Fell Stanley C
Department of Cardiothoracic Surgery, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461, USA.
Chest Surg Clin N Am. 2002 Aug;12(3):541-63. doi: 10.1016/s1052-3359(02)00023-6.
The ineluctable conclusion to be drawn from this article is that thoracic surgery could not develop without endotracheal ventilation. What is astounding is that this technique, known since the 16th century and perfected in the late 19th century, was ignored and in fact rejected by surgeons [4]. The negative effect that Sauerbruch had on the development of thoracic anesthesia was well stated by Comroe: "An impressive piece of hardware, backed by a highly prestigious designer, can hold back progress for decades" [49]. Before the formation of the AATS, there was no forum for the discussion of methods for solving the problems of pulmonary resection and anesthesia. Experience gained in the animal laboratory was largely ignored and not applied to pneumonectomy in humans. Ligation of the pulmonary artery does not initiate the clinical course of massive pulmonary embolism. In the absence of infection, concern about the postpneumonectomy space is groundless. Preresection phrenic nerve crush and pneumothorax are unnecessary, as are attempts to stabilize the postpneumonectomy mediastinum by adjusting intrapleural pressure or by thoracoplasty. It behooves thoracic surgeons to heed Comroe's comment: "Finally, what are we, with our infinite wisdom and magnificent technical advances, doing today that will appear primitive, curious or even stupid 50 years from now?"
从本文中得出的不可避免的结论是,没有气管内通气,胸外科就无法发展。令人震惊的是,这项自16世纪就已为人所知并在19世纪末得到完善的技术,却被外科医生忽视甚至拒绝了[4]。康罗伊很好地阐述了索尔布鲁赫对胸科麻醉发展所产生的负面影响:“一件令人印象深刻的硬件设备,有一位极具声望的设计者支持,却能阻碍几十年的进步”[49]。在胸外科医师协会(AATS)成立之前,没有讨论解决肺切除和麻醉问题方法的论坛。在动物实验室获得的经验基本上被忽视,未应用于人类肺切除术。结扎肺动脉不会引发大规模肺栓塞的临床过程。在没有感染的情况下,对肺切除术后残腔的担忧是毫无根据的。术前膈神经压榨和气胸是不必要的,试图通过调整胸腔内压力或胸廓成形术来稳定肺切除术后纵隔的做法也是不必要的。胸外科医生理应留意康罗伊的评论:“最后,凭借我们无限的智慧和巨大的技术进步,我们今天所做的哪些事情在50年后会显得原始、古怪甚至愚蠢呢?”