Tracheal and bronchial foreign bodies are one of the common emergency or subacute diseases in otolaryngology. The type and size of foreign bodies inhaled by patients vary greatly, and the time of consultation varies greatly, so treatment needs to be tailored to the patient’s condition. We reviewed the results of the diagnosis and surgical treatment of 501 cases of tracheal and bronchial foreign bodies in the past 4 years and report them as follows.1. Clinical data 1.1 General data: Cases were selected from December 2006 to October 2010, and 501 cases were admitted to the hospital with the diagnosis of tracheal foreign bodies. Among them, 340 cases were male and 161 cases were female; age ranged from 9 months to 7 years, weight ranged from 7 to 22 kg; duration of illness ranged from 20 min to 5 y. Clear history of foreign body choking was available in 425 cases, and there was no history of foreign body but recurrent lung inflammation without healing under anti-infection treatment in 76 cases. Patients mostly had cough, wheezing and inspiratory dyspnea.1.2 Imaging: Chest radiographs showing mediastinal oscillations can suggest complete and incomplete obstruction of one side of the bronchus. Chest radiographs often only reflect significant pulmonary atelectasis and emphysema. Bronchial coronal CT and multilayer spiral CT 3D reconstruction can locate the foreign body more intuitively and accurately, which is superior to chest radiograph and fluoroscopy, and can help help the operator understand the location of the foreign body, which can provide a diagnostic basis for suspected tracheal foreign body.2. All surgical methods are performed with intravenous compound anesthesia, and the operator picks up the epiglottis with a direct access laryngoscope in the left hand, and enters the main airway as soon as possible with the mirror in the right hand, and the end of the rigid bronchoscope is connected to the anesthesia machine, with which he controls The end of the rigid bronchoscope was connected to the anesthesia machine and used to control breathing. If the child chokes and holds his breath during the operation, the anesthesia should be deepened with propofol. In case of transient respiratory arrest or continuous decrease in SpO2, the bronchoscope can be retreated to the main airway and the observation hole can be blocked to prevent air leakage, and the respiratory bag of the anesthesia machine can be used for manual control of breathing. When the child’s SpO2 rises to normal and the spontaneous breathing returns to stable, continue the exploration. Maintain a clear view during the operation, and the foreign body, tracheoscopic lumen and foreign body clamp opening should be in a straight line to avoid accidental clamp. Ensure airway patency or tracheal intubation, and then remove the intubation after the condition is stable. If the condition of the weak child is still unstable, the child can be sent to ICU or continue ventilator-assisted breathing until the child’s condition is stable and then remove the intubation. When the child with mild disease has SpO2 > 90% under deoxygenation and is stable for 15 min, and stimulated to cough, he can be sent to the ward. And it was instructed to continuously monitor HR, SpO2, and oxygen until fully awake.3. ResultsA total of 475 cases of foreign body were removed in this group. Among them, 15 cases had surgical complications. Among the foreign bodies, there were 71 cases of foreign bodies in the main airway and larynx, 212 cases of foreign bodies in the right bronchus, 178 cases of foreign bodies in the left bronchus, and 14 cases of bilateral bronchus. 18 cases did not see foreign bodies intraoperatively, and 8 cases were coughing up on their own without abnormalities on CT. During and after the operation, some patients had short time hoarseness, laryngospasm and loose teeth. There were 10 cases of hoarseness (resolved on their own within 2 days), 3 cases of laryngospasm (sent to ICU after tracheal intubation and extubated after 2-3 days), and 2 cases of loose teeth. There were no serious complications such as pneumothorax.4. Discussion Foreign body in trachea and bronchus is an important cause of accidental death in young children. After the occurrence of tracheal and bronchial foreign bodies in children, a rapid diagnosis should be made promptly by taking medical history, physical examination and imaging, especially chest fluoroscopy and pulmonary CT, and tracheoscopy is required in all cases where there is a clear history of foreign bodies even if no obvious foreign body is found by CT, and a missed CT diagnosis cannot be ruled out to be related to body position, which is related to the life safety of patients [1]. During the foreign body removal by tracheoscopy under general anesthesia, we have learned the following ① The operation should be gentle to avoid damaging teeth, mouth and lips, voice box, and tracheal mucosa. Forced insertion of the tracheoscope with the vocal hatch closed may result in significant hoarseness in the child after surgery. ② Larger foreign bodies cannot be removed from the mirror by clamping, can be clamped and then withdrawn with the mirror, passing through the vocal canal gently and making the opening of the foreign body clamp to protect the foreign body with the opening perpendicular to the vocal canal opening to prevent the foreign body from falling off due to vocal canal obstruction when passing through the vocal canal [2]. ③After removing the foreign body by retracting the scope, the trachea needs to be re-entered and examined bilaterally to avoid bilateral foreign bodies and multiple foreign bodies on one side. The procedure can be concluded only after confirming the patency of each bronchus and segmental bronchus. It is still necessary to pay attention to the subglottis when retracting the mirror to the main airway of the voice to prevent the foreign body from remaining. ④When exploring for foreign body, if the foreign body clamp cannot exit homeopathically and move with breathing, and there is elastic resistance feeling when gently pulling the foreign body clamp, the clamp mouth should be opened immediately to release the clamped tissues, do not pull forcefully. ⑤ watermelon seeds and sunflower seeds foreign body can be removed with alligator pliers, pliers teeth to prevent excessive wear, so as not to be unable to clamp the foreign body, otherwise the foreign body through the swollen trachea and the acoustic valve is very easy to fall off. Peanuts and beans can use the small teeth of the peanut rice pliers clamping, larger can be clamped to remove, smaller can not be clamped out available suction device. Plastic or metal foreign body removal, preoperative need to try to eliminate mucosal swelling, intraoperative to make the tracheoscope close to the foreign body, if necessary, the tracheoscope to the side of the foreign body to advance, so that the foreign body and the tracheal wall between the gap, so that the foreign body clamp inserted into the gap to clamp the foreign body [2]. (6) If the above methods still fail to remove the foreign body, it is recommended to transfer to thoracic surgery for open-heart surgery to remove the foreign body. Avoid forced tracheoscopic surgery with adverse consequences such as pneumothorax. In the treatment of tracheal and bronchial foreign bodies in children, the most important purpose of surgery is to remove the airway obstruction as soon as possible, except for special cases such as pre-operative feeding and heart failure, foreign bodies should be removed as early as possible, especially active foreign bodies with complications of respiratory distress. The success of intraoperative anesthesia is related to the smooth removal of foreign body, which can significantly reduce the occurrence of surgical complications. The operation must be done carefully and meticulously, do not pull and pull, otherwise it may lead to serious complications such as pneumothorax, or push the foreign body to deeper segments of the bronchus, making it impossible to remove. In these 501 cases, except for the coughing out by themselves, all of them were performed under general anesthesia for tracheoscopy and foreign body removal, with few intraoperative complications and fast recovery. It has been proved that bronchoscopy under general anesthesia for foreign body removal is safe and effective.