DIABETES MELLITUS SEBAGAI PREDIKTOR KEMAMPUAN HIDUP PASIEN IKTERUS OBSTRUKTIF KARENA TUMOR PANKREAS PASKA PINTASAN BILIODIGESTI

REGINA ESTERLINA REHATTA, dr. Hendro Wiratmo, Sp.B., KBD.

2014 | Tesis | S2 Ilmu Bedah

Latar Belakang: Prevalensi diabetes mellitus (DM) di dunia saat ini diperkirakan mencapai 171 juta orang. World Health Organization (WHO) memperkirakan Indonesia akan menempati urutan ke-4 dengan jumlah penderita DM mencapai 12,4 juta orang pada tahun 2025. 85% pasien ikterus obstruktif karena tumor pankreas datang pada stadium lanjut dan hanya memerlukan terapi paliatif. DM sering ditemukan bersamaan dengan penyakit keganasan. Komplikasi vaskular DM akan menciptakan keadaan iskemik pada tumor, yang menyebabkan progresifitas tumor terhambat. Tujuan: Mengetahui perbedaan angka kemampuan hidup pasien ikterus obstruktif karena tumor pankreas paska pintasan biliodigesti yang menderita DM dibandingkan bukan penderita DM. Metode Penelitian: Desain penelitian adalah kohort retrospektif. Analisis kesintasan kemampuan hidup subyek penelitian kelompok DM dan tidak DM disajikan dengan kurva Kaplan Meier. Analisis statistik dilakukan dengan analisis bivariat cox regression. Hasil: Didapatkan 32 subyek penelitian, 13 orang (41%) menderita DM, 19 orang (59%) tidak menderita DM. Angka kemampuan hidup 1 tahun kelompok DM 25% dengan median survival 62 hari, sedangkan kelompok tidak DM 21,05% dengan median survival 110 hari. Dengan p=0,814. Angka kemampuan hidup 9 bulan kelompok DM 45% dengan median survival 253 hari, sedangkan kelompok tidak DM 21,6% dengan median survival 90 hari. Dengan p=0,0347. Simpulan: Angka kemampuan hidup pasien ikterus obstruktif karena tumor pankreas paska pintasan biliodigesti yang menderita DM lebih baik daripada bukan penderita DM.

Background: The world prevalence of diabetes mellitus (DM) already reaches 171 million people. World Health Organization (WHO) predicts that Indonesia will be on the top 4 with about 12,4 million people diagnosed DM in year 2025. Eigthy five percent of patients with obstructive jaundice due to pancreatic tumor diagnosed at advance stage, require palliative treatment only. DM often found in cancer patients as comorbid. DM vascular complication will create ischaemic condition on the tumor site, which will inhibit tumor progressivity. Objective: To identify the difference of survival rate level on patients with obstructive jaundice due to pancreatic tumor performed biliodigestive shunting whom suffered DM compare to those without DM. Method: The study design was retrospective cohort. Survival analysis of both groups, DM and non-DM was performed by the Kaplan Meier curve. Cox regression bivariate analysis was used to determine the consistency of both groups survival rate difference. Results: There were 32 subjects included; thirteen subjects (41%) DM, while 19 subjects (59%) non-DM. This study indicates that one year survival for DM group was 25% and median survival was 62 days while for non-DM group 21,05% and 110 days respectively, with p=0,814. If the study was performed for a shorter period (9 months), it was found that 9 months survival was 45% and median survival was 253 days for the DM group, while for non-DM group 21,6% and 90 days respectively, with p=0,0347. Conclusion: Patients with obstructive jaundice due to pancreatic tumor performed biliodigestive shunting whom suffered DM have better survival rate level than those without DM.

Kata Kunci : ikterus obstruktif, diabetes mellitus, pintasan biliodigesti, tumor pankreas