Abstract: Abstract Objective: To compare pleural abrasion\talc slurry and pleural abrasion plus talc slurry in the treatment of spontaneous pneumothorax. Methods: Between January 2009 and February 2011, 180 patients among indicated surgical treatment for spontaneous pneumothorax in our hospital allowed this prospective study. The patients were randomly assigned to 3 groups: pleural abrasion (group A, n=61), talc slurry (group B, n=61), and pleural abrasion plus talc slurry (group C, n=58). The variables studied were recurrence, surgical time, morbidity and post-operative hospital stay, postoperative chest drainage, parenteral analgesics. Statistical analysis was done by ANOVA ,Bonferroni test、χ2 test (SSPS 17.0). Results: Statistically significant differences were observed in the variables: surgical time (A: 51.64 ± 6.17; B: 42.79 ± 8.14 ;C：55.09 ± 8.40 min P <0.001); post-operative hospital stay (A: 5.95 ± 2.35; B: 5.10 ± 0.98;C: 5.21 ± 1.81d P = 0.008), Parenteral analgesics (frequencies/patient) (A: 2.48 ± 0.595; B: 2.61 ± 0.737;C :4.34 ± 0.637 P < 0.001); Rate of fever (>38.0°C) (A: 38; B: 41; C: 55 P < 0.001); Rate of fever (>38.5°C) (A:3; B: 4;C: 14 P<0.001);apical air camera (A: 9; B: 2; C: 2 P =0.026); pleural effusion (A: 7; B: 1; C: 2 P = 0.046). Conclusions: Talc slurry shows shorter surgical time and post-operative hospital stay, Morbidity is higher in patients with pleural abrasion . Parenteral analgesics, Rate of fever (>38.0°C ,>38.5°C) are higher in patients with pleural abrasion plus talc slurry. Statistically significant differences were not observed in recurrence, persistent air leaks>5days, atelectasis , empyema and haemothorax. Thus we recommend talc slurry as the first priority for the treatment of spontaneous pneumothorax in the Video-assisted thoracoscopic surgery.