Perubahan kadar enzim aminotransaminase pasca laparoskopi dibandingkan laparotomi kolesistektomi

SIBURIAN, Jansu, Dr. Hendro Wartatmo, SpB, KBD

2010 | Tesis | S2 Ilmu Bedah

Latar belakang: Pada The National Institutes of Health Consensus Development Conference di Maryland, Amerika Serikat tahun 1992, laparoskopi kolesistektomi ditetapkan sebagai Gold standard pada penanganan kolelitiasis simptomatik. Tekanan intraabdomen pada bedah laparoskopi 14 mmHg kira-kira dua kali lipat dibandingkan tekanan vena porta yaitu 7-10 mmHg. Hal ini akan menyebabkan aliran darah ke hati menjadi berkurang yang akan mengakibatkan perubahan enzimhati. Tujuan: Mengetahui perbedaan kadar enzim aminotransaminase pasca tindakan laparoskopi kolesistektomi dibandingkan laparotomi kolesistektomi. Metode Penelitian : Desain penelitian adalah kohort prospective. Data karakteristik subyek penelitian disajikan dalam bentuk rerata dan simpang baku. Perbedaan rerata kadar AST/ALT antara kelompok laparoskopi kolesistektomi dan laparotomi kolesistektomi dianalisis dengan student’s t test berpasangan untuk distribusi normal dengan uji alternatif Wilcoxon, McNemar dan Cohran. Hasil: Didapatkan 68 subyek penelitian, laparoskopi kolesistektomi 25 subyek dan laparotomi kolesistektomi 43 subyek. Persentase peningkatan nilai AST/ALT pra operasi dengan 24 jam (49% dan 49,6%) dan praoperasi dengan 72 jam (26,3% dan 30,7%) pada laparoskopi kolesistektomi. Perbandingan rerata nilai AST/ALT berdasarkan prosedut tindakan nilai AST/ALT pada 24 jam (28,12±7,535 dan 22,63±7,095 dengan p=0,000), dan 72 jam (23,93±5,423 dan 21,44±6,720 dengan p=0,027) pasca laparoskopi kolesistektomi. Simpulan: Terdapat peningkatan yang signifikan dari enzim AST dan ALT pada 24 jam dan peningkatan yang signifikan dari AST pada 72 jam pasca tindakan laparoskopi kolesistektomi.

Background: At the National Institutes of Health Consensus Development conference in Maryland, the United States in 1992, laparoscopic cholecystectomy as the gold standard set at cholelitiasis symptomatic treatment. Intra-abdominal pressure on the surgical laparoscopy 14 mmHg approximately doubled compared to venous pressure porta is 70-10 mmHg. This will cause blood flow to the heart be reduced which will result in a change enzimhati. Objective: To identify differences in enzyme levels of post-action aminotransaminase laparoscopic cholecystectomy compared to laparotomy cholecystectomy. Method: The study design is prospective cohort. Data characteristics of study subjects are presented in the form of mean and intersections standard. Differences in average concentrations of AST / ALT between laparoscopic group cholecystectomy and laparotomy cholecystectomy were analyzed by Student's paired t test for normal distribution with an alternative test Wilcoxon, McNemar and Cohran. Results: There were 68 subjects of the study, laparoscopic cholecystectomy 25 laparotomy cholecystectomy subjects and 43 subjects. Percentage increase value of AST / ALT preoperative with 24 hours (49% and 49.6%) and preoperative with 72 hours (26.3% and 30.7%) in laparoscopic cholecystectomy. Comparison of the mean value of AST / ALT values according to the procedure of action AST / ALT at 24 hours (28.12 ± 22.63 ± 7.535 and 7.095 with p = 0.000), and 72 hours (23.93 ± 21.44 ± 5.423 and 6.720 with p = 0.027) after laparoscopic cholecystectomy. Conclusion: There was a significant increase of AST and ALT enzyme at 24 hours and a significant increase of AST at 72 hours post laparoscopic cholecystectomy ction

Kata Kunci : Enzim aminotransaminase,Laparoskopi,Laparotomi kolesistektomi