Tracheobronchial foreign bodies in children

　　1. The etiology of tracheobronchial foreign bodies in clinical practice is often divided into two categories.

　　1. Endogenous foreign bodies are less common. Examples include pseudomembranes, granulation tissue, secretions, and crusts caused by ulcerated bronchial lymph nodes and various inflammatory conditions.

　　2. Exogenous foreign bodies are very common. They are diverse, and can be divided into solid, liquid, and further into vegetable, animal, mineral, and chemical products. Clinical cases include melon seeds, peanuts, soybeans, chestnuts, tangerine seeds, corn kernels, bone fragments, nails, large needles, hairpins, small balls, plastic pen caps, whistles, and so on.

　　The etiology of the disease is that the children's molars have not yet erupted, and their masticatory function is poor.

　　Poor laryngeal protective reflex function; children tend to cry, laugh, and play while eating; school-age children like to put small toys, pen caps, whistles, and other objects in their mouths. When they cry, laugh, are frightened, and take a deep breath, it is very easy to inhale foreign bodies into the trachea. In severe or comatose children, due to weakened or absent swallowing reflex, it is occasionally possible to cough up vomit, blood, food, teeth, and other substances into the trachea. Clinically, there are also cases where comatose children have worms climbing up and entering the trachea.

　　1. Emphysema refers to a pathological condition characterized by reduced elasticity, overinflation, and increased airway volume of the distal terminal bronchioles (respiratory bronchioles, alveolar ducts, alveolar sacs, and alveoli), or simultaneously accompanied by destruction of the airway wall.

　　2. Atelectasis (atelectasis) refers to a decrease in the volume or gas content of one or more lung segments or lobes. Due to the absorption of gas in the alveoli, atelectasis is usually accompanied by a decrease in opacity in the involved area, with adjacent structures (bronchi, pulmonary vessels, pulmonary interstitium) gathering towards the atelectasis area. Sometimes, there may be consolidation of the alveolar cavity, and other lung tissues may compensate with emphysema. Lateral air communication between the lobules and segments (occasionally the lobes) allows the completely blocked area to still have a certain degree of translucency.

　　3. Bronchitis refers to a chronic non-specific inflammation of the tracheal and bronchial mucosa and its surrounding tissues. Clinically, it is characterized by long-term cough, expectoration, or accompanied by wheezing and recurrent attacks.

　　4. Lung abscess (lung abscess) is a suppurative lesion of lung tissue caused by various etiologies. In the early stage, it is a suppurative inflammation, followed by necrosis to form an abscess. It often occurs in adults, with more males than females. According to the cause of onset, there are three types: tracheal infection type, hemogenic infection type, and infection type caused by multiple abscesses and lung cancer.

　　5. Chronic bronchitis (chronic bronchitis) is a chronic non-specific inflammation of the tracheal and bronchial mucosa and its surrounding tissues. Clinically, it is characterized by recurrent attacks of cough, expectoration, or accompanied by asthma.

　　There are three typical symptoms of tracheal foreign bodies:

　　1. Wheezing and asthma:It occurs due to air passing through the obstructed area, and it can be heard more clearly when breathing with the mouth open.

　　2. Tracheal impact sound:Foreign bodies collide with the subglottis with the expiratory airflow, which is more prominent during coughing, and there is no such sound when the foreign body is fixed and does not move.

　　3. Tracheal impact sensation:The principle of occurrence is the same as that of tracheal impact sound. Palpation of the trachea can feel a sense of impact. Foreign bodies stop on one side of the bronchus. The child has a cough, difficulty in breathing, and symptoms of wheezing are relieved, known as the asymptomatic period. During this period, there is only slight cough and wheezing. Later, due to foreign body obstruction and concurrent inflammation, symptoms such as emphysema or atelectasis of the lung may occur, which are symptoms of bronchial obstruction. For foreign bodies that have lasted for a long time, inflammation becomes more severe, especially for lipidic plant foreign bodies such as peanuts, which stimulate the tracheal mucosa, causing congestion and swelling, and secreting serous or purulent secretions. Mild cases may be accompanied by bronchitis and lipoid pneumonia; severe cases may be accompanied by lung abscess and empyema, which can exacerbate difficulty in breathing and cause systemic toxic symptoms such as high fever. Generally, foreign bodies stay in the bronchus. A few small foreign bodies such as大头针 (large needle) can enter the segmental bronchi, such as the basal bronchi of the middle and lower lobes. Small mineral foreign bodies are not enough to block the bronchus and may not have significant symptoms. After several weeks or months, lung lesions occur, and the child has recurrent fever, cough, expectoration, and symptoms such as chronic bronchitis, chronic pneumonia, bronchiectasis, or lung abscess. For typical cases, diagnosis can be made based on the medical history, symptoms, and signs. Chronic bronchial foreign body cases are often misdiagnosed as pneumonia. Chest X-ray透视 (transillumination) or radiography may be necessary, especially chest radiography. Bronchoscopy may be necessary if necessary.

　　Respiratory tract foreign bodies are completely preventable. Public education should be widely carried out for parents and caregivers. Children under 3 years of age who have not yet erupted their deciduous teeth should not be given peanuts, seeds, beans, and other foods with seeds. When children are eating, they should not run around or jump around to avoid inhaling food when they fall. Do not scare, amuse, or scold children when eating to avoid crying or laughing and accidentally inhaling. Educate children to get rid of bad habits such as holding pen caps, whistles, and small toys in their mouths. Items that children may inhale or swallow should not be used as toys. Pay special attention to eating for critically ill and unconscious patients to prevent aspiration.

　　One, X-ray examination

　　1, Fluoroscopy: It is the main method for X-ray diagnosis of tracheobronchial vegetable foreign bodies, and can be observed repeatedly for the movement of organs such as the mediastinum, heart, and diaphragm.

　　2, Chest X-ray: When taking chest X-rays, it is necessary to take photos of both inspiration and expiration, as well as frontal and lateral views, which can determine the location, size, and shape of the foreign body, determine whether the foreign body is in the trachea or esophagus, and detect respiratory obstruction, such as emphysema, atelectasis, and mediastinal displacement. Since bronchial foreign bodies block different lobes of the lungs differently, different pathological changes may occur in different lobes. For example, in the case of a right bronchial foreign body, X-ray examination may show atelectasis in the right upper lobe, while the right middle lobe may be emphysematous.

　　Two, CT

　　In recent years, with the clinical application of spiral CT, it has important value in the judgment and localization of respiratory tract foreign bodies in children. Through three-dimensional reconstruction, the simulated bronchoscope can show the location and size of the foreign body, which has guiding significance for the surgery of difficult-to-diagnose and morphologically specific foreign bodies.

　　Three, Bronchoscopy

　　If there is a suspicion of tracheobronchial foreign bodies, bronchoscopy should be performed.

　　One, Tracheobronchial foreign body patients should eat:
　　Eat light and nutritious food, pay attention to dietary balance.
　　1, Watermelon: High in vitamins, it is conducive to promoting tissue repair.
　　2, Tomato: Rich in vitamin C and vitamin B, it can promote the absorption of trace elements.
　　3, Glutinous Rice Porridge: High in vitamins, calories, and carbohydrates, it is beneficial for energy supply.
　　Two, Avoid eating for tracheobronchial foreign body patients:
　　1. Chilies: Chilies contain a high vitamin content, but they are very刺激性, which is not conducive to the recovery of foreign bodies in the tube.
　　2. White liquor: It has a刺激性, can cause local congestion and even edema in the injured area.
　　III. Dietary precautions for tracheobronchial foreign bodies:
　　Do not force a child to swallow large pieces of food, first parents should educate children not to put small toys and other objects in their mouths. Secondly, children should avoid talking, laughing, or crying while eating; and bad habits such as eating while walking or playing should be changed. It is best not to give children under the age of 5 foods such as瓜子, peanuts, and beans, and do not force things into a child's mouth when they are crying, as this may cause danger of aspiration into the trachea.

　　If an object has entered the trachea or bronchus, the chance of it being naturally coughed out is only about 1%, so it is necessary to try to remove the object. Bronchoscopy is not only a very effective immediate diagnosis but also a method with therapeutic significance. Surgery can be performed under general anesthesia, local surface anesthesia, or without anesthesia. For special types of tracheobronchial foreign bodies such as pen caps, bone fragments, and nails, surgery should be performed under general anesthesia, and the largest possible bronchoscope should be chosen to better protect the object from being smoothly exhaled. It is best to avoid using ketamine alone during general anesthesia, although this drug can effectively calm and relieve pain, it is easy to cause laryngospasm. For foreign bodies such as tacks and large pieces of rubber that are removed from the glottis, they are easily scraped off by the vocal cords and can cause asphyxiation, so consideration should be given to tracheotomy to remove the object from the tracheal incision. For glass balls and certain large smooth toys that are difficult to remove under bronchoscopy, the trachea and bronchus can be opened to remove the object. There are also methods of removing the object by using a bile duct stone basket to grasp the foreign body under a fiberoptic bronchoscope. Some small foreign bodies have entered the upper lobe opening or the deep part of the basal branch, and they can be removed using a small foreign body forceps under a fiberoptic bronchoscope. When the bronchoscope moves down the trachea and bronchus, if granulation tissue is found instead of a visible foreign body, the foreign body may be located below the granulation tissue. The foreign body can be removed by removing the granulation tissue or passing over it. There is a possibility of laryngeal injury and edema after removing the foreign body with a rigid bronchoscope, so postoperative treatment with antibiotics and adrenal cortical hormones should be given, and the duration of medication can be appropriately extended for severe cases. For severe laryngeal obstruction, tracheotomy should be performed.