated to prevent recurrence of pneumothorax in high-risk cases. Whether or not the body position is rotated after drug injection does not affect the distribution of the drug in the chest cavity unless there is a large amount of gas that may prevent free distribution of the drug. The choice of drug needs to pay attention to the efficacy, application route and toxic reactions. In recent years, talc has the tendency to replace tetracycline in the treatment of pneumothorax, and according to the comprehensive analysis, the efficiency of preventing pneumothorax or pleural fluid recurrence is as high as 91%. Adverse reactions include fever (69%), chest pain (varying in severity) and pneumothorax (3%~11%). The commonly used dose is 5 g per dose, with the same efficacy as a dry powder spray or suspension injected into the chest cavity. Excessive doses may cause acute respiratory distress syndrome (ARDS), and the treatment failure rate is higher for pulmonary maculoplasm >2 cm in diameter. If the condition does not restrict the use of small bore chest tubes, pleural adhesions via small bore chest tubes have the same efficacy as large bore chest tubes. (vi) Surgical treatment Conventional dissection or thoracoscopic alveolar resection combined with mechanical pleural abrasion or pleural dissection or talcum powder pleural cavity spraying is the main means to prevent recurrence of spontaneous pneumothorax (sp). Indications include: persistent air leakage; recurrent pneumothorax; spontaneous bilateral pneumothorax; and patients with a first occurrence of pneumothorax but in a high-risk occupation, such as divers or pilots. Thoracoscopic methods to eliminate macrosomia include: electrocoagulation, laser, suture ligation, and endoscopic cutting and suturing. Recurrence is prevented by mechanical abrasion, filling with soluble or insoluble mesh, and injecting drugs or talcum powder to induce pleural sclerosis. Advantages of thoracoscopic surgical treatment compared to dissection include faster lung reopening, reduced risk of postoperative pulmonary insufficiency, less pain, and shorter hospital stay. Prospective studies with either dissection or VATS for persistent air leak ≥ 5 days sp showed that VATS > dissection in terms of operative time for both psp and ssp. Postoperative lung function loss was more pronounced in the dissection group, but there were no significant differences in postoperative morphine use, chest tube drainage and length of hospital stay, pneumothorax recurrence rate and mortality between the two groups. The treatment failure rates were 13% (4/30 cases) and 3.3% (1/30 cases) in the VATS group and the dissection group, respectively, both in psp patients; the pneumothorax recurrence rates after 15 months were 6.7% and 3.3%, respectively. Therefore, VATS is considered superior to dissection for psp only, while it is not reliable enough for ssp and may be beneficial only for patients who cannot tolerate dissection. A study with a mean follow-up of 4 years showed that the recurrence rate of pneumothorax after dissection combined with mechanical pleurodesis (apical and total) and herniotomy was <1%. 223 cases had 3.8% serious complications, including 3 deaths, all of whom underwent total pleurodesis, 4 cases of respiratory failure, and 2 cases of hemorrhage. The risk of complications was significantly increased in patients with COPD as their primary disease.