Tesis

Keberhasilan Terapi Argon Plasma Coagulation pada Penderita Kolitis Radiasi dan Faktor yang Memengaruhinya = Efficacy of Argon Plasma Coagulation Treatment in Radiation Colitis Patients and its confounding factors.

Latar belakang: Argon Plasma Coagulation (APC) merupakan modalitas terapi yang banyak digunakan untuk pengobatan kolitis radiasi pada pasien keganasan ginekologi, kolorektal dan urologi yang mendapatkan radioterapi di RSUPN-CM. Tujuan: Menilai hasil dari APC yang dilakukan pada penderita kolitis radiasi dan faktor perancunya. Metode: Penelitian deskriptif analitik dengan desain kohort retrospektif berdasarkan data dari rekam medis RSUPN-CM antara bulan April 2012 sampai dengan Oktober 2019. Variabel yang dinilai meliputi umur, jenis kelamin, jenis keganasan, diabetes melitus, hipertensi, dan status anemia, dengan luaran berupa keberhasilan APC. Pengujian kemaknaan statistik dilakukan sesuai dengan karakteristik data serta tujuan penelitian, dengan p < 0,05 dianggap bermakna. Juga dilakukan analisis multivariat untuk melihat variabel perancu yang paling memengaruhi keberhasilan APC. Hasil: Sebanyak 180 pasien kolitis radiasi yang mendapatkan terapi APC memenuhi kriteria penelitian dengan proporsi terbanyak berjenis kelamin perempuan sebesar 89,4%, dan berusia > 50 tahun sebanyak 83,9%. Sedangkan jenis tumor terbanyak adalah keganasan ginekologi sebanyak 88,9%. Sebanyak 81,3 % subyek mengalami keberhasilan terapi APC. Nilai tengah frekuensi APC sebanyak 2 sesi dengan rentang 1 sampai 12 sesi. Terdapat 180 subyek (100%) menderita anemia sebelum menjalani APC yang pertama. Kadar hemoglobin pada penderita APC meningkat dengan median Hb sebelum APC pertama sebesar 8 g/dL (3-11 g/dL) menjadi 12 g/dL (10-14 g/dL) sebelum APC terakhir. Sebanyak 59,2% subyek yang mengalami keberhasilan APC tidak lagi menderita anemia setelah terapi APC, dengan perbaikan status anemia meningkat sebesar 1,628 kali lebih baik pada subyek yang mengalami keberhasilan APC dibandingkan dengan subyek yang mengalami ketidakberhasilan terapi APC (p=0,017). Usia, jenis kelamin, jenis keganasan, hipertensi dan diabetes melitus bukan merupakan faktor perancu terhadap status anemia pada keberhasilan APC. Kesimpulan: Terdapat perbaikan status anemia pada penderita kolitis radiasi yang mendapatkan terapi APC di RSUPN-CM.
Kata kunci: anemia, APC, argon plasma coagulation, kolitis radiasi.


Background: Argon Plasma Coagulation (APC) is recently widely used in the treatment of radiation colitis among patients with gynecology, colorectal and urology malignancy. Purpose: To measure the result of APC conducted on radiation colitis patients and its counfounding factors. Methods: An analytic descriptive study with retrospective cohort design based on RSUPN-CM database between April 2012 until October 2019. Variables measured were age, gender, tumor types, diabetes melitus, hypertension, and anaemia, with efficacy of APC treatment as the outcome. Statistical tests conducted according to characteristics and the purpose of the study, with p value < 0.05 considered significant. Multivariate analysis was also conducted to evaluate which factors influenced to the efficacy of APC therapy. Results: As much as 180 radiation colitis patients received APC treatment fulfilled inclusion criteria with characteristics female patients (89.4%), and age > 50 years old (83.9%) were found in this study. Types of tumor were dominated by gynecology malignancy (88.9%). As much as 81.3% subjects had successful APC treatment. Median number of efficacy of APC treatment in this study was 2 sessions. All of the subjects had anaemia before the first APC treatment. There was improvement in Hb level, median Hb before the first APC treatment was 8 g/dL (3-11 g/dL) and median Hb level before the last APC treatment was 12 g/dL (10-14 g/dL). As much as 59.2% subjects who had successful APC treatment were no longer anaemia after APC treatment, with improvement of anaemia status was 1.628 times more likely in subjects who had successful APC treatment compared to subjects who did not have successful APC treatment (p=0.017). Age, gender, malignancy types, hypertension dan diabetes melitus were not confounding factors to anaemia status in successful APC treatment. Conclusion: There was improvement in anaemia status on radiation colitis patients receiving APC treatment in RSUPN-CM.
Keywords: anaemia, APC, argon plasma coagulation, radiation colitis.