目的分析胸腹腔镜联合食管癌根治术后肺部并发症的危险因素,探讨肺保护性通气策略对肺部并发症的影响。方法行胸腹腔镜联合食管癌根治术患者348例,采用单因素和多因素分析方法探讨胸腹腔镜联合食管癌根治术后肺部并发症的独立危险因素。结果 348例患者肺部并发症的发生率为24.42%。多因素分析显示,高龄[优势比(OR)=3.934,95%可信区间(95%CI):1.431~9.478]、吸烟(OR=3.256,95%CI:1.204~8.863),术前合并糖尿病(OR=4.835,95%CI:1.454~11.562),术前合并慢性阻塞性肺疾病(OR=6.714,95%CI:1.528~13.762),肿瘤位于胸上段(OR=4.346,95%CI:1.447~10.382),术前合并低蛋白血症(OR=3.977,95%CI:1.344~9.896)是胸腹腔镜联合食管癌根治术后肺部并发症的危险因素,术中采取肺保护性通气策略(OR=0.273,95%CI:0.194~0.875)是胸腹腔镜联合食管癌根治术后肺部并发症的保护因素。结论通过分析食管癌术后肺部并发症发生的相关危险因素,发现肺保护性通气策略是胸腹腔镜联合食管癌根治术后肺部并发症发生的保护因素。 Objective To analyze the risk factors of pulmonary complications after thoraco-laparoscopic combined with radical resection of esophageal cancer and investigate the effect of protective ventilation strategy on pulmonary complications. Methods 348 patients underwent thoracic and laparoscopic radical esophageal cancer radical mastectomy. Univariate and multivariate analysis were used to explore the independent risk factors of pulmonary complications after thoracotomy combined with radical mastectomy for esophageal cancer. Results The incidence of pulmonary complications in 348 patients was 24.42%. In the multivariate analysis, the odds ratio (OR = 3.934, 95% CI: 1.431-9.478), smoking (OR = 3.256, 95% CI: 1.204-8.863), preoperative diabetes mellitus (OR = 4.835, 95% CI: 1.454 ~ 11.562), preoperative with chronic obstructive pulmonary disease (OR = 6.714, 95% CI: 1.528-13.762) ~ 10.382). Preoperative hypoproteinemia (OR = 3.977, 95% CI: 1.344-9.896) was a risk factor for pulmonary complications after thoraco-laparoscopic combined with esophagectomy. Pulmonary protective ventilation strategy (OR = 0.273, 95% CI: 0.194-0.875) were the protective factors of pulmonary complications after thoracotomy combined with radical resection of esophageal cancer. Conclusion Through analyzing the risk factors of postoperative pulmonary complications in patients with esophageal cancer, it is found that the protective ventilation strategy is a protective factor in the development of pulmonary complications after thoracoscopic laparoscopy and esophagectomy.