การผ่าตัดต่อมทอมซิล

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ในปัจจุบันไม่ค่อยได้มีการทำการผ่าตัดต่อมทอนซิลในเด็กกันมากเหมือนแต่ก่อน ทั้งนี้เพราะมีการวินิจฉัยทอนซิลอักเสบและมีการใช้ยาปฏิชีวนะในการรักษาทอนซิลอักเสบ กันมากขึ้น ทำให้การติดเชื้อที่ทอนซิลหายได้เร็วขึ้น และไม่ค่อยพบโรคแทรกซ้อนมาก เหมือนเมื่อก่อน อีกทั้งความรู้ความเข้าใจของคุณพ่อคุณแม่ และแพทย์ผู้ดูแลเกี่ยวกับ การรักษาทอนซิลอักเสบที่ถูกต้องก็ดีขึ้นด้วย ทำให้มีความจำเป็นในการทำผ่าตัด ต่อมทอนซิลน้อยลง

การติดเชื้ออักเสบของทอนซิลเป็นอย่างไร ?
ทอนซิลเป็นต่อมน้ำเหลืองที่อยู่เป็นก้อน เห็นได้ชัดในคอ ซึ่งมีส่วนการดักจับเชื้อโรค ที่ผ่านเข้ามาทางการรับประทานอาหาร และทางเดินหายใจ และช่วยในการสร้างภูมิคุ้มกัน (แอนติบอดี) ต่อเชื้อโรค แต่ถึงแม้ทอนซิลจะมีหน้าที่ต่อสู้กับเชื้อโรค และเกิดการติดเชื้อ ที่ทอนซิลขึ้นได้ ซึ่งจะแสดงออกโดยรู้สึกเจ็บคอ มีไข้ ทอนซิลมีขนาดโตขึ้น และแดงอักเสบ หรือมีหนองที่ทอนซิล เวลากลืนจะรู้สึกเจ็บ บางครั้งจะพบต่อมน้ำเหลืองที่ข้างคอโตด้วย

ผลแทรกซ้อนของการติดเชื้อทอนซิลอักเสบคืออะไร ?
ในอดีตเมื่อประมาณ 20 กว่าปีที่ผ่านมาพบว่า การติดเชื้ออักเสบของทอนซิล ด้วยเชื้อโรคบางชนิด เช่น เชื้อสเตรปโตคอกคัส กรุ๊ป เอ (Group A Streptococci) สามารถทำให้เกิดโรคแทรกซ้อนเกี่ยวกับหัวใจได้ในภายหลัง คือ โรคไข้รูห์มาติค และโรคหัวใจรูห์มาติค มีปัญหากล้ามเนื้อหัวใจอักเสบ และลิ้นหัวใจตีบจากการที่มี การติดเชื้อสเตรป กรุ๊ป เอ นี้บ่อยๆ ที่ทอนซิล แต่ในปัจจุบัน เนื่องจากมีการดูแล ทางการแพทย์และยาปฏิชีวนะที่ดี ทำให้การรักษาการติดเชื้อสเตรป นี้ทำได้ดีขึ้น จึงไม่ค่อยพบปัญหาโรคไข้รูห์มาติค และโรคหัวใจรูห์มาติค มากเหมือนเมื่อก่อน

นอกจากนี้ก็มีบางรายงานของการติดเชื้อสเตรป ที่ทอนซิล ชนิดที่เป็นเชื้อลุกลามเร็ว หรือดื้อยา ที่สามารถทำให้เกิดการอักเสบเป็นฝีหนองในบริเวณช่องคอ (Peritonsillar abscess) ได้อย่างมาก ทำให้เกิดการติดเชื้อรุนแรงเข้าสู่กระแสเลือด (Sepsis) และเป็นอันตราย ต่อคนไข้ได้

ตำแหน่งของทอนซิล
เนื่องจากต่อมน้ำเหลืองที่บริเวณในลำคอนี้มีอยู่เป็นจำนวนมาก จึงได้มีการแบ่งกลุ่ม ของทอนซิล ออกตามตำแหน่งที่อยู่ในลำคอ เป็น 3 อย่างคือ
กลุ่มที่ 1 อยู่ในคอที่เห็นเป็นลูกอยู่ 2 ข้างของในคอ เรียกว่า พาลาทีน ทอนซิล (Palatine tonsils)

กลุ่มที่ 2 ได้แก่ ต่อมทอนซิลที่อยู่ที่ตำแหน่งโคนลิ้น (มองไม่เห็นจากการดูคอ) ที่เรียกว่า ลิงก์กัวล์ ทอนซิล (Lingual tonsils) และ

กลุ่มที่ 3 คือต่อมที่อยู่เหนือเพดานอ่อนในคอที่เรียกว่า ต่อมอะดีนอยด์ (Adenoid) หรือที่เรียกกันอีกชื่อหนึ่งว่า นาโสฟาริงก์เจียลทอนซิล (Nasopharyngeal tonsils)

ซึ่งพบว่าในการติดเชื้ออักเสบของทอนซิลนั้นมักจะมีการอักเสบร่วมกันทั้ง 3 ตำแหน่งนี้ และทำให้ต่อมต่างๆ นี้มีขนาดใหญ่ขึ้นมากจนทำให้เกิดการอุดตันของทางเดินหายใจส่วนบน ทำให้หายใจไม่สะดวก มีเสียงหายใจดัง นอนกรน และไอเรื้อรัง ทำให้ในหลายราย ที่ทำการผ่าตัดทอนซิล จะมีการทำการผ่าตัดต่อมอะดีนอยด์ ออกไปด้วย เพื่อช่วยให้การหายใจ ของเด็กดีขึ้น

การตรวจดูว่าต่อมอะดีนอยด์ที่มีตำแหน่งอยู่เหนือเพดานอ่อนในช่องโพรงจมูก มีขนาดโตมากแค่ไหน นอกจากจะใช้การดูลักษณะการหายใจค่อนข้างจะเสียงดังแล้ว จะสามารถดูได้จากการทำเอกซเรย์ดูต่อมอะดีนอยด์ว่ามีขนาดโตจนปิดบัง ช่องทางเดินหายใจส่วนบนมากแค่ไหน ซึ่งแพทย์มักจะทำการตรวจเอกซเรย์เพื่อประเมิน ก่อนการพิจารณาแนะนำให้ทำการผ่าตัด

คำถามที่คุณพ่อคุณแม่มักจะถามก็คือว่า หากเอาต่อมทอนซิลหรือต่อมอะดีนอยด์ออกแล้ว จะทำให้ภูมิต้านทานของลูกลดลงหรือลูกจะติดเชื้อง่ายขึ้นหรือไม่ ซึ่งความจริงแล้วต่อมทอนซิล และต่อมอะดีนอยด์ มีส่วนในการสร้างภูมิคุ้มกันโรคในเด็กเล็กอายุประมาณ 1-3 ปี หลังจากนั้นหน้าที่ของต่อมทอนซิลและอะดีนอยด์จะลดลง และร่างกายยังมีอวัยวะอื่นๆ ที่ช่วยในการสร้างภูมิคุ้มกันโรคอีกมาก เช่น ระบบต่อมน้ำเหลือง ต่อไทมัส และม้าม เป็นต้น ฉะนั้นการผ่าตัดต่อมทอนซิลและอะดีนอยด์ออกจะไม่ทำให้ภูมิต้านทานโรคเปลี่ยนแปลง

ข้อบ่งชี้ในการพิจารณาทำการผ่าตัด
ในปัจจุบันเนื่องจากมียาปฏิชีวนะที่ดี สามารถรักษาการติดเชื้อของทอนซิลให้หายได้ จึงไม่ได้แนะนำให้ทำการผ่าตัดต่อมทอนซิลกันมากเหมือนสมัยก่อน แต่ในบางรายที่มีข้อบ่งชี้ เช่น มีการติดเชื้อทอนซิลอักเสบบ่อย 6-7 ครั้งในหนึ่งปี หรือมีการอักเสบของทอนซิลแบบเรื้อรัง เป็นๆ หายๆ อย่างน้อย ประมาณ 5 ครั้งต่อปี เป็นเวลามากกว่า 2 ปี หรือพบว่า ทอนซิลมีขนาดใหญ่ และทำให้เกิดการอุดตันของทางเดินหายใจส่วนบน ทำให้นอนกรน หายใจเสียงดัง ในบางรายทำให้เกิดการหยุดหายใจเป็นช่วงๆ (ที่เรียกว่า Obstructive Sleep Apnea) เด็กจะเหมือนนอนหลับไม่สนิท และมีปัญหาไปนอนหลับในห้องเรียน เรียนไม่รู้เรื่อง ขาดเรียนบ่อยๆ และต้องทานยารักษาบ่อยๆ ก็เป็นข้อบ่งชี้ว่าควรทำการผ่าตัดทอนซิล (และต่อมอะดีนอยด์ที่โต)

การผ่าตัดทอนซิลทำอย่างไร ?
โดยทั่วไปอาจทำการผ่าตัดแบบสามารถกลับบ้านได้ในวันเดียวกัน หรือในเด็ก มักจะแนะนำให้อยู่เพื่อสังเกตอาการหลังผ่าตัดอีก 1 คืน เพื่อให้แน่ใจว่าไม่มีผลแทรกซ้อนอื่นๆ
การผ่าตัดทำโดยการดมยา ให้เด็กหลับก่อน โดยวิสัญญีแพทย์ (หมอดมยา) จากนั้นแพทย์ผู้ทำผ่าตัด (หมอ หู คอ จมูก) จะทำผ่าตัดเอาต่อมทอนซิลทั้ง 2 ข้างของลำคอ หรือบริเวณใบหน้าเลย ขั้นตอนการผ่าตัดนี้ใช้เวลาไม่นาน คือประมาณครึ่งถึงหนึ่งชั่วโมงเท่านั้น หลังจากนั้น เด็กจะตื่นจากการดมยา และสามารถหายใจเองได้
ปัญหาแทรกซ้อนที่อาจเกิดขึ้นก็คือ การเลือดออกตรงบริเวณที่ทำผ่าตัดไว้ แต่ส่วนใหญ่แล้ว แพทย์ผู้ทำผ่าตัดจะตรวจเช็กจนแน่ใจว่าได้ห้ามเลือดในบริเวณนั้น จนเรียบร้อยก่อนที่จะนำคนไข้ออกมาจากห้องผ่าตัด

ระยะพักฟื้นหลังการทำผ่าตัดทอนซิล
ในช่วงแรกของการพักฟื้น อาจจะยังมีอาการเจ็บคอ และไม่อนุญาตให้ทานอาหารแข็ง แต่จะสามารถดื่มน้ำหรือทานซุปใสๆ ได้ ในเวลาต่อมาก็ทานเป็นอาหารอ่อน เช่น โจ๊ก ข้าวต้มเละๆ และเริ่มเป็นอาหารปกติได้ในวันต่อๆ มา

ในช่วง 3-4 วันแรกหลังผ่าตัดคุณพ่อคุณแม่ผู้ดูแลเด็กก็ต้องคอยระวังอย่าให้เด็ก เอานิ้วแยงในคอ หรือตะโกน เค้นคอมาก หรือแปรงฟันแรงและลึกเกินไปกระแทกถูกในคอ อาจทำให้เกิดเลือดออกได้ นอกจากนั้นแล้วก็ไม่น่าจะมีปัญหาอื่น เรื่องการติดเชื้อแทรกซ้อนนั้น ก็พบได้น้อยมาก แพทย์มักจะสั่งการรักษาและให้ยาปฏิชีวนะควบคุมไว้ตอนให้กลับบ้านอยู่แล้ว ซึ่งจะใช้เวลาประมาณ 1-2 สัปดาห์ที่แผลจะหายสนิท

ที่มา : หนังสือ นิตยสารใกล้หมอปีที่ 25 ฉบับที่ 5 พฤษภาคม 2544

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アディダス社は1920年に西ドイツのアドルフとルドルフのダスラー兄弟がアディダスシューズ靴製造会社「ダスラー兄弟社」を設立したアディダスオリジナルスのが始まり。兄のルドルフが販売、アディダススニーカーアドルフが生産を主に担当。1924年にスポーツシューズアディダス靴製造工場を建設し、体育館用シューズを本格的に作り始めた。アディダスランニングシューズ 1948年、兄弟の意見対立により「ダスラー兄弟商会」を解消、アディダスアウトレットアドルフがアディダス社を設立しその後も製品技術向上を目指し改良を重ね、アディダス通販世界でも有数のスポーツ用品メーカーへと成長した。アディダス CC ライド 誰もが知っている伝統的な「スリーストライプス(三本線）」は、1948年にアドルフ・ダスラーが初めてスーパースター靴スポーツシューズに使用したことから誕生。アディダススーパースターメンズ翌年アディダスの商標として登録された。またアディダスには、『アディダススーパースター』、『セダンスミス』、『スタンスミス』、『カントリー』アディダスレディース、『トップサラ』、『プレデター』といったオリジナルロングセラー商品も多く、アディダススタンスミスアディダスの靴の人気の高さを示している。世界で一番売れたアディダスランニング、シューズのメーカーであるアディダス。アディダスジェレミースコット ギネスブックにも載った名品スタンスミスを初め、スーパースターやカントリーなど、アディダス JS(adidas)の時代を築いてきたスニーカーたちは特に有名です。アディダストップテン東京オリンピックでは、出場選手の10人中8人はアディダスランソンを履いていたといわれる程、実績ある名ブランドです。アディダスコートスターサッカーシューズやジョギング、ランニングシューズとしてはもちろんアディダスアディライズミッドプロバスケットやオリンピック選手等からも非常に高い評価を得てきたシューズがアディダス(adidas)です。アディダスハードランド サッカー日本代表のユニフォームもこのアディダスフォーラムミッド が担当。その品質の良さは文句なしのアディダススーパースターレディース世界レベルです。

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