Abstract: OBJECTIVE To explore the value of thoracoscopy combined with pleural effusion gene-Xpert in diagnosis of tuberculous pleurisy. METHODS Totally 86 patients with suspected tuberculous pleurisy who were treated in the Respiratory Medicine Department 2 were enrolled in the study, all of the enrolled patients received the conventional examinations but could not be diagnosed. All of the patients underwent thoracoscopic pleural biopsy and pleural fluid gene-Xpert examination, and the specificity and sensitivity of the thoracoscopic pleural biopsy, pleural fluid gene-Xpert examination and the thoracoscopic pleural biopsy combined with pleural fluid gene-Xpert examination in diagnosis of tuberculous pleurisy were calculated. RESULTS Totally 66 of 86 patients were diagnosed with tuberculous pleurisy by the thoracoscopic pleural biopsy, 40 patients were detected with Mycobacterium tuberculosis by the pleural fluid gene-Xpert examination. The result of the thoracoscopic pleural biopsy combined with pleural fluid gene-Xpert examination indicated that 28 patients had tuberculosis, the result of the thoracoscopic pleural biopsy displayed chronic inflammation, and 12 patients were detected with M.tuberculosis by the pleural fluid gene-Xpert gene examination. The sensitivity of the thoracoscopic pleural biopsy combined with pleural fluid gene-Xpert examination was 81.94% in diagnosis of tuberculous pleurisy, the specificity 71.43%, the accuracy 80.23%; the specificity and sensitivity of the thoracoscopic pleural biopsy combined with pleural fluid gene-Xpert examination were higher than those of the single thoracoscopic pleural biopsy or pleural fluid gene-Xpert examination. The 72 patients with tuberculous pleurisy were given the standard antituberculous therapy, and the follow-up showed that there was no case of recurrence. CONCLUSION The thoracoscopic pleural biopsy combined with pleural fluid gene-Xpert examination may facilitate the rapid and accurate diagnosis of the tuberculous pleurisy, provide guidance for effective treatment in early stage and improve the prognosis of the patinets.