Abstract: Objective To compare effect of thoracoscope-assisted small incision surgery and traditional thoracotomy in the treatment of pulmonary bulla patients complicated with spontaneous pneumothorax. Methods Totally 80 pulmonary bulla patients complicated with spontaneous pneumothorax were divided into thoracoscope group(treated by thoracoscope-assisted small incision surgery)and thoracotomy group(traditional thoracotomy)according to different surgical methods, with 40 cases in each group. The general conditions, postoperative pain, lung function indexes ［forced expiratory volume in one second as a percentage of predicted value(FEV₁%), minute ventilation(MV), forced vital capacity(FVC), diffusion capacity for carbon monoxide of lung(DLCO)］ and complications were compared between the two groups. Results The operation time, intra-operative blood loss, postoperative extubation time and hospitalization time of thoracoscope group were significantly better than those of thoracotomy group(P<0.05). At 1, 3 and 7 days after surgery, pain scores in thoracoscope group were significantly lower than those in thoracotomy group(P<0.05). At 7 days after surgery, FEV₁%, FVC, MV and DLCO in both groups were significantly lower than those before surgery(P<0.05), and the degree of reduction in thoracoscope group was significantly less than that in thoracotomy group(P<0.05). The incidence rate of postoperative complications in thoracoscope group was significantly lower than that in thoracotomy group(12.50% vs. 37.50%, P<0.05). The two groups were followed up for 6 months, without recurrence of pneumothorax. Conclusion The thoracoscope-assisted small incision surgery is superior to traditional thoracotomy in treatment of pulmonary bulla patients complicated with spontaneous pneumothorax, which has advantages of mild - postoperative pain, quick recovery and few influence on lung function.