Perbandingan Efektivitas Methylen Blue, Dextran 70 dan Oxidized Regenerated Cellulose dalam Pencegahan Adhesi Intraperitoneal Pascaoperasi Laparotomi dengan Abrasi Ileum Terminal pada Hewan Percobaan Kelinci

Abstract

Intraperitoneal adhesions cause a lot of clinical complications such as intestinal obstruction, abdominal and chronic pelvic pain, infertility, and complicate subsequent surgery, so it affects the quality of life. One of the measures preventing intraperitoneal adhesions by intraperitoneal use of topical agents such as inhibitors of inflammatory mediators (methylen blue), the mechanical barrier fluid (dextran 70) and mechanical barrier membranes by oxidized regenerated cellulose (ORC). This research was conducted to prove the difference in the effectiveness of anti-adhesion compound were above the third. This study used 20 male guinea pigs, aged 4-6 months weighing 500-1000 grams, which is divided into four groups each mas-ing groups of five rats. All the rabbits performed laparo-anatomy and abrasion terminal ileum. Group 1 (control) was not given any two given methylen kelopok blue 1% 7 ml / kg, group 3 was given 10 ml / kg 6% dextran 70, and group 4 were oxidized regenerated cellulose which dilengketkan to abrasion ar-eas. Fifteen days relaparotomi pascalaparotomi conducted to assess the incidence of adhesions. To compare the differences between the treatment group used "Kruskal-Wallis test", while comparing each treatment with the control group used "Mann-Whitney test." Differences are considered significant if p <0.05. Results showed that there was adehesi in all groups with 10 adhe-sion events (50%). The highest incidence of adhesions in the control group 4 / 5 (80%) followed by dextran 3 / 5 (60%), ORC two fifths (40%), the smallest adhesion on blue methylen fifth (20%). "Kruskal Wallis test" of the five variables (incidence, number, volume, et al Zuhike score, and score vaskulerisasi Hulka adhesion modification) showed a mean ranking of most small blue methylen, followed by the ORC, dextran and control, which has the smallest mean rank anti- best adhesion, whereas the p-value of the five variables p> 0.05 means no significant difference from the three preparations. When compared between each treatment group with kintrol by "Mann-Whitney test" results there are differences between me-thylen blue bermakan to controls with p <0.05, whereas in the group of ORC and dextran p> 0.05. From the results of this study concluded that giving methylen blue 1% 7 ml / kg intraperitoneal pascalaparo effective in preventing adhesion-anatomy. Anti-adhesion properties are more effective than blue Methylen ORC and dextran.

Adhesi intraperitoneal banyak menimbulkan komplikasi klinis seperti obstruksi usus, sakit perut dan panggul kronis, infertilitas, serta mempersulit pembedahan berikutnya, sehingga sangat mempengaruhi kualitas hidup. Salah satu upaya pencegahan terjadinya adhesi intraperi-toneal dengan penggunaan bahan topikal intraperitoneal seperti, penghambat mediator inflamasi ( methylen blue ), barier mekanik cairan( dextran 70 ) dan membran barier mekanik oleh oxidized regenerated cellulose ( ORC). Penelitian ini dilakukan untuk membuktikan perbedaan efektifitas anti-adhesi ketiga sediaan tersebut diatas. Penelitian ini menggunakan 20 ekor kelinci percobaan, usia 4 – 6 bulan, dengan berat 500 - 1000 gram, yang dibagi atas 4 kelompok ma sing-masing kelompok berjumlah 5 ekor. Semua kelinci dilakukan laparo-tomi dan abrasi ileum terminal. Kelompok 1 ( kontrol ) tidak diberi apapun, kelopok 2 diberi methylen blue 1% 7 ml/Kgbb, kelompok 3 diberi 10 ml/Kgbb 6% dextran 70 , dan kelompok 4 diberi oxidized regenerated cel-lulose yang dilengketkan ke daerah abrasi. Lima belas hari pascalaparo-tomi dilakukan relaparotomi untuk menilai kejadian adhesi. Untuk membandingkan perbedaan diantara kelompok perlakuan digunakan “Kruskal-Wallis test” , sedangkan untuk membandingkan masing-masing kelompok perlakuan dengan kontrol digunakan “Mann–Whitney test “. Perbedaan dianggap bermakna bila p < 0,05. Hasil penelitian menunjukkan terjadi adehesi pada semua kelom-pok dengan 10 kejadian adhesi ( 50% ). Kejadian adhesi tertinggi pada kelompok kontrol 4/5 ( 80% ) diikuti dextran 3/5 ( 60% ), ORC 2/5 ( 40% ), adhesi terkecil pada methylen blue 1/5 ( 20% ). “Kruskal Wallis test” dari 5 variabel ( angka kejadian, jumlah, volume, skor Zuhike et al, dan skor vas-kulerisasi adhesi Hulka modifikasi) menunjukkan mean ranking methylen blue paling kecil, diikuti ORC, dextran dan kontrol, dimana mean rangking terkecil memiliki anti-adhesi paling baik, sedangkan nilai p dari kelima variable p > 0,05 artinya tidak terdapat perbedaan bermakna dari ketiga sediaan. Ketika dibandingkan antara masing-masing kelompok perlakuan dengan kintrol dengan “Mann–Whitney test “ hasilnya terdapat perbedaan bermakan antara methylen blue dengan kontrol dengan p < 0,05, sedang-kan pada kelompok ORC dan dextran p > 0,05. Dari hasil penelitian ini disimpulkan bahwa pemberian methylen blue 1% 7 ml/Kgbb intraperitoneal efektif mencegah adhesi pascalaparo-tomi. Sifat anti-adhesi Methylen blue lebih efektif dibandingkan ORC dan dextran.