Objective To observe the changes of the clinical indicators and hemodynamics in patients applied to the thoracoscopic radical esophageal malignancy surgery under carbon dioxide pneumothorax in general anesthesia with visual bronchial closure tube or single-lumen tracheal catheter, to evaluate the advantages and safety of anaesthetic method with visual bronchial closure tube in this type of operation. Methods A total of 60 patients who underwent elective thoracoscopic radical esophagectomy in Anyang Tumor Hospital from January 2019 to November 2021 were selected as the research subjects, and they were divided into single-lumen endotracheal tube group (group S) and visual bronchial occlusion tube group (group V) by completely random number table method, with 30 cases in each group.All patients received general anesthesia,in group S,the single-lumen endotracheal tube was intubated into the main trachea.Group V was intubated to 3 cm aove the carina of the main trachea under visualization, after seeing the carina, the occluder cuff was accurately positioned to the bronchial opening under the carina on the affected side.During the operation, mechanical ventilation was suspended at an appropriate time, at the same time carbon dioxide (CO2)gas(3-7 L/min)was slowly filled into the thoracic cavity of the operation side within the specified time,and the intrathoracic pressure was maintained at 3-7 mmHg (1 mmHg=0.133 kPa), in order to collapse the affected lung and achieve onelung ventilation.In group V, the occluder cuff was properly inflated after the lung collapsed on the operation side.Indicators of clinica include Blood pressure (BP), heart rate (HR), pulse blood oxygen saturation (SpO2), central venous pressure (CVP), and peak airway pressure (Paw), end-tidal carbon dioxide partial pressure (PetCO2), and arterial blood gas were collected at 5 min before pneumothorax (T1), 5 min after pneumothorax (T2), 15 min after pneumothorax (T3),30 min after pneumothorax (T4), 60 min after pneumothorax (T5), 100 min after pneumothorax (T6).The CO2 pressure injected into the thoracic cavity of the operation side, CO2 pneumothorax time, operation time, ICU treatment time,hospitalization time, and hospitalization expenses were also observed and studied in the two groups. Results All cases were successfully completed by thoracoscopic operation, significant arrhythmias and severe complications were not found at each time point.The CVP, Paw, PetCO2 on T2, T3, T4, T5 and T6 of the two groups were higher than those of T1,BP, HR, partial pressure of blood oxygen (PaO2) and pH on T2, T3, T4, T5 and T6 were lower than those of T1, the differences were statistically significant (P＜0.05).The CVP, Paw and PetCO2 on T2, T3, T4, T5 and T6 in group S were higher than those in group V, the differences were statistically significant (P＜0.05).PaO2, pH value on T2, T3, T4, T5 and T6 in group S were lower than those in group V, and HR on the T3 was higher than that in group V, diastolic pressure on the T3, T4 was lower than that in group V, the differences were statistically significant (P＜0.05).SpO2 between the two groups was not significant difference (P＞0.05).The CO2 inflation pressure and hospitalization expenses in group S were higher than those in group V, the CO2 pneumothorax time and hospital stay in group S were longer than those in group V, the differences were statistically significant (P ＜0.05). Conclusion The application of carbon dioxide pneumothorax under general anesthesia with visual bronchial occlusion tube in video-assisted thoracoscopic radical esophageal cancer anesthesia was easy to operate, reduces the pressure of carbon dioxide insufflation, and control the hemodynamics of patients during the operation.This method had its unique advantages and safety, and was more suitale for it to promote to primary clinics.