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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Prof. Dr. med. K. Wiedemann
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