ABSTRAK
Latar Belakang: Kebocoran anastomosis adalah komplikasi yang dapat terjadipasca dilakukannya reduksi manual, reseksi dan anastomosis end-to-end padakasus intususepsi. Faktor-faktor yang mempengaruhi kebocoran anastomosisantara lain teknik operator, kondisi lokal usus, kondisi umum pasien dan gradingkolagen yang terbentuk pada proses penyembuhan luka.Tujuan: Mengetahui pengaruh perubahan grading kolagen usus pasca reseksianastomosis terhadap kebocoran pada kasus intususepsi.Metode: Dua puluh satu tikus Sprague-dawley dilakukan laparatomi untuk dibuatmodel intususepsi (IN). Setelah 45 menit dilakukan destrangulasi selama 10menit, dinilai adanya nekrosis dan dilanjutkan reseksi anastomosis. Tikus dibagimenjadi 3 kelompok, kelompok A : reseksi anastomosis pada batas usus yangnekrosis, kelompok B : reseksi anastomosis pada batas usus yang mengalamitrombosis pembuluh darah mesenteriumnya, dan kelompok C : reseksianastomosis pada batas usus yang sehat. Sampel usus yang direseksi diperiksasecara Histopatologi untuk menilai grading kolagen. Setelah 5 hari dilakukanlaparatomi ulang, dinilai secara subjektif ada tidaknya kebocoran anastomosis,lalu diambil sampel segmen anastomosis usus untuk dinilai kembali gradingkolagennya. Diharapkan jika terjadi kenaikan grading kolagen, anastomosis akanpaten, sebaliknya jika terjadi penurunan akan terjadi perforasi.Hasil: Kelompok A: grading kolagen menurun dengan perforasi 6 (85,7%),grading kolagen tetap tanpa perforasi 1 (14,2%). Kelompok B: grading kolagenmenurun dengan perforasi 2 (28,6%), tetap dengan perforasi 1 (14,3%),meningkat tanpa perforasi 4 (42,9%). Kelompok C: grading kolagen meningkattanpa perforasi 5 (71,4%), menetap tanpa perforasi 2 (28,6%).Kesimpulan: Terdapat perubahan grading kolagen pasca reseksi anastomosisusus yang mempengaruhi tingkat kebocoran anastomosis pada kasus intususepsi
ABSTRACT
Background: Anastomosis leakage is a common complication following manualreduction, resection and end-to-end anastomosis in treating intussusceptions.Factors influencing the anastomosis leakage such as surgeon?s technique, localbowel condition, systemic condition of patients and the concentration of collagenin the bowel tissue during the anastomosis healing.Aim: To study the effect of collagen concentration changes after resection andanastomosis procedure, in relation to the anastomosis leakages in intussusceptionscase.Methods: 21 Sprague-dawley rats were performed laparotomy to create theintussusception model (IN). The IN models were applied for 45 minute, after thebowel considered necrotic, destrangulation were performed for 10 minutescontinued with resection and anastomosis on 3 group of resection margin: A onnecrotic margin of bowel, B: on the thrombotic mesenterium vessel margin, C: onnormal bowel margin. Resected bowels were sent for histopathology examinationof collagen concentrations. After 5 days, another laparotomy was performed andthe anastomosis leakages were subjectively assessed. The anastomosed segmentswere sampled for collagen concentration and grade.Results: In study group A the collagen grading were found to be decreased with 6leakages occurred (85.7%) and 1 subject (14.2%) with stable collagen grading andno leakages. From group B, subjects with decreased collagen and leakages were 2(28.6%), and 1 subjects (14.3%) were stable in grading with leakages, and 4subjects (42.9%) with increased collagen without leakages. In Group C, 5 rats(71.4%) had increased collagens without leakages, and 2 rats were at stablecollagen grade without leakages.Conclusion: There were collagen grade changes in bowel anastomosis that affectthe extent of leakages in intussusceptions case |
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