本文系统梳理并总结中国胸腔镜微创食管切除术（MIE）三十余年的发展历程与未来趋势。回顾自20世纪90年代初至今，中国食管癌微创治疗从起步探索到全面普及的演进路径，分析器械革新、术式演变、关键技术突破及综合治疗模式转变。20世纪90年代初，面对传统开胸手术创伤巨大、并发症频发的临床痛点，中国胸外科先驱在器械匮乏、技术空白及理念保守的"三重壁垒"中开启了微创探索。历经三十年砥砺前行，该领域实现了历史性跨越：微创器械完成了从"简易自制"到"高端国产化、智能化"的迭代；手术术式从早期的胸腔镜辅助发展为全胸腔镜、机器人辅助及单孔胸腔镜、纵隔镜等多元化体系；侧俯卧位、管状胃制作、各类创新吻合及淋巴结清扫等关键技术日臻成熟。治疗理念已从单纯追求"切口微创"升华为"围术期多学科全程管理"。此外，基于中国数据的多项高水平临床研究（如NEOCRTEC5010、ESCORT-NEO等）改写了国际指南，标志着中国在食管癌诊疗领域从"跟跑"转向"领跑"。总体而言，中国MIE已建立起规范、成熟的技术体系。未来将向更精准的影像规划、更智能的机器人平台、更极致的器官功能保留及更规范的同质化诊疗方向持续迈进，以"中国智慧"造福广大食管癌患者。

This paper systematically reviews the evolution and future prospects of thoracoscopic minimally invasive esophagectomy (MIE) in China over the past three decades. The developmental trajectory of MIE in China from the early 1990s to the present was analyzed, focusing on instrument innovation, surgical approach evolution, breakthroughs in key techniques, and the shift in comprehensive treatment paradigms. In the early 1990s, in response to the significant trauma and high morbidity associated with traditional open transthoracic esophagectomy, Chinese thoracic surgeons initiated minimally invasive exploration despite challenges such as reliance on imported instruments, lack of technical precedents, and conservative mindsets. Over the past thirty years, the field has achieved a comprehensive leap: surgical instruments have evolved from "homemade adaptations" to sophisticated domestic manufacturing and intelligent systems; surgical approaches have diversified from video-assisted thoracoscopic surgery to totally thoracoscopic, robot-assisted, uniportal, and mediastinoscopic techniques. Critical breakthroughs have been made in the semi-prone position approach, tubular gastric conduit reconstruction, and the innovative anastomosis techniques. The treatment paradigm has shifted from surgery alone to perioperative multidisciplinary comprehensive therapy. Notably, several high-impact clinical trials led by Chinese researchers have been incorporated into international guidelines, signifying a shift from "following" to "leading" in the global arena. Overall, a standardized and mature technical system for MIE has been established in China. Future developments will focus on greater precision through imaging planning, intelligent robotic platforms, organ preservation strategies, and the standardization of care across regions, aiming to optimize outcomes for esophageal cancer patients with "Chinese solutions" .