Some patients are misdiagnosed as bronchitis or asthma and treated until they have obvious inspiratory dyspnea. Therefore, early diagnosis is still a key issue in the treatment of tracheal tumors. In patients with dyspnea, irritating dry cough and hemoptysis, chest X-ray without abnormalities should be alerted to the possibility of tracheal tumor. Some of the tumors with tissues may also present with dyspnea and wheezing episodes, and wheezing may improve with position change. Tracheal X-ray, CT, MRI and fiberoptic bronchoscopy can be used to make a clear diagnosis. CT scan can show the size of tumor in the lumen and the metastasis of lymph nodes in the mediastinum, and MRI can also be used to further examine the relationship between tumor and blood vessels. Although bleeding may occur during biopsy and there is a risk of asphyxiation in patients with severe airway obstruction, fiberoptic bronchoscopy can determine the nature, location, length, and invasion of the tumor and help in the selection of the surgical approach. Sometimes the tumor margin cannot be reached from outside the trachea during surgery, and the exact location of the tumor can be determined by the transmission of the light source through the tracheal cannula to guide the surgery. Therefore, it is recommended that all patients with tracheal convex tumors should undergo fibrinoscopy. All patients with tracheal convex tumor should be operated as long as the diagnosis is clear and there is a possibility of resection. If the lesion is serious and causes obvious tracheal obstruction, emergency surgery should be performed after the necessary preoperative preparation to prevent accidents. The principle of tracheal tumor surgery is to relieve tracheal obstruction and completely remove the lesion. The incision should be selected according to the location, size and length of the tumor. For the cervical segment and above the aortic arch, a cervical collar incision can be used, and according to the situation, a median split in the upper sternum is added, while a posterior-lateral incision is used if the tumor occurs in the thoracic trachea. The posterior lateral incision is better exposed and easy to operate to meet the needs of thoracic trachea and aorta surgery. On the premise that the lesion can be removed and the airway obstruction can be relieved, the trachea is incised at the distal end of the lesion as soon as possible, and a sterilized tracheal tube is inserted from the stage for external threaded tube ventilation to relieve the airway obstruction, and then the lesion is removed and the trachea is anastomosed through the incised trachea and further explored upward to confirm that the lesion is removed and the post-anastomosis tension is not excessive. In general, continuous sutures are used, and in case of large differences in lumen size, attention is paid to uniform reduction and anastomosis of the posterior wall first, and after anastomosis of more than 1/2 turn, the onstage tracheal tube is removed and offstage intubation is performed for ventilation. For intraoperative anastomosis with a small amount of air leakage, the effect of sealing is generally satisfactory by adding a needle or covering with pleura plus biologic adhesive. The anastomosis should be routinely covered with the nearby mediastinal pleura or pericardial piece, paying special attention to isolate it from the nearby vessels to prevent serious consequences of frictional damage to the vessels. After resection of tracheal tumor, there is no ideal alternative material and the resection length is limited. The length of the resected trachea varies depending on individual anatomy, age, posture and other factors, but the maximum length of resection is usually 4-6 cm. If the resection limit is exceeded or if the lesion is extensive and infiltrated, partial resection or lesion scraping or cautery can be used to relieve the obstruction, and a silver clip can be placed locally to mark the residue. After resection of the augmentation, a trachea + left main bronchus + right bronchus “pincer” anastomosis is performed. When reconstructing the augmentation, a tracheal tube is inserted from the stage to ventilate the left main bronchus, and careful hemostasis is performed in the operative field. Since intubation hinders the operation, a good experience is: “intermittent anastomosis, intermittent ventilation, use oxygen reserve, complete the anastomosis”. After intermittent ventilation of the left main bronchus and sufficient oxygen reserve, the intubation is removed and intermittent anastomosis is performed. At this time, the transoral tracheal tube is inserted downward into the left main bronchus to maintain ventilation, and then the right bronchus is anastomosed “end to end”. If needed, the right bronchus is incised longitudinally to adjust the angle and size of the right bronchus. The “triangular part” was reinforced with mattress sutures. Postoperative airway management Before removing the endotracheal tube after surgery, fiberoptic bronchoscopy should be used to inspect the anastomosis and remove the distal tracheal secretions at the same time to facilitate early postoperative coughing and sputum excretion. Postoperative treatment with hormone (methylprednisolone) can reduce anastomotic edema and prevent scarring of the anastomosis. The patient should be encouraged to cough up sputum and be given ultrasonic nebulized inhalation, because the patient’s cough reflex sensitivity is reduced and respiratory secretions are retained. If sputum is difficult to be coughed up or if pulmonary atelectasis is combined, fiberoptic bronchoscopy should be used decisively to aspirate sputum until coughing ability is restored. Sensitive antimicrobial agents should be used to prevent respiratory complications. Postoperative fixation in the flexed position can reduce anastomotic tension and facilitate the healing of the anastomosed trachea. It is generally accepted that patients with reconstruction of rongeur resection and tracheal resection less than 4 cm can be fixed without fixation. In conclusion, preoperative fibrinoscopy, proper surgical selection, excellent anastomosis technique, close cooperation between surgeons and anesthesiologists, postoperative fibrinoscopic aspiration, active anti-infection and nutritional support are the keys to ensure safe and successful tracheal and bulbar total lung resection or bulbar resection and reconstruction surgery.