Objective  The experience of the therapy to acute respiratory distress syndrome(ARDS) after the 145 cases of esophagus operation was given.Methods  It is important to manage the operation with the individual pre  operation lung function;to prevent and treat the complications using the nitroprusside or enzyme  inhibitors;to reduce the pulmonary vessel resistance before operation,and to manage organ supporting after operation;to maintain the normal cardiopulmonary function by using vasodilatation and digitalises;to intervene the mechanism of systemic inflammatory response syndrome by using unsteroid anti  infective drugs.Results  The morbidity and mortality of ARDS is 13.7% and 4%.Conclusion  A comprehensive treatment and prevention can reduce the morbidity and mortality of ARDS after high  aged patients’ esophagus tumor resection.