Objective:To compare the postoperative recovery between non-intubated spontaneous ventilation (NISV) anesthesia and endotracheal intubation (ETI) general anesthesia in children undergoing thoracoscopic surgery.Methods:This retrospective study included 260 children undergoing elective thoracoscopic resection of pulmonary or mediastinal lesions at the Capital Children′s Medical Center, Capital Medical University between June 2024 and October 2025. Patients were classified into the NISV group ( n=86) and ETI group ( n=174). Propensity score matching was performed to balance age, sex, body weight, American Society of Anesthesiologists physical status, surgical site, and laterality between the two groups. After 1∶1 matching, 86 patients were included in each group. The primary outcome was postoperative length of stay. Secondary outcomes included chest drain duration, postoperative pulmonary complications, intraoperative respiratory parameters, time to removal of the airway device, post-anesthesia care unit stay, emergence delirium and hospitalization costs. Results:Baseline characteristics were well balanced after matching. Compared with the ETI group, the NISV group had a shorter postoperative length of stay [3.0 (3.0, 4.0) vs 4.0 (3.0, 5.0) days; Hodges-Lehmann (HL) difference=-2.0 days, 95% CI -2.5 to -1.0, P<0.001], a shorter duration of chest drain [2.0 (0, 3.0) vs 2.5 (2.0, 4.0) days; HL difference=-1.5 days, 95% CI -2.5 to -1.0, P<0.001], and a lower incidence of postoperative pulmonary complications [0 vs 7.0% (6/86); risk difference=-7.0, 95% CI -12.8 to -2.3, P=0.041]. The NISV group had higher lowest SpO 2 and peak EtCO 2, shorter time to airway-device removal, and lower hospitalization costs (all P<0.05). Conclusion:Compared with ETI general anesthesia, NISV anesthesia in pediatric thoracoscopic surgery can shorten postoperative length of stay and the duration of chest drain placement, reduce the incidence of postoperative pulmonary complications, and help promote postoperative recovery in children.