Airway FB is the most common respiratory emergency in children. Aspiration of a foreign body into the airway is usually divided into three stages . The first stage is the sudden impact of a FB into the airway, leading to acute cough, stridor, respiratory distress and cyanosis. This stage is the most dangerous. If a foreign body is trapped in the glottis and airway, it may cause suffocation and even death. The patient usually progresses to an asymptomatic stage, followed by airway FBs that are trapped in a fixed position in the tracheobronchial tree, and the airway reflex gradually weakens over time. The third stage involves complications secondary to chronic airway FB, manifested as infections, such as recurrent pneumonia, chronic cough, unilateral wheezing, or asthma-like symptoms. Further delay in the diagnosis of airway FB may lead to bronchiectasis and permanent damage to lung tissue. Therefore, children with recurrent cough, wheezing, hemoptysis, lung inflammation and other unknown causes after repeated anti-inflammatory treatments should be highly vigilant for airway FB, and bronchoscopy should be perfected as soon as possible to confirm the diagnosis and treatment.
Studies have reported that rigid bronchoscopy has been used as the gold standard for diagnosis and treatment of FB in the airway . However, because the rigid bronchoscope cannot bend, the field of view is narrow. For the foreign body in the deeper part or the FB broken during the removal of the rigid bronchoscope, a flexible bronchoscope should be used to remove the foreign body. In recent years, flexible bronchoscopy technology has gradually been widely used in clinical practice. It has the advantages of simple operation, fast operation, small trauma, and can involve the remote airway. It can also improve the safety of ventilation during the inspection of children’s airways. Sexuality, and better control of bronchoscopy during treatment with minimal complications. In this group of studies, the complication of children with airway FB during and after flexible bronchoscopy was 19.6%, and there were no deaths due to FB and treatment. This is consistent with many reports in the literature [4–6]. Therefore, flexible bronchoscopy has become a commonly used method for removing FB in the airway of children.
In this study, the airway FB taken out by the flexible bronchoscope were mainly edible plant FB, which may be related to the immature swallowing mechanism of the child . The success rate of the flexible bronchoscope for removing FB varies from study to study. Tang et al. used flexible bronchoscope to remove FB from the airway of 1027 children with a success rate of 91.3% . Rodrigues et al. reported that the success rate of using 33 cases of flexible bronchoscope to remove FB was 82.5% . In this study, 628 cases of FBs were removed through a flexible bronchoscope, and the success rate of removal was 99.2%. Under normal circumstances, the flexible bronchoscope treatment port can smoothly grasp a part of the airway FB through the foreign body forceps, and some FBs due to the abnormal size, texture, and shape, or due to the long time in the airway, the surrounding granulation tissue proliferation is obvious or even the FB is completely wrapped, and it is difficult to remove the foreign body smoothly with foreign body forceps. For the removal of airway FB of different natures, the flexible bronchoscope can be used alone or in combination with foreign body forceps, net baskets, freezing, balloons, lasers and other technologies. For a small number of intractable airway FB, when there is a risk of massive hemoptysis, airway perforation, etc., surgical intervention is ultimately required [10, 11]. The 628 cases of airway FBs in this group were successfully removed except 5 cases with rigid bronchoscopy and 123 cases had mild side effects, which were all improved after treatment. There were no major hemoptysis, dyspnea, pneumothorax and other conditions caused. The experience is summarized as follows: (1) For FB that have a short retention time and are particularly small, non-sharp FB can be directly adsorbed on the end of the bronchial lens by negative pressure and slowly moved out of the airway with the bronchoscope. (2) FB with irregular shapes, relatively rough surfaces, and movable FB can be fine-tuned to the appropriate gripping position with foreign body forceps. The clamps are slowly moved out of the airway with the bronchoscope. (3) Smooth, spherical or elliptical, fragile and movable FB. The foreign body can be taken out by freezing or mesh basket. (4) The incarcerated foreign body can be taken out by forceps, and the balloon will slowly pass through the gap between the airway and the foreign body, enter the distal end of the foreign body, expand and pull and cause the foreign body to loosen. Use forceps or mesh basket to take out the remaining FB (5) The foreign body that is wrapped and covered by granulation tissue can be removed by laser, freezing or electrocoagulation to clean the surrounding granulation tissue, and then the foreign body clamp or mesh basket is used to take out the foreign body.