EVALUASI PERIOPERATIF OBSTRUKSI DUODENUM KONGENITAL DI RSUP DR SARDJITO YOGYAKARTA PADA JANUARI 2009 SAMPAI DESEMBER 2013

YOHANES ARIF EKO NURYANTO, dr. Hj. Nunik Agustriani SpB, SpBA

2015 | Tesis | SP ILMU BEDAH ANAK

Latar belakang: Obstruksi duodenum kongenital merupakan kelainan yang sering ditemukan pada neonatus. Kelainan kongenital ini dapat ditegakkan diagnosisnya melalui anamnesis, pemeriksaan fisik serta pemeriksaan foto abdomen polos. Seiring dengan berkembangnya pengetahuan dan kemampuan dokter spesialis bedah anak, diharapkan akan dapat mengurangi angka kesakitan dan kematian. Namun masih banyak hal yang mempengaruhi managemen dan mortalitas kasus ini. Metode: Digunakan metode penelitian case control dengan pengumpulan data antara Januari 2009 sampai Desember 2013 dengan jumlah kasus 47 di RSUP Dr Sardjito Yogyakarta. Dilakukan evaluasi tentang mortalitas penderita yang dirawat berdasarkan atas jenis kelamin, berat badan lahir, usia kehamilan, rujukan, kelainan kongenital penyerta, usia saat datang ke RS dan saat operasi, hemoglobin, trombosit, albumin saat datang, tipe sumbatan, lama operasi, jenis tindakan, lama perawatan preoperasi dan pasca operasi yang dilakukan uji statistik dengan chi square dan fisher exact test. Hasil: Terdapat hubungan antara lama perawatan preoperasi dan durasi operasi dengan mortalitas penderita obstruksi duodenum kongenital. Tidak terdapat hubungan antara jenis kelamin, berat badan lahir, usia kehamilan, rujukan, kelainan kongenital penyerta, usia saat datang ke RS dan saat operasi, hemoglobin, trombosit, albumin saat datang, tipe sumbatan, jenis tindakan dan lama perawatan pasca operasi dengan mortalitas penderita obstruksi duodenum kongenital. Terdapat kecenderungan bahwa shunting duodenoduodenostomy merupakan jenis tindakan operasi yang berhubungan paling rendah dengan mortalitas. Kesimpulan: Semakin lama perawatan preoperasi dan durasi operasi akan meningkatkan resiko mortalitas pada penderita obstruksi duodenum kongenital. Shunting duodenoduodenostomy memberikan angka survival rate yang lebih tinggi.

Background: Congenital duodenal obstruction is a common anomaly in the neonatal. Diagnosis for this form of obstruction can be established by anamnesis, physical examination and plain abdominal image examinations. With better knowledged and skilled from the pediatric surgeons led to the reduction of morbidity and mortality. However, management and death is often associated with many other things. Method: A case control study method was used with data collection between Januari 2009 to December 2013 with 47 cases in Sardjito Hospital Yogyakarta. An evaluation was done to know the differences in mortality on the basis of sex, birth weight, age pregnancy, referal, other congenital anomaly, age on admission and preoperative, hemoglobin, trombocyte, albumin on admission, type of obstruction, length of surgery, type of surgery, length of preoperative and postoperative care which statistical tests performed by chi square and fisher exact tests. Result: There were relation between length of preoperative care and length of surgery with mortality in patients with congenital duodenal obstruction. There were no relation between sex, birth weight, age pregnancy, referal, other congenital anomaly, age on admission and preoperative, hemoglobin, trombocyte, albumin on admission, type of obstruction, type of surgery, length of postoperative care with mortality in patients with congenital duodenal obstruction. There were lean that duodenoduodenostomy had low relation with mortality. Conclusion: The longer the length of preoperative care and length of surgery will increase the risk of mortality in patients with congenital duodenal obstruction. Duodenoduodenostomy gives higher survival rate.

Kata Kunci : Obstruksi duodenum kongenital, mortalitas, shunting duodenoduodenostomy.