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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.
Open Access Copyright 2021 JAI (Jurnal Anestesiologi Indonesia)

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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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