PREDIKTOR KOLANGITIS PADA PASIEN ATRESIA BILIER PASCA OPERASI KASAI PORTOENTEROSTOMI

FEBRICILLA CITRA P, Dr. dr. Titis Widowati, Sp.A(K).; dr. Nenny Sri Mulyani, Sp.A(K)

2019 | Tesis | MAGISTER ILMU KEDOKTERAN KLINIS

Latar belakang Kolangitis merupakan komplikasi yang serius dan paling sering terjadi pada bayi dengan atresia bilier (AB), terutama dalam tahun pertama pasca operasi Kasai portoenterostomi (KPE). Kejadian kolangitis akan mempercepat terjadinya kerusakan hati dan berakibat kematian. Penyebab kolangitis belum diketahui secara pasti, diduga berbagai faktor mempengaruhi kejadian kolangitis. Tujuan mengetahui prediktor terjadinya kolangitis pasca operasi KPE. Metode Penelitian kohort restrospektif dilakukan dengan mengambil data sekunder dari rekam medis pasien di Instalasi anak RSUP Dr. Sardjito Yogyakarta. Subjek penelitian adalah bayi <1 tahun yang terdiagnosis atresia bilier berdasar pemeriksaan kolangiografi intraoperatif, serta menjalani operasi dan perawatan di RSUP Dr. Sardjito sejak Januari 2012 sampai dengan Desember 2018. Subjek dengan data rekam medis tidak lengkap dieksklusi dari penelitian. Usia saat operasi KPE, jenis kelamin, status gizi saat operasi KPE, kadar bilirubin direk awal, telah terjadi fibrosis dan sirosis hati saat operasi KPE dianalisis sebagai prediktor kolangitis pasca operasi KPE dan dipresentasikan sebagai Odds Ratio (OR) dan interval kepercayaan 95% (IK 95%). Hasil Penelitian ini melibatkan 64 subjek dengan dominasi bayi atresia bilier jenis kelamin laki laki. Tiga puluh delapan (59%) bayi atresia bilier diketahui mengalami kolangitis pasca operasi KPE, dan 10 (26%) di antaranya mengalami kejadian kolangitis yang berulang. Pada analisis multivariat menunjukkan bahwa jenis kelamin laki -laki (P=0,03, RR=0,17; 95% IK 0,04-0,87), kadar bilirubin direk serum >10 mg/dL sebelum operasi (P=0,04, RR=0,15; 95% IK 0,02-0,97), dan telah terjadinya sirosis hati pada saat operasi KPE (P=0,02, RR:=9,11; 95% IK:1,03-63,23) terbukti bermakna secara statistik dan klinis sebagai prediktor kolangitis pasca operasi KPE. Faktor jenis kelamin laki - laki dan kadar bilirubin direk serum >10 mg/dL berefek protektif terhadap terjadinya kolangitis. Usia saat operasi KPE, jenis kelamin, status gizi, kadar bilirubin direk awal, dan telah terjadinya fibrosis hati saat operasi KPE tidak bermakna secara stastitik dan klinis sebagai prediktor kolangitis pasca operasi KPE. Kesimpulan: Jenis kelamin laki -laki, kadar bilirubin direk serum >10 mg/dL sebelum oeprasi KPE, dan telah terjadinya sirosis hati pada saat dilakukan operasi Kasai merupakan faktor prediktor terjadinya kolangitis pasca operasi KPE.

Background:Cholangitis is the most common and serious complication in patients with biliary atresia within the first year after Kasai portoenterostomy. The inicidence of cholangitis contributes to development of liver chirrosis and higher mortality risk. The etiology of cholangitis is still unknown. Many factors have been considered affecting the cholangitis. Objective: to identify the predictors of cholangitis in biliary atresia infants after Kasai surgery Methods: A retrospective cohort study was conducted using secondary data from medical records of pediatric department of Dr. Sardjito Hospital Yogyakarta. The inclusion criteria were infants with biliary atresia according to cholangiography intraoperative and underwent Kasai hepatoportoenterostomy surgery in Sardjito hospital Yogyakarta from January 2012 to Desember 2018. Subject with incomplete required medical record data were excluded from this study. Age of surgery, gender, nutritional status, preoperative level of direct bilirubin, confirming liver fibrosis and cirrhosis when underwent Kasai surgery were analyzed as predictors of cholangitis after Kasai surgery in biliary atresia patients and presented as relative risk (RR) and confidence interval 95% (CI 95%). Results: Sixty four infants were included in this study with male predominance. Out of 38 (59%) biliary atresia patients had cholangitis, and 10 (26%) patients had recurrence of cholangitis. Multivariate analysis showed that male sex (RR= 0.17; 95%CI 0.04-0.87; P=0.03), preoperative level of direct bilirubin >10 mg/dL (RR=0.15; 95%CI 0,2-0.97; P=0.04), and liver chirrosis when underwent Kasai surgery (RR= 9.11; 95%CI 1.03-63.23; P=0.04) was statistically significant as a predictor of cholangitis after Kasai hepatoportoenterostomy surgery in biliary atresia patients. Male and preoperative level of direct bilirubin >10 mg/dL had protective effect on cholangitis after Kasai surgery. Age at surgery, nutritional status, initial were not significantly associated with cholangitis after Kasai surgery in biliary atresia patients. Conclusion: The predictors of cholangitis after Kasai hepatoportoenterostomy in biliary atresia children is male, preoperative level of direct bilirubin >10 mg/dL, and liver cirrhosis while confirm on day undergo Kasai surgery.

Kata Kunci : kolangitis, operasi Kasai, atresia bilier, cholangitis, Kasai surgery, biliary atresia