1, The anastomosis method and operation technique is one of the main factors in the occurrence of postoperative anastomotic fistula. 2.Infection and malnutrition failure are the main causes of death. 3, Three tubes (chest tube, gastric tube, nutritional tube) are unobstructed is the key to treatment. 1 Data and methods 1.1 Clinical manifestations and diagnosis Clinical manifestations vary according to the anastomosis site and the time of fistula occurrence. Early intrathoracic fistula mostly occurs in 3~6 days after surgery, with severe symptoms, elevated temperature of 39 or more, which is not easy to be controlled by simple antipyretic drugs, accelerated pulse and heart rate, chest pain, chest tightness, and respiratory distress. Auscultation on the side of the breath sounds weakened, percussion local turbidity or drum sound, thoracic puncture can be extracted gas and turbid acidic thin pus or gastric fluid. Blood tests show elevated white blood cells, mainly neutrophils, X-ray fluoroscopy imaging to see the contrast agent from the anastomosis spill can be confirmed. The later the fistula occurs, the more mild the symptoms, some only manifested as persistent low-grade fever, contrast examination can be found small fistula. In this group, there are three cases of advanced small fistula, two of which do not have any symptoms, routine anastomosis imaging found linear fistula, no obvious inflammation around the shadow, a case of persistent low fever, imaging found small fistula and anastomosis next to the diameter of about 2.0cm wrapped small pus cavity, change position, contrast medium can be returned to the stomach. Cervical anastomotic fistula systemic symptoms are not obvious, there may be elevated body temperature, leukocytes, local redness, swelling, heat, pain, after incision of putrid pus, gastric fluid, saliva and/or gas spillage can be diagnosed. 1.2 Treatment methods According to the time of anastomotic fistula, site, fistula size and the patient’s general condition to adopt different treatment methods. Thoracic larger early fistula symptoms are more serious, data show that the mortality rate is very high [4], the treatment of early should be mainly anti-infection, first of all, chest tube drainage and gastric tube decompression suction, the two tubes of effective drainage can make the systemic symptoms of toxicity in the 3~5 days significantly reduced, followed by effective antibiotic treatment should be given. After the infection is basically controlled, supportive therapy should be given. Before the gastrointestinal function is normalized, intravenous nutrition is the mainstay, and after it is normalized, nutrient solution is injected into the nutrient tube (the nutrient tube is pre-positioned in the anastomosis during the operation, the distal end is placed in the distal part of duodenum, and the proximal end is guided to the outside of the body through the anastomosis with the gastric tube from the nostril). Nutrient solution should be rich in animal and plant proteins, fats, multivitamins and trace elements. In this group, three cases of small intrathoracic fistula were not performed thoracic drainage, only dietary restrictions, gastric tube decompression and nutritional tube supportive therapy, and soon healed. Cervical anastomotic fistula should be incised to drain adequately, prohibit diet, gastric tube decompression and nutritional tube support therapy. This group of 148 cases of anastomotic fistula in the course of treatment were not taken esophagogastric re-anastomosis and fistula repair, and did not carry out jejunostomy. In 7 cases, the injected nutrient solution refluxed heavily and was sucked out from the gastric tube, and it was found that the nutrient tube was too shallow or had been returned to the stomach by imaging, and the nutrient tubes were repositioned far away from the ligament of Trichophytosis under fluoroscopy via guidewire, so as to avoid nutrient solution reflux. 2 results 148 cases of anastomotic fistula in this group, except for 1 case of combined type II diabetes mellitus, and allergic to a variety of antimicrobial agents, secondary to double lung infection and incision infection, failed to effectively control, died of infectious shock and multiple organ failure 15 days after fistula, the remaining 147 cases were cured. Hospitalized 22-68 days, the average hospitalization of 46 days, discharged in March, September follow-up are not abnormal. 3 Discussion 3.1 Pathogenesis of anastomotic fistula (1) anastomosis mode and skills: the current esophagogastric anastomosis mode is diverse, it is reported that in recent years the use of anastomosis mechanical anastomosis is more and more. This group all manual anastomosis, most of the esophagus – gastric mucosa suspended into the gastric cavity type anastomosis (the incidence of anastomotic fistula 0.87%) [5]. We believe that: rough intraoperative operation, uneven edge alignment, too sparse or too dense needle spacing, too narrow margins, too loose or too tight wire knots, local contamination, etc., are important causes of anastomotic fistula. (2) Poor blood flow in the anastomotic area: intraoperative gastric omentum right blood vessel injury, distortion, compression, and submucosal hematoma in the anastomotic area can cause poor healing. (3) Excessive anastomotic rise: neck anastomosis or intrathoracic anastomosis with too small residual stomach can affect healing due to high tension. The incidence of cervical anastomotic fistula in this group was 8.8 times of the intrathoracic incidence, which was related to the high tension of cervical anastomosis. (4) Local inflammation: inflammation and edema in the anastomotic area and tissue necrosis can cause anastomotic fistula. 3.2 Causes of death of anastomotic fistula Infection and malnutrition failure are the main causes of death of anastomotic fistula. Early large anastomotic fistula in the chest, if it can not be effectively drained in time, most of the serious systemic toxic symptoms, infectious shock, and even death. Afterwards, most of them can not be sufficient to supplement calories, long-term malnutrition, resulting in multiple organ failure and death. Elderly and frail, combined with diabetes, heart, lung, liver, kidney dysfunction disease, anastomotic fistula mortality is higher. Thoracic late small fistula, especially if the package has been limited to the linear fistula, neck anastomotic fistula, generally do not cause death. 3.3 The treatment of anastomotic fistula Previously reported anastomotic fistula mortality rate is very high, generally 40-60%, the mortality rate of this group is only 0.68% (1/148), we believe that the key to treatment is to control infection and supportive therapy, infection control should focus on smooth drainage, while the gastric tube decompression suction, minimize gastric contents from the fistula overflow, the use of effective antibiotic therapy, most of them can pass through the infection smoothly, the majority of the time, but also the majority of the patients can be treated with antibiotics. Most of them can pass through the infection smoothly; then supportive treatment becomes the main problem of treatment, early blood transfusion or transfusion of albumin, fat milk, etc., but the economic cost is heavier, long-term use, the majority of patients can not afford it, through the nasal small intestine nutrient tube to give nutrient solution is both economic and effective support method.