Gambaran Karakteristik Penderita, Prosedur dan Temuan Operasi pada Penderita Rinosinusitis Kronis yang Menjalani Bedah Sinus Endoskopik Fungsional (BSEF) di RSUP H. Adam Malik Medan

Abstract

Introduction: Functional endoscopic sinus surgery (FESS) has become the standard surgical treatment for patients with chronic rhinosinusitis (CRS), particularly those who have failed medical treatment. There are many CRS cases in General Hospital of H. Adam Malik, Medan, as well as CRS patients treated with FESS. This research is expected to provide information on characteristics of CRS patients, FESS procedure and operative findings in General Hospital of H. Adam Malik, Medan. Aim: To determine the characteristic of patients, procedures and operative findings in patients who underwent FESS in General Hospital of H. Adam Malik, Medan. Methods: A case-series descriptive study conducted in General Hospital of H. Adam Malik, Medan. Data collected from patients using a questionnaire formula. Results of endoscopic examination, paranasal sinus coronal computed tomography, procedures and operative findings were recorded. Results: CRS with polyps were the commonest group found in patients who underwent FESS (62.50%). Mostly were in moderate disease category based on SNOT-20 (81.25%). Patients given antibiotics as primary treatment and patients with other history of medical treatment were 37.50% respectively. Inferior turbinate mucosal edema was the commonest pre-operative endoscopic findings (100%). The commonest computer tomography findings are ostiomeatal complex obstruction (87, 50%) and maxillary sinus involvement (100%). The commonest stage in severity of the disease based on Harvard staging system was stage III (46.88%). Uncinectomy and bilateral middle meatal antrostomy were the commonest procedure performed (68.75%). The commonest intraoperative finding was ethmoid polypoid mucosal (84,39%). Conclusion: CRS with polyp were the commonest type of CRS treated with FESS in General Hospital of H. Adam Malik, Medan. Treatment of CRS patients before FESS should be re-evaluated. Most performed procedures were uncinectomy and middle meatal antrostomy. The commonest intraoperative finding was ethmoid polypoid mucosal.

Pendahuluan: Bedah sinus endoskopik fungsional (BSEF) telah menjadi standar tindakan bedah dalam penatalaksanaan rinosinusitis kronis (RSK), khususnya bagi penderita yang gagal dengan pengobatan medikamentosa. Di RSUP H. Adam Malik, Medan, penderita RSK cukup banyak begitu juga dengan penderita RSK yang ditangani dengan BSEF. Diharapkan penelitian ini dapat memberikan informasi mengenai gambaran karakteristik penderita RSK dan tindakan BSEF di RSUP H. Adam Malik, Medan. Tujuan Penelitian: Untuk mengetahui gambaran karakteristik penderita, prosedur dan temuan operasi pada penderita RSK yang menjalani BSEF di RSUP H. Adam Malik, Medan. Metode Penelitian: Penelitian deskriptif dengan desain case-series dilakukan di RSUP H. Adam Malik, Medan. Data dikumpulkan berdasarkan formula kuesioner, pencatatan hasil pemeriksaan endoskopik, tomografi komputer sinus paranasalis dengan potongan koronal, prosedur dan temuan operasi pada tindakan BSEF. Hasil: Penderita RSK yang menjalani BSEF terbanyak adalah penderita RSK dengan polip (62,50%). Kategori penyakit berdasarkan SNOT-20 terbanyak adalah kategori penyakit sedang (81,25%). Jumlah penderita RSK dengan riwayat pengobatan antibiotik sama banyak dengan penderita RSK dengan riwayat pengobatan medikamentosa lainnya, yaitu 37,50%. Temuan endoskopik pre-operatif terbanyak adalah edema mukosa konka inferior (100%). Gambaran tomografi komputer terbanyak menunjukkan obstruksi kompleks ostiomeatal sebanyak 87,50% dan keterlibatan sinus maksilaris 100%. Derajat keparahan penyakit berdasarkan Harvard staging system terbanyak adalah derajat III (46,88%). Tindakan BSEF terbanyak dilakukan adalah unsinektomi dan antrostomi meatus media bilateral, masing-masing 68,75%. Temuan intraoperatif terbanyak dijumpai adalah mukosa etmoid polipoid yaitu (84,39%).