Tesis

Hubungan Rasio Usus-Vertebra pada Radiografi Abdomen Supine dengan Temuan Intra Operatif Obstruksi Usus Pediatri di RSAB Harapan Kita = The Association between Intestinal-Vertebral Ratio by Supine Abdominal Radiography and Pediatric Intestinal Obstruction Surgical Findings in Harapan Kita Women’s and Children’s Hospital.

Variasi yang luas pada anatomis saluran cerna pediatri, mencetus kebutuhan penyesuaian pengukuran dilatasi lumen usus kasus obstruksi, dengan acuan ukuran standar yang terdapat pada individu untuk mendapatkan nilai absolut dan kuantitatif, yaitu dengan pengukuran rasio ususvertebra pada radiografi abdomen supine. Metode yang digunakan adalah studi observasional potong lintang menggunakan data sekunder pada 31 subjek yang menjalani radiografi abdomen supine di Bagian Radiologi dan menjalani operasi laparotomi di Bagian Bedah Anak RSAB Harapan Kita dalam kurun waktu Januari – Juni 2014 dan Januari – Desember 2015. Subjek dibagi dalam dua kelompok, yaitu kelompok dengan temuan intra operatif obstruksi usus dan nonobstruksi usus. Uji komparatif McNemar disertai analisis Kappa menunjukkan terdapat kesamaan bermakna dengan hubungan cukup kuat (R Kappa= 0,54; p= 0,003) antara rasio usus-vertebra radiografi abdomen supine dengan temuan intra operatif obstruksi dan non-obstruksi usus pediatri. Sebagai kesimpulan, terdapat hubungan cukup kuat antara rasio usus-vertebra radiografi abdomen supine dengan temuan intra operatif obstruksi dan non-obstruksi usus pediatri, dengan proporsi nilai rasio usus-vertebra pada kelompok temuan intra operatif obstruksi usus lebih besar dibandingkan kelompok non-obstruksi usus. Analisis receiver operating characteristic mendapatkan nilai titik potong optimal rasio usus-vertebra radiografi abdomen supine sebesar 1,024 memiliki sensitifitas 83,3% dan spesifisitas 84,6%; untuk membedakan kedua kondisi tersebut.
Kata kunci: Pediatri, rasio usus-vertebra, radiografi abdomen supine, intra operatif, obstruksi usus



The vast anatomical variation in pediatric’s intestines, sugest the need of a standard reference to measure quantitatively the bowel dilatation in pediatric intestinal obstruction cases. With the standard reference for each individual measurement in the form of intestinal-vertebral ratio, we can get quantitative and absolute measurement result. A cross-sectional observational study was conducted in 31 patients underwent supine abdominal radiograph in radiology department and laparotomy procedure in pediatric surgery department Harapan Kita Women’s and Children’s Hospital during January – June 2014 and January – December 2015. The patients were divided into 2 main groups based on the surgical findings, the obstructive intestinal group and nonobstructive group. McNemar comparative test and Kappa analysis revealed significant homogenity with moderate association between the intestinal-vertebral ratio and the surgical findings in both pediatric group (R Kappa= 0,54; p= 0,003). As conclusion, there is a moderate association between the intestinal-vertebral ratio and the surgical findings in pediatric obstructive and nonobstructive intestinal group. The intestinal-vertebral ratio in obstructive intestinal group is greater than the non-obstructive intestinal group. The receiver operating characteristic analysis revealed 1,024 for the optimal intestinal-vertebral ratio cut off point, which gives 83,3% sensitivity and 84,6% specificity to differentiate between pediatric obstructive and non-obstructive intestinal group.
Keywords: Pediatric, intestinal-vertebral ratio, supine abdominal radiograph, surgical finding, intestinal obstruction