Objective To compare the effects of different pleural fixation methods in thoracoscopic lung cancer surgery and investigate their significance for rapid rehabilitation surgery. Methods A total of 100 lung cancer patients with a high risk of postoperative lung air leakage from October 2023 to May 2024 were selected as study subjects, and randomly divided into two groups with 50 cases in each group. Both groups underwent preventive pleuropexy during thoracoscopic surgery. The control group was only subjected to simple gauze ball friction on the pariferus pleura, and the observation group was additionally subjected to 50% hypertonic glucose solution 100 mL+2% lidocaine 5mL spray evenly on the lung surface and wound surface. The incidence, degree, duration of lung air leakage, retention time of thoracic drainage tube, and incidence of complications were compared between the two groups. Results The incidence of postoperative pulmonary air leakage in the observation group was lower than that in the control group （P<0.05）, but the degree of air leakage was not statistically different between the two groups （P>0.05）. The duration of postoperative lung air leakage and retention time of thoracic drainage tube in observation group were shorter than those in control group, and the incidence of chest pain was lower in the observation group than in control group （P<0.05）. Conclusion The application of 50% hypertonic glucose solution combined with 2% lidocaine for spraying lung surface and wound surface in thoracoscopic lung cancer surgery can effectively prevent postoperative lung air leakage, reduce the risk of persistent lung air leakage, and help shorten the retention time of thoracic drainage tube.