Tesis

Kesintasan Keluhan Nyeri Pasca Pembedahan pada Pasien Endometriosis serta Faktor-Faktor yang Mempengaruhi di RSUPN Cipto Mangunkusumo = Post-operative Pain Survival and Correlation Factors in Endometriosis Patient at Cipto Mangunkusumo Hospital.

Latar Belakang: Endometriosis merupakan implantasi kelenjar abnormal menyerupai endometrium (kelenjar dan jaringan stroma) di luar kavum uterus. 1–6 Endometriosis mempengaruhi 5-10% wanita usia reproduksi (usia 15-49). 5,7–11 Di RSUPN Cipto Mangunkusumo: keluhan nyeri panggul (82,5%), dismenorea(81%), low back pain (32,5%), dispareunia (20,9%), disuria (6,9%) dan diskezia(4,6%) dapat menurunkan kualitas hidup wanita 7,12,13 Tatalaksana endometriosis dari konservatif yaitu medisinalis (hormonal ataupun non hormonal) sampai invasif (laparoskopi atau laparatomi). 14,15 Namun angka rekurensi endometriosis pasca pembedahan tinggi mencapai 21.5% dalam 2 tahun. Beberapa faktor risiko rekurensi adalah usia saat didiagnosis, usia menarke, stadium penyakit, terapi medisinalis atau tindakan pembedahan sebelumnya. 16,17 Tujuan: Mengetahui kesintasan keluhan nyeri 3, 6, 9 dan 12 bulan dan adanya hubungan antara faktor usia saat didiagnosis, usia menarke, paritas, stadium penyakit dan terapi medisinalis pasca pembedahan pada pasien endometriosis di RSUPN Cipto Mangunkusumo. Metode: Rancangan penelitian ini menggunakan desain kohort prospektif dengan metode analisis kesintasan pada pasien endometriosis yang telah dilakukan terapi pembedahan dari 2015 sampai 2017. Hasil: Kesintasan 3,6,9, dan 12 bulan keluhan nyeri pasien endometriosis pasca bedah adalah 99,2%; 96,6%, 93% dan 88,4%. Tidak ada hubungan yang bermakna antara usia (p=0,138), usia menarke (p=0,492), paritas(p=0,110), stadium (p=0,908); terdapat hubungan bermakna pada terapi medisinalis pasca bedah terhadap kesintasan keluhan nyeri (p=0,027), pada subjek terapi medisinalis memiliki risiko 0,26 kali (HR=0,26 (IK95% 0,081-0,857)) kekambuhan nyeri dibandingkan dengan terapi non-medisinalis, atau memiliki risiko kekambuhan nyeri yang turun 73,6% dibandingkan dengan terapi non-medisinalis. Kesimpulan: Kesintasan 3,6,9, dan 12 bulan keluhan nyeri adalah 99,2%; 96,6%, 93% dan 88,4%. Subjek dengan terapi medisinalis pasca bedah memiiki hubungan bermakna terhadap kesintasan keluhan nyeri (p=0,027) pasca bedah pada endometriosis dengan risiko 0,26 kali dibandingkan dengan terapi non-medisinalis (HR=0,26 (IK95% 0,0810,857))
Kata Kunci: Kesintasan, Nyeri pasca pembedahan, endometriosis, terapi medisinalis


Background: Endometriois is implantation of abnormal endometrial-like gland (gland and stromal tissue) outside the uterine cavity. Endometriosis impact about 5-10% reproductive age women (age 15-49). In Cipto Mangunkusumo hospital was found that symptoms: pelvic pain (82.5%), dysmenorrhea (81%), low back pain (32.5%), dyspareunia ( 20.9%), dysuria (6.9%) and dyschezia (4.6%) can reduce women quality of life. Conservative management endometriosis were medication (hormonal or nonhormonal) and surgical (laparoscopic or laparotomy). However, recurrence rate of endometriosis post-operative medication was high about 21.5% in 2 years observation. Several risk factors of recurence rate were age of diagnosis, age of menarche, parity, stage of disease, post-operative medication. Purpose: To know the survival of pain complaints at 3, 6, 9 and 12 months and the correlation between age at diagnosis, age of menarche, parity, stage of disease and postoperative medication in endometriosis patient at RSUPN Cipto Mangunkusumo. Method: This study was a prospective cohort design with survival analysis method in endometriosis patients who performed surgical therapy from 2015 to 2017. Result: Pain complaints survival at 3,6,9, and 12 months of post-operative endometriosis patient was 99.2%; 96.6%, 93% and 88.4% respectively. There was no significant correlation between age of diagnosis (p = 0,138), age of menarche (p = 0,492), parity (p = 0,110), stage of disease (p = 0,908); there was a significant correlation in post-operative medication on pain complaints survival (p = 0.027), in the subjects of post-operative medication had a risk of 0.26 times (HR = 0.26 (CI 95% 0.081-0.857)) pain recurrence compared with non post-operative medication, or the subject had lower risk of pain recurrence 73.6% than non post-operative medication. Conclutions: Pain complaints survival at 3,6,9, and 12 months of post-operative endometriosis patient was 99.2%; 96.6%, 93% and 88.4% respectively. The subjects of post-operative medication had a risk of 0.26 times (HR = 0.26 (CI 95% 0.081-0.857)) pain recurrence compared with non post-operative medication.
Keywords: Survival, Post-operative pain, endometriosis, post-operative medication