摘要目的：探讨提高结肠代食管手术安全性的措施。方法总结2003年1月至2014年12月，65例结肠代食管手术，男43例，女22例，年龄41～76岁；均曾行胃大部切除术。改良手术方案和部分程序，主要包括：手术前评估、结肠段选择、简化血管解剖、改颈部吻合为胸内吻合、改良吻合顺序和加强术前准备。结果全组无围手术期死亡，颈部吻合口瘘10例，占27.77％（10／36），胸内吻合口瘘2例，占6.89％（2／29），其中2例颈部瘘患者，因营养不良自动出院，其余经引流、换药后治愈。空肠造瘘后完全性肠梗阻2例，经再次手术证实1例为肠扭转，1例为肠套叠。结论虽然结肠代食管手术过程复杂，但只要掌握好手术指征，改良部分手术程序，可以得到良好的效果并大大提高手术的安全性。

abstractsObjective To explore the improving safety measures of colon interposition after esophagectomy .Methods From January 2003 to December 2014, 65 cases of colon interposition after esophagectomy were performed, and some improve-ments were made in the methods and procedures .Mainly including: Preoperative evaluation to first operation; Selection of co-lon segment; Simplify vascular anatomy;Cervical anastomosis was replaced by intrathoracic anastomosis;Modified anastomosis sequence; Strengthen preoperative preparation.Results There were no perioperative deaths.Only 2 patients with cervical fis-tula, due to malnutrition automatically discharged.The rate of anastomotic leakage on neck were 27.77%(10/36) and 6.89%(2/29) in the chest.2 cases were completed intestinal obstruction after jejunostomy , 1 cases of volvulus and 1 cases of intus-susception confirmed by reoperation.Conclusion Colon interposition after esophagectomy is a very important way of surgery. The operation process is complex, but as long as mastering the point of surgery, improving the surgical procedures, the good effect can be obtained and greatly improve the safety of the operation .