Sudibyoko, Hananta (2017) Perbedaan Lama Perawatan, Lama Kembali Beraktivitas Dan Tingkat Nyeri Pasca Operasi Pada Pasien Kolelitiasis Yang Dilakukan Mini Laparotomi Kolesistektomi Dengan Laparoskopi Kolesistektomi Di Rumah Sakit Saiful Anwar Malang. Magister thesis, Universitas Brawijaya.
Abstract
Kolelitiasismerupakanendapansatuataulebihkomponenempeduyaitukolester ol, bilirubin, garamempedu, kalsium, protein, asamlemak, danfosfolipid di dalamkandungempeduDi AmerikaSerikat, sekitar 20 juta orang (10-20% populasidewasa) mengalamikolelitiasis. Kolesistektomimerupakanprosedur yang umumdilakukansertakomplikasinyajarangmenimbulkankematian.Saatini, kolesistektomilaparoskopimerupakanprosedurpembedahan yang bersifatinvasif minimal dantelahmenjadiprosedurstandar di rumahsakitdibandingkandenganprosedurkolesistektomiterbuka.Akhirakhirinitelahdilakukanpengembanganteknikkolesistektomidenganpendekatanminil aparotomidimanalukainsisi subcostal yang dilakukanberkisarantara 3-5 cm. PenelitianolehChalkooet al (2009) menunjukkanbahwakolesistektomiminilaparotomisangatmungkindilakukandanam ankarenamempunyaitingkatmorbiditasdannyeripascaoperasilebihrendahdibandin gkankolesistektomikonvensional. Penelitian ini merupakan penelitian observasional analitik prospektif yang membandingkan kelompok kolesistektomi laparoskopi dan kelompok kolesistektomi mini-laparotomi. Parameter yang dibandingkan adalah tingkat nyeri, lama perawatan, dan lama kembali beraktifitas pasien pasca operasi. Penelitian ini menggunakan sample sebanyak 67 pasien yang terbagi dalam 2 kelompok perlakuan. Masing-masing sebanyak 33 pasien untuk kelompok laparoskopi kolesistektomi dan 34 pasien untuk kelompok minilaparotomi kolesistektomi. Penelitian ini dilakukan pada pasien dengan diagnosis kolelitiasis simtomatis yang datang ke poli bedah digestif Rumah Sakit Saiful Anwar Malang mulai Januari 2015 sampai Juli 2016. Parameter yang dicatat sebagai data penelitian, diantaranya usia, indeks, Estimated blood loss, durasi operasi (dihitung mulai insisi kulit sampai penutupan kembali kulit), komplikasi intraoperative (mayor dan minor), nyeri dievaluasi dengan visual analogue. jangka waktu rawat inap dicatat (hari pembedahan sebagai hari ke-0), serta lama kembali beraktifitas di evaluasi dengan menggunakan skala barthel indeks. Pada penelitian ini lama perawatan di rumah sakit baik untuk kelompok kolesistektomi laparoskopi maupun minilaparotomi tidak berbeda karena pada kedua kelompok tersebut sama-sama menjalani 2 hari perawatan. Masa pemulihan (kembali beraktivitas normal) kurang dari 2 minggu dengan skala 100. Rerata skala nyeri metode laparoskopi (skor VAS 2.5±0.6) lebih rendah dibandingkan dengan metode minilaparotomi (skor VAS 2.8±0.74). Hasil uji statistik dengan Mann-Whitney U menunjukkan nilai p = 0.167. Oleh karena nilai p > 0.05 maka hasil ini menunjukkan bahwa rerata skor nyeri metode laparoskopi tidak berbeda signifikan dengan metode minilaparotomi. rerata durasi operasi metode laparoskopi (106.5±11.8 menit) lebih panjang dibandingkan dengan metode minilaparotomi (57.5±5.3 menit). Hasil uji statistik dengan Mann-Whitney U menunjukkan nilai p = 0.000. Oleh karena nilai p < 0.05 maka hasil ini menunjukkan bahwa durasi operasi metode minilaparotomi secara signifikan lebih pendek dibandingkan dengan metode laparoskopi. rerata jumlah pendarahan metode laparoskopi (29.5±9.8 cc) lebih sedikit dibandingkan dengan metode minilaparotomi (36.8±12.7 cc). Hasil uji statistik dengan Mann-Whitney U menunjukkan nilai p = 0.013. Oleh karena nilai p < 0.05 maka hasil ini menunjukkan bahwa rerata jumlah pendarahan metode laparoskopi secara signifikan lebih sedikit dibandingkan dengan metode minilaparotomi.
English Abstract
Cholelithiasis is a precipitate one or more components of bile is cholesterol, bilirubin, bile salts, calcium, protein, fatty acids and phospholipids in the gall bladder. 1.2 In the United States, approximately 20 million people (10-20% of the adult population) had cholelithiasis. Cholecystectomy is a common procedure and complications rarely cause of death. Currently, laparoscopic cholecystectomy is a surgical procedure that is minimally invasive and has become a standard procedure in the hospital compared with open cholecystectomy. Lately, this has been done the development of techniques minilaparotomy cholecystectomy approach whereby subcostal incision made ranging between 3-5 cm. Previous research suggests that the mini laparotomy cholecystectomy is feasible and safe because they have the morbidity and postoperative pain was lower than conventional cholecystectomy. This study is a prospective observational study comparing laparoscopic cholecystectomy group and mini-laparotomy cholecystectomy group. Parameters were compared was the level of pain, duration of treatment, and length of postoperative patients back their activities. This study used a sample of 67 patients were divided into 2 groups. Respectively of 33 patients for laparoscopic cholecystectomy group and 34 patients to group minilaparotomi cholecystectomy. This study was conducted in patients with a diagnosis of symptomatic cholelithiasis who came to the digestive surgery outpatient clinic in Saiful Anwar Hospital from January 2015 through January 2017. The parameters were recorded as research data, including age, Estimated blood loss, duration of surgery (calculated from skin incision to closure back skin), intraoperative complications (major and minor), was evaluated by visual analogue pain, hospitalization time period is recorded (day surgery as day 0), and the long back daily activity in the evaluation using the Barthel index scale. In this study, a long hospital stay good for laparoscopic cholecystectomy and minilaparotomy groups did not difference for the two groups were equally undergoing two days of treatment. The period of recovery (return to normal daily activities) less than 2 weeks with a scale of 100 in barthel index score. The mean pain scale laparoscopic method pain scale (VAS score 2.5 ± 0.6) was lower than the method minilaparotomi (VAS score of 2.8 ± 0.74). Results of statistical test by Mann-Whitney U test showed the value of p = 0.167. Therefore the value of p>0.05 then the results indicate that the average pain score was not significantly differences laparoscopic methods with methods minilaparotomy. The mean duration of surgery laparoscopic method (106.5 ± 11.8 minutes) longer than the method minilaparotomy (57.5 ± 5.3 minutes). Results of statistical test by Mann- Whitney U test showed the value of p = 0.000. Therefore the value of p <0.05 then the results indicate that the duration of the operation minilaparotomy method is significantly shorter than the laparoscopic method. Number of bleeding laparoscopic method (29.5 ± 9.8 cc) less than the method minilaparotomi (36.8 ± 12.7 cc). Results of statistical test by Mann-Whitney U test showed the value of p = 0.013. Therefore the value of p <0.05 then the results indicate that the average amount of bleeding laparoscopic method is significantly less compared to the method minilaparotomy.
Other obstract
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| Item Type: | Thesis (Magister) |
|---|---|
| Identification Number: | TES/617.03/SUD/p/2017/041802325 |
| Uncontrolled Keywords: | REHABILITATION, MEDICAL REHABILITATION |
| Subjects: | 600 Technology (Applied sciences) > 617 Surgery, regional medicine, dentistry, ophthalmology, otology, audiology > 617.03 Rehabilitation |
| Divisions: | Profesi Kedokteran > Spesialis Ilmu Bedah, Fakultas Kedokteran |
| Depositing User: | Endang Susworini |
| Date Deposited: | 10 Dec 2019 02:44 |
| Last Modified: | 10 Dec 2019 02:44 |
| URI: | http://repository.ub.ac.id/id/eprint/176696 |
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