Esophageal cancer; intrathoracic anastomotic fistula; care. Postoperative anastomotic fistula is one of the major postoperative complications of esophageal cancer, but it is extremely rare, with an average incidence of 5% to 10%, and intrathoracic anastomotic fistula is even rarer, and the mortality rate can be as high as 28.5% to 71%. The nursing team plays a pivotal role in the treatment process,. In order to speed up the cure and improve the quality of life of patients, we have a specific nursing plan to provide comprehensive care to patients until they are cured. Careful nursing is an important part of the patient’s recovery. We have gained some experience to share with you. I. Clinical data From 2008 to 2013, 312 patients with esophageal cancer were admitted to our ward. 13 cases of anastomotic fistula occurred after surgery, including 9 cases of cervical anastomotic fistula and 4 cases of intrathoracic anastomotic fistula. 12 cases were cured after conservative treatment and 1 case was cured after secondary surgical treatment. The patients’ vital signs and changes in condition were observed. 1, basic care: First of all, the ward should be kept quiet, comfortable and clean. Patients with anastomotic fistula are wasted due to fasting and physical exertion. Patients should be turned frequently to give skin care, functional exercise, and topical application of ulcer patches to the bone ridge, and be turned once every 2 hours to prevent decubitus ulcers. UV disinfection should be carried out regularly in the ward to prevent the occurrence of infection. (1) Gastrointestinal decompression: Patients with anastomotic fistula are immediately given gastrointestinal decompression, which can reduce local edema and tension of the anastomosis, and can reduce the leakage of digestive fluid into the chest cavity, thus avoiding or reducing intrathoracic infection. Keep the drainage tube unobstructed to prevent folding, bending and pressure, and keep detailed and accurate records of the color, volume and nature of the 24h drainage during the period of gastric tube placement to keep abreast of changes in the condition. If necessary, the gastric tube should be intermittently suctioned, and the tube should be removed when the gastrointestinal function is restored according to medical advice. (2) Chest drainage tube care: maintain the effectiveness of drainage, properly fix the chest drainage tube to prevent twisting, pulling, slipping, and give semi-recumbent position if the patient’s condition allows, and closely observe the amount, color, nature and fluctuation of water column of drainage fluid. Keep the dressing of the local incision of the chest drain intact, clean and dry. The patient’s respiratory rate was closely observed during the lavage, and the patient was encouraged to take deep breaths and given back patting and coughing to expel sputum, which was conducive to the discharge of fluid in the chest cavity. Give the patient ultrasonic nebulizer inhalation three times a day to prevent the occurrence of intrapulmonary infection. (3) Care of jejunostomy port: The jejunostomy port is essentially for strengthening nutritional support and maintaining the patient’s thermal energy needs. There are also complications of enteral nutrition by nutrition tube, mainly bloating and diarrhea, which are related to the drip rate, concentration and temperature of nutrition solution, we think the 24h enteral nutrition solution for patients with jejunostomy tube is about 2000ml. the drip rate is about 20 drops per minute, if the drip rate is too fast, diarrhea and bloating will easily occur. The temperature of the nutrient solution is best controlled at 32℃~38℃, and zinc oxide ointment is applied around the fistula. (4) Oral care: Because of the patient’s long-term water fasting, weakness, resistance and inability to eat, bacteria tend to grow and multiply in the mouth causing oral infection. Therefore, oral care should be strengthened, and the mouth should be moistened with cotton swabs dipped in saline or coated with paraffin oil. 3.Correcting nutritional disorders Post-operative anastomotic fistula of esophageal cancer causes large amount of fluid loss and increase of protein catabolism, adequate nutrition is an important condition for the cure of anastomotic fistula. (1) Parenteral intravenous nutrition should be strictly implemented with aseptic technique, the daily amount of fluid is about 3000ml, and if necessary, plasma or red blood cells should be input. (2) Enteral nutrition generally has duodenal nutrition tube and jejunostomy. The patient has a self-contained jejunostomy tube. The purpose of the operation should be explained to the patient and family members before the enteral nutrition infusion, and it should be explained that the tube must be properly protected to avoid accidental extraction. In the application of enteral nutrition, attention should be paid to the speed, amount and temperature of the drip. The type of liquid to be infused: choose low-fat and low-sugar dregs-free liquid food rich in various vitamins, alternately infused with milk, soybean milk, rice soup, vegetable soup, chicken soup, fresh juice, etc. The daily supply of calories should not be less than 2000kcal, and the tube lumen should be flushed with 30-50ml of warm boiled water before and after each drip to prevent blockage. The gastrointestinal tract should be closely observed during the drip, and patients should be observed for abdominal distension, abdominal pain, diarrhea and other uncomfortable symptoms. The preparation apparatus should be boiled and sterilized for application to avoid infection. The jejunostomy port should be changed daily to keep it clean and dry, and the 24h in and out volume should be recorded daily. 4, the extraction of care chest closed drainage tube after removal should be closely observed whether the patient has chest tightness, dyspnea, incision air leakage, exudate, bleeding, subcutaneous emphysema, etc., found abnormalities immediately reported to the doctor. After the jejunostomy tube is removed, the local incision dressing should be kept intact without exudation and the medication should be changed regularly. The anastomotic fistula has an acute onset and is a serious condition, and patients often have different psychological disorders such as nervousness and anxiety, reticence and indifference. In response to these psychological states, patients should be comforted and explained patiently, explaining that anastomotic fistula is a possible complication of normal treatment after surgery, and that anastomotic fistula is easily curable and not life-threatening, and that health education should be provided orally, in writing, by demonstration, etc. The recovery of the same case can also be introduced to help patients build confidence in overcoming the disease. In the process of communication with patients, on the one hand, patiently listen to patients’ feelings and understand their pain; on the other hand, with a kin-like posture, language is used in a directly targeted or diversified form to inform patients and their families of good information and disease-related knowledge. Through subtle service, attentive service, perceptive service and smiling service to show humanized care, reflecting care and respect for patients, thus eliminating patients’ tension, anxiety and fear. Psychological care is a very important part of the whole disease treatment process, and successful psychological care is the key to overcome the disease. 6.Summary Postoperative anastomotic fistula is the most serious complication of esophageal cancer, with long course and high death rate. However, with careful treatment and care, the fistula healed within 20-45 days in 13 cases of this group and the patients were discharged. The above cases made us realize that rich clinical nursing knowledge and skillful nursing operation techniques are the basic requirements for nurses. If you find that the patient’s condition has changed, you should report it to the doctor in time, so that the doctor can grasp the first-hand clinical information to prescribe the right medicine and promote the recovery of the condition. In short, as a qualified nursing staff should also be familiar with psychological knowledge, do a good job of psychological guidance of patients, relieve the patient’s psychological pressure, and establish their confidence to overcome the disease, which is the most basic requirement for nurses in clinical care in the new era of holistic care.