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Laparoskopi Hemihepatektomi pada Hepatoseluler Karsinoma Hemiliver Dextra Et Causa Hepatitis B

Departemen Anestesiologi dan Terapi Intensif, Fakultas Kedokteran, Universitas Diponegoro/ RSUP Dr. Kariadi Semarang, Indonesia

Published: 30 Nov 2022.

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Abstract

Latar Belakang: Reseksi hati untuk karsinoma hepatoseluler (HCC) saat ini dikenal sebagai prosedur yang lebih aman daripada sebelumnya karena kemajuan teknis dan perbaikan dalam manajemen pasien pascaoperasi dan tetap menjadi pengobatan lini pertama untuk HCC pada sirosis kompensasi. Hepatektomi adalah strategi pengobatan kuratif yang umum digunakan untuk pasien HCC stadium awal dan awal dengan fungsi hati yang dipertahankan. Teknik laparoskopi telah terbukti mempercepat pemulihan, meningkatkan nyeri pascaoperasi, dan menghasilkan kosmetik yang lebih baik daripada pendekatan terbuka.

Kasus: Pasien laki-laki usia 51 tahun datang dengan nyeri perut kanan sejak 2 minggu, riwayat asma, hipertensi, penyakit jantung, sedasi, operasi, demam, sesak napas, batuk, pilek disangkal. Pasien tampak sakit sedang dengan kesadaran kompos mentis. Vital sign : tekanan darah  129/77 mmHg, laju jantung 83x/menit regular, isi dan tengangan cukup, laju napas 20x/menit, suhu = 36,2°C, saturasi oksigen 100% room air. Pada pemeriksaan laboratorium, ditemukan HBsAg = positif, AFP = 3,46 ng/ml, anti HCV = 0,09 IU/L, SGOT = 26 U/L, SGPT = 22 U/L. Pada pemeriksaan multislice computed tomography abdomen (MSCT abdomen), ditemukan hepatomegali disertai massa solid dengan area nekrotik di dalamnya pada segmen 8 hepar dan limfadenopati interaortocava.

Pembahasan: HCC adalah tumor primer hati dan merupakan lebih dari 90%   tumor primer hati. HCC sekarang menjadi penyebab paling umum kelima kanker di seluruh dunia. Anestesi umum dipertahankan dengan anestesi volatil (isofluran sevofluran, desfluran, nitrous oxide), anestesi intravena (propofol, dexmedetomidine, ketamin, opiat), atau kombinasi dari semuanya, relaksan otot kerja pendek dan menengah lainnya (atracurium, rocuronium, vecuronium). Reseksi hati membawa risiko kehilangan darah yang melekat dengan pembedahan diseksi inferior vena cava (IVC), vena portal, dan vena hepatik dan transeksi parenkim yang sangat vaskularisasi.

Kesimpulan: Hepatektomi laparoskopi menghindari kerugian dari hepatektomi standar pada pasien yang dipilih dengan benar dan bermanfaat untuk kualitas hidup pasien, karena merupakan prosedur invasif minimal.

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Keywords: hepatomegaly; karsinoma hepatoseluler; laparoskopi hemihepatektomi; reseksi hati; vena porta; vena hepatik

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  1. Wilks, Jonathan A., Shannon Hancher-Hodges, and Vijaya NR Gottumukkala. "Contemporary Perioperative Anesthetic Management of Hepatic Resection." Advances in Anesthesia 34.1 (2016): 85-103
  2. Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015 Mar 01;136(5):E359-86. [PubMed]
  3. Schulze K, Nault JC, Villanueva A. Genetic profiling of hepatocellular carcinoma using next-generation sequencing. J Hepatol. 2016 Nov;65(5):1031-1042. [PubMed]
  4. Thiele M, Gluud LL, Fialla AD, Dahl EK, Krag A. Large variations in risk of hepatocellular carcinoma and mortality in treatment naïve hepatitis B patients: systematic review with meta-analyses. PLoS One. 2014;9(9):e107177
  5. Yi, Yong, et al. "Laparoscopic versus open left hemihepatectomy for hepatocellular carcinoma: a propensity score matching analysis." Translational Cancer Research 9.9 (2020): 5484
  6. Kaneko, Hironori. "Laparoscopic hepatectomy: indications and outcomes." Journal of hepato-biliary-pancreatic surgery 12.6 (2005): 438-443
  7. Gaillard, Martin, Hadrien Tranchart, and Ibrahim Dagher. "Laparoscopic liver resections for hepatocellular carcinoma: current role and limitations." World Journal of Gastroenterology: WJG 20.17 (2014): 4892
  8. Patrick J. Navin, Sudhakar K. Venkatesh. Hepatocellular Carcinoma : State of the Art Imaging and Recent Advances. Journal of Clinical and Translational Hepatology 2019 ; 7 (1) : 72-85
  9. Petrick JL, Kelly SP, Altekruse SF, McGlynn KA, Rosenberg PS. Future of hepatocellular carcinoma incidence in the United States forecast through 2030. Journal of Clinical Oncology 2016;34:1787-1794
  10. Heimbach JK, Kulik LM, Finn RS, Sirlin CB, Abecassis MM, Roberts LR. AASLD guidelines for the treatment of hepatocellular carcinoma. Hepatology 2018;67:358-380
  11. Marrero JA, Ahn J, Rajender Reddy K. ACG clinical guideline: the diagnosis and management of focal liver lesions. Am J Gastroenterol 2014;109:1328-1347
  12. Wilson SR, Lyshchik A, Piscaglia F, Cosgrove D, Jang HJ, Sirlin C. CEUS LI-RADS: algorithm, implementation, and key differences from CT/MRI. Abdom Radiol (NY) 2018;43:127-142
  13. Wimmer T, Steiner J, Talakic E, Stauber R, Quehenberger F, Portugaller RH. Computed tomography perfusion following transarterial chemoembolization of hepatocellular carcinoma: A feasibility study in the early period. J Comput Assist Tomogr 2017;41:708-712
  14. Pan S, Wang XQ, Guo QY. Quantitative assessment of hepatic fibrosis in chronic hepatitis B and C: T1 mapping on Gd-EOB-DTPA-enhanced liver magnetic resonance imaging. World J Gastroenterol 2018;24:2024-2035
  15. Peng Z, Li C, Chan T, Cai H, Luo Y, Dong Z. Quantitative evaluation of Gd-EOB-DTPA uptake in focal liver lesions by using T1 mapping: differences between hepatocellular carcinoma, hepatic focal nodular hyperplasia and cavernous hemangioma. Oncotarget 2017;8:65435-65444
  16. Marrero JA, Kulik LM, Sirlin CB, et al. Diagnosis, staging, and management of hepatocellular carcinoma: 2018 practice guidance by the American Association for the study of liver diseases. Hepatology. 2018 ; 68(2):723–750
  17. Akinyemiju T, Abera S, Ahmed M, et al. The burden of primary liver cancer and underlying etiologies from 1990 to 2015 at the global, regional, and national level: results from the global burden of disease study 2015. JAMA Oncol. 2017 ; 3 (12) : 1683–1691
  18. Song T, Li L, Wu S, et al. Peripheral blood genetic biomarkers for the early diagnosis of hepatocellular carcinoma. Front Oncol. 2021;11:583714
  19. Kulik L, Heimbach JK, Zaiem F, et al. Therapies for patients with hepatocellular carcinoma awaiting liver transplantation: a systematic review and meta-analysis. Hepatology. 2018 ; 67 (1) : 381–400
  20. Goh BKP, Syn N, Teo JY, et al. Perioperative outcomes of laparoscopic repeat liver resection for recurrent HCC: comparison with open repeat liver resection for recurrent HCC and laparoscopic resection for primary HCC. World J Surg 2019;43:878–85
  21. Hendi, Maher MD ; Lv, Jiemin MD ; Cai, Xiu-Jun MD. Current status of laparoscopic hepatectomy for the treatment of hepatocellular carcinoma. A systematic literature review. 2021. Volume 100 – Issue 50

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