Overview: Esophageal cancer is a common digestive tract tumor, which is more common in the middle esophagus, followed by lower esophagus and less common in the upper esophagus; most of them are squamous epithelial cell carcinomas; the clinical manifestations are progressive dysphagia, and pneumonia will occur if reflux is mistakenly inhaled into the trachea, and those with serious obstruction will have a foul smell in the expiration, lowered appetite, and loss of weight; the diagnosis can be confirmed by gastroscopy; surgical resection is the first choice of treatment. Xu Bing II, Pre-operative Nursing 1, Psychological Nursing Patients with esophageal cancer are often anxious about the progressively aggravating eating difficulty and decreasing weight; they have partial or more comprehensive knowledge about the disease and eagerly hope for early surgery to resume eating. However, they are worried about anesthesia and surgical accidents, whether the lesion can be completely removed, possible postoperative complications and the quality of life in the future and show increasing tension, fear, insomnia, loss of appetite, and even depression. Nurses should strengthen communication with patients and their families to understand the degree of cognition and psychological status of patients and their families about the disease and surgery. Implement patient psychological counseling according to the patient’s specific situation. Explain and provide knowledge and precautions related to surgery and various treatments, etc., to reduce their adverse psychological reactions as much as possible. Create a quiet and comfortable environment for the patient; use sleeping, sedative and analgesic drugs when necessary to ensure that the patient has sufficient rest. Strive for relatives in the psychological and economic aspects of active support and cooperation, relieve the patient’s worries. 2.Nutritional support Strengthen the nutrition of those who can still eat, should be given high-calorie, high-protein, high-vitamin fluid or semi-liquid diet. Those who can not eat should be given intravenous supplemental water, electrolytes and calories. Patients with hypoproteinemia should be corrected with blood or plasma protein transfusion. 3.Respiratory preparation Before operation, patients should be advised to quit smoking strictly, strengthen the expectoration, and use antibiotics to control infection. Train patients to cough effectively and abdominal deep breathing, in order to facilitate the postoperative relief of wound pain, active sputum expectoration. And actively treat chronic oral diseases, maintain oral hygiene. Brush teeth in the morning and evening, rinse the mouth after meals, and rinse the mouth after vomiting, to eliminate oral odor and improve appetite. 4. Gastrointestinal preparation: patients with obstruction and inflammation of esophageal cancer should take oral antibiotics as prescribed by doctor before operation; they should eat liquid food three days before operation and take enema one night before operation; patients with test tube surgery should take enema once a night for three days before operation, and clean enema in the morning of operation; gastric tube should be routinely placed in the morning of operation, and it should not be forced to enter when passing through the obstructive part so as not to poke through the test tube. 5. Skin preparation: Shave the skin of the surgical area, pay attention to not shaving the skin. Scope: anterior thoracic midline to posterior spinal line on the operative side, including the axilla, and up from the level of the clavicle to the subxiphoid process. Postoperative care 1, vital signs monitoring According to the general anesthesia postoperative care routine, early observation of vital signs, once every thirty minutes, once every one to two hours after the smooth. 2, respiratory care After waking up from general anesthesia, immediately encourage patients to cough and deep breathing, in order to form the respiratory tract impact, so that secretion discharge; to ensure that the air circulation in the ward, open the window at least twice a day, each time for thirty minutes. At the same time, limit the accompanying and visiting people; within twenty-four to forty-eight hours after the operation, assist the patient to cough and take deep breaths every one to two hours, give the correct back clasp, and with the help of gravity and shock force, make the secretions adhering to the respiratory tract loosen and fall off, in order to facilitate drainage; oxygen inhalation: continuous oxygen inhalation of 4-6L/min, in order to maintain the effective respiratory function; dilute the sputum: if the patient If the respiratory secretion is sticky, chymotrypsin, dexamethasone, antibiotics and other drugs can be used for ultrasonic nebulization to dilute sputum, anti-inflammatory and antispasmodic purposes. 3, closed chest drain care Maintain the drainage tube open, observe the amount and nature of drainage fluid, and record carefully; if the drainage flow in the three hours after the operation is 100ml per hour, bright red and more blood clots, the patient appeared to be agitated, blood pressure dropped, pulse rate increased, urine and other blood volume deficiency performance, should consider active bleeding; if there is food residue in the drainage fluid, suggesting that there is esophageal anastomotic leakage; if there is an increased amount of drainage fluid, there is a leakage of esophageal anastomosis; if there is an increase in the amount of drainage fluid, there is a leakage of esophageal anastomosis. If the amount of drainage fluid increases, there is cool to turbid, it suggests that there is celiac chest, should report to the physician to give pretreatment; 2—3 days after the operation, the dark red bloody fluid from the closed chest drainage gradually becomes lighter, the amount decreases, and the amount of 24 hours is less than 50 ml, the drainage tube can be removed. 4, gastrointestinal decompression care Continuous gastrointestinal decompression, keep the gastric tube open, properly fixed to prevent dislodgement, such as gastric tube dislodgement should closely observe the condition, should not be blindly re-inserted, so as not to poke through the anastomosis, resulting in anastomotic fistula; close observation of the drainage flow, the nature of the color and the correct record; six to twelve hours after the operation, can be suctioned from the gastric tube a small amount of bloody fluid or coffee-colored liquid, and then the color gradually become lighter. If a large amount of fresh blood or bloody fluid is drained out, and the patient has irritability, decreased blood pressure, increased pulse rate, decreased urine output, etc., anastomotic bleeding should be considered, and the patient should notify the physician immediately and cooperate with the treatment; patients with test tubes for colon, due to the reflux of colon fluid into the oral cavity, the patient often smells the odor of feces, and the patient should be explained to explain the reason and guided to strengthen oral hygiene, which can be gradually relieved after half a year. 5, diet care esophagus lack of plasma membrane layer, so the anastomosis healing slower, three to four days after surgery need to fasting water, fasting period by intravenous rehydration daily, and give oral care, two to four times a day. The duodenal nutritional tube can be placed in the second day after surgery after the recovery of intestinal peristalsis, through the catheter drip into the nutritional solution to reduce the amount of infusion. One week after the operation, if there is no special change in the condition, a liquid diet can be fed orally, in small quantities, with equal amounts of boiled water during the intervals, and the amount can be increased day by day if there is no adverse reaction. On the 10th to 12th postoperative days, change to semi-fluid diet without residue, but should pay attention to prevent eating too fast and too much, pay attention to dietary care, give light, nutritious, easy-to-digest food, and should pay attention to the color, aroma, taste and shape of the food in order to improve appetite and ensure nutrition. 6.Functional exercise Because open heart surgery has to cut off the chest muscles, it is necessary to prevent muscle adhesion after surgery and prevent shoulder joint ankylosis on the side of surgery, so it is necessary to encourage the patient to do functional exercise. The patient can do upper limb lifting, chest expansion exercise, inward or forward flexion of the upper limb and inward scapula and other exercises. And the patient can consciously comb his/her head with the affected upper limb, climb the wall with fingers, touch the opposite ear over the top of the head, and serve bowls. Observation of postoperative complications of esophageal cancer In addition to anastomotic fistula, postoperative complications of esophageal cancer may include diarrhea, reflux esophagitis, functional thoracic and gastric emptying disorders and respiratory infections. (1) Functional thoracic and gastric emptying disorders: after resection of esophageal cancer, gastric dyskinesia often occurs, causing thoracic and gastric emptying disorders and leading to retention of large amount of gastric contents. According to the specific conditions, patients should be treated with gastrointestinal decompression, jejunostomy or gastric liquid infusion, and given enteral and parenteral nutritional support and medicines to regulate the function of gastrointestinal tract, so as to improve the symptoms of nausea and vomiting, and to promote the recovery of thoracic and gastric functions. (2) Reflux esophagitis: It is a common complication after esophageal cancer surgery, which is mainly manifested as acidic liquid or food reflux from the gastroesophageal tube to the pharynx or oral cavity every time when the patient lies in forward bending after meal or sleeps in bed at night, accompanied by burning sensation or pain at the back of the sternum, difficulty in swallowing and other symptoms. Patients should be instructed to take semi-recumbent position or sitting position for diet, and they can choose fluids or semi-fluids, prefer small amount of meals, slow swallowing action, and avoid tobacco, alcohol, spicy and other stimulating foods; avoid lying down after meals, and when lying down, the head of the bed should be lifted up to 20-30cm. The pants belt should not be bundled up too tight to avoid high abdominal pressure. (3) Respiratory tract infection after esophageal cancer surgery: manifested as cough, chest tightness, dyspnea and other symptoms. (4) Severe diarrhea: gastrointestinal dysfunction after resection of esophageal cancer leads to diarrhea, which is clinically believed to be related to vagus nerve severance and increased concentration of gastrin, so anti-diarrhea drugs should be given actively, and rehydration should be given at the same time in order to avoid dehydration of the patients. Health education for patients with esophageal cancer surgery 1. Regular living and good sleep can prevent patients from depression, do not let patients live alone as much as possible, communicate with others, encourage patients to do some household chores and physical exercise within their ability, and keep cheerful and happy mood. 2.Diet of esophageal cancer patients should focus on light, but some patients like heavy taste, but too light to affect patients’ appetite, therefore, dietary attention should be paid to patients’ personal appetizing food, as long as it is nutritious, and what they like to eat. Conditions can be stewed more broth, eggs, fish, shrimp, a variety of meats, pig liver and other foods with high protein content are very good nutrients, can also be appropriate to supplement some powdered milk, milk, soybean milk and so on. Vegetables can help to supplement vitamins. 3.After esophageal cancer surgery, due to removal of a section of esophagus, the esophagus becomes shorter, coupled with the fact that there is anastomosing stomatitis often secondary to the surgery, the gastro-esophageal surgical connection is narrowed to different degrees, therefore, food can not be entered into the stomach as fast as normal people do when they eat, but is easy to be retained in esophagus lumen and refluxed to the pharyngeal lumen and trachea lumen, which will easily cause difficulty in eating and coughing, etc. Therefore, post-surgery patients of esophageal cancer should pay attention to diet Chew and drink slowly, have small amount of meals. After meals, it is better to stand up and take a walk, and when sleeping, put pillows up so that the head and shoulders are in the state of “high pillow”, which can help prevent gastroesophageal reflux. 4, to overcome bad habits. Do not eat “hot” rice, hot tea, etc., eat slowly chewing, avoid swallowing; oral hygiene; quit smoking, drink less alcohol.