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DOI: 10.1055/s-2001-20007
Zur Geschichte der Seitentrennung der Atemwege
Separation of the Airways: Historical Aspects Herrn Professor Dr. O. H. Just zum 80. Geburtstag gewidmetPublikationsverlauf
Publikationsdatum:
13. Februar 2002 (online)
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Zusammenfassung
Die Seitentrennung der großen Atemwege wurde im 19. Jahrhundert im physiologischen Labor zur Untersuchung des pulmonalen Gaswechsels eingeführt. Der hauptsächlich benutzte endobronchiale Katheter verschiedener Bauart lieferte Daten aus der einzelnen Lunge, war aber das erste Instrument das 1905 am Menschen zur Seitentrennung der Luftwege eingesetzt wurde. Vorläufer von Doppellumen-Trachealkanülen, darunter die Koaxialkanüle von Werigo 1892, deren Prinzip sich im koaxialen Doppellumen-Bronchoskop von Jacobaeus und Frenckner wiederfindet, erlaubte gleichzeitige Untersuchungen beider Lungen. In der Lungenchirurgie der 30er Jahre war das Ziel der Seitentrennung, Sekretverschleppung aus der erkrankten Lunge durch Bronchusblocker-Katheter oder durch endobronchiale Intubation der gesunden Lunge zu verhindern. Das Prinzip der Kombination von Blocker-Katheter und Trachealtubus erkennt man im heutigen Univent®-Tubus wieder. Die Seitentrennung der Luftwege durch Doppellumen-Tuben und ihre Vorgänger, die Doppellumen-Bronchoskope der Stockholmer Schule, wurde zunächst für die Bronchospirometrie genutzt und erst danach für die Lungenchirurgie entdeckt. Doch bald nach dem ersten Einsatz zur Resektion eines tuberkulösen Abszesses 1949 entwickelte sich eine Vielzahl von Varianten, unter welchen sich links- und rechtsbronchiale PVC-Doppellumen-Tuben als Standardinstrumente herausbildeten.
Abstract
Techniques to separate the airways to both lungs were employed in the laboratory by renowned physiologists like Pflüger and C. Bernard to study gas exchange. Pflüger's catheter, as used by Wolffberg in 1871 in the dog, essentially constituted an early example of endobronchial single lumen tube, and was to be the first airway separator introduced into man by Loewy and v. Schrötter in 1905 in experiments on circulation. As a variation of this device the carinal hook made ist appearance used by Hess in 1912 in rabbits. While the endobronchial catheters afforded airtight access to only one lung at a time for concomitantly studying ventilation in both lungs, a short tracheal cannula was combined with one introduced into the left main bronchus by Head in 1889, constituting as it were the prototype of double lumen (DL) tubes applicable to rabbits and turtles even. Werigo described 1892 a coaxial DL-tracheostomy cannula for dogs which construction principle was adopted in the first DL-bronchoscope used in man. In lung surgery during the 30s and 40s the ventilated lung was prevented from drowning by pus or secretions from the lung under surgery by sealing off ist main bronchus, either by endobronchial intubation or by a bronchial blocker inserted alongside the endotracheal tube. This principle gave rise to sophisticated devices, from the fixed combination of tube and blocker to the present-day tube housing a movable blocker. Remarkably, DL-intubation in its proper sense then was performed in bronchospirometry only. This technique was introduced by Jacobaeus upon suggestion of Liljestrand when dissatisfied with the restriction to sequential spirometry by customary bronchoscopic catheterization, relying on Frenckner's ingenious DL-bronchoscope. Rubber DL-tubes were developed by Gebauer 1939 and Zavod 1940 exclusively with bronchospirometry in mind, even E. Carlens primarily constructed his tube to improve this procedure. After its usage in over 100 bronchospirometries it was introduced for the first time in November 1949 for its familiar purpose: the resection of a tuberculous abscess in the right upper lobe. Once introduced into thoracic anaesthesia, the DL-principle so far fostered a wide variety of tube designs.
Schlüsselwörter:
Doppellumen-Tubus - Univent-Tubus - Bronchusblocker-Katheter - Luftwegstrennung - Thoraxchirurgie
Key words:
Double lumen tube - Univent-Tube - Bronchial blocker catheter - Airway separation - Thoracic surgery
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