Objective To analyze the reasons for postoperative pulmonary complication in patients with the middle and lower thoracic esophageal carcinoma and investigate the reasonable methods to cure and prevent it． Methods Clinical data of 412 cases of the middle and lower thoracic esophageal carcinoma were analyzed retrospectively，and the association between postoperative respiratory complications and operational methods， preopeartive complications，perioperative blood-transfusion，or the using of antibiotic and pulmonary complication were analyzed． Result 68 cases( 16． 5%) had pulmonary complication，24 cases( 5． 8%) had two or more kinds of complications，2 cases died during perioperation period ( mortality rate 1． 5%) ． Smoking， pulmonary diseases，perioperative blood-transfusion，tri-incisiong operation，operation lasted for more than 5 hours，and long mechanical ventilation time were factors affecting complications( P ＜ 0． 05) ． But FEV1%， blood loss，time using medicine，perioperative radiotherapy and chemotherapy，TNM staging，and histological type were not associated with increased morbidity( P ＞ 0． 05) ． Conclusion Emphasis on treatment of the associated pulmonary diseases，intensifying perioperative dealing of patients，full preoperative preparations， reasonable choosing of procedure for operation，improvement of operation skill，and reducing blood-transfusion during the preoperative period help to reduce the occurrence and control the development of postoperative pulmonary complication．

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