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Abstrak :
PURPOSE: Interstitial pneumonia (IP) is a progressive and irreversible fibrosis and can be fatal if acute exacerbation (AE) occurs. While a useful risk-scoring system has been established for lung surgery, no risk evaluation exists for AE of IP related to non-pulmonary surgery. The objective of this review is to describe the management for patients with IP. METHODS: We experienced three hepatectomy cases with IP. The first was a 72-year-old male patient diagnosed with hepatocellular carcinoma. Preoperative computed tomography (CT) revealed IP with reticular shadow at the base of both lungs. After hepatectomy, his IP became acutely exacerbated and did not improve with steroid or sivelestat treatment. The second was a 74-year-old male patient diagnosed with hepatocellular carcinoma, and the third was a 75-year-old male patient with liver metastasis. In both these cases, CT revealed a reticular shadow in the lung fields, with increased serum KL-6 levels. We administered pirfenidone for perioperative management, during which time no respiratory complications occurred. RESULTS: Perioperative management with pirfenidone for hepatectomy accompanied by IP was successful in our cases. CONCLUSION: We reviewed reports on the perioperative prevention, intraoperative risk factors, and treatment of postoperative AE of IP and summarized the perioperative management techniques for IP patients undergoing non-pulmonary surgery.

Abstrak :
ABSTRAK
Pendahuluan: Alfa fetoprotein AFP merupakan penanda tumor yang mengalami peningkatan pada karsinoma hepatoselular KHS namun dapat juga normal pada 40 kasus. Peningkatan AFP dikatakan menghasilkan diferensiasi tumor yang buruk. Kasus KHS yang datang ke RSCM cenderung lanjut dengan karakteristik tersendiri. Penelitian ini bertujuan menilai korelasi AFP terhadap derajat diferensiasi KHS di RSCM.Metode: Data 32 kasus KHS di RSCM yang dilakukan hepatektomi dikumpulkan secara retrospektif dari 2010-2016. Data dasar karakteristik pasien dinilai berdasarkan nilai AFP dan derajat diferensiasi. Lalu dilakukan analisis untuk melihat korelasi nilai AFP dengan derajat diferensiasi KHS.Hasil: Nilai rata-rata AFP adalah 20183 ng/mL, usia 51,75 tahun, 81 kasus terjadi pada laki-laki, 59,4 berdiferensiasi buruk, 50 berukuran >5-10 cm, 50 kasus sirosis, dan 68,8 terdapat invasi pembuluh darah. Diferensiasi buruk 42 pada laki-laki, 47,4 pada HbsAg positif, 50 pada Anti HCV positif, 31,2 sirosis, dan 40,9 mengalami invasi pembuluh darah. Nilai AFP 20 ng/mL 42,1 berdiferensiasi buruk. Pada analisis orelasi didapatkan r=0,203 dengan p>0,05.Kesimpulan: AFP tidak dapat memprediksi derajat diferensiasi karsinoma hepatoseluler pada karakteristik kasus KHS di tempat kami.

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ABSTRACT<>br> Background AFP is a tumor marker which is increased in HCC, but might be found normal in 40 cases. Increased AFP implies a worsen tumor differentiation. Correlation between AFP with HCC managed in RSCM Ciptomangunkusumo hospital remains unclear. This study aimed to find the correlation between histological differentiation grade of HCC and AFP serum level.Method A total of 32 of HCC cases following hepatectomy in RSCM during 2010 2016 were enrolled in a retrospective study. Subject characteristics, AFP levels and histological differentiation grade were the variables in this study, and subjected to statistical analysis. Significancy found if p 5 10cm in diameter, 50 subjects were cirrhotic, and 68.8 subjects with microvascular invasion. AFP level found in range of 0.5 400000 ng mL 20183 SD75580.08 . Among all the subjects 12.5 were well differentiated, 28.1 were moderate differentiated, and 59.4 were poorly differentiated. AFP level 20ng mL was 42.1 . Correlation analysis revealed an r 0.203 with p 0.05.Conclusion There is no correlation between AFP serum level and histological differentiation grade of HCC in our study

Abstrak :
Hepatocelluler carcinoma merupakan penyakit keganasan yang terjadi pada hati. Salah satu penatalaksanaan penyakit yang dilakukan adalah dengan laparoskopi hepatektomi dimana sebagian hati dengan sel karsinoma akan diangkat. Pasien paska pembedahan laparoskopi hepatektomi rentan mengalami komplikasi paska operasi. Saat ini pasien berada pada hari rawat kelima paska pembedahan, dimana komplikasi yang mungkin terjadi yaitu infeksi, perdarahan dan asites. Sehingga perawat memiliki peran penting untuk mencegah komplikasi paska bedah. Salah satu cara untuk mencegah komplikasi paska bedah yaitu dengan pemberian intervensi ambulasi. Pemberian intervensi ambulasi efektif dalam mencegah komplikasi paska pembedahan, meningkatakan kemandirian, mengurangi lama hari rawat di rumah sakit dan meningkatkan kualitas hidup pasien paska pembedahan laparoskopi hepatektomi. Intervensi ambulasi mudah dilakukan, tidak membutuhkan alat dan mudah dilakukan kembali oleh pasien dan keluarga pasien. Intervensi ambulasi dilakukan selama empat hari dengan empat kali sesi pertemuan. Hasil yang didapatkan menunjukkan adanya penurunan tingkat nyeri, peningkatan skor kemandirian pasien dengan kuesioner barthel index, tidak ada tanda-tanda infeksi pada luka insisi pasien dan berkurangnya perdarahan. Sehingga penulis merekomendasikan pemberian intervensi ambulasi untuk mencegah komplikasi paska pembedahan laparoskopi hepatektomi.

< Hepatocellular carcinoma is a malignant disease that occurs in liver. Laparoscopic hepatectomy is one of the managemen for the disease which part of the liver with carcinoma cells will be removed. Patients after laparoscopic hepatectomy surgery are prone to postoperative complications. Currently the patient is on the fifth postoperative day of stay, where possible complications include infection, bleeding and ascites. Nurses have an important role in preventing post-surgical complications. One way to prevent post-surgical complications is by giving ambulation intervention. The advantages of ambulation intervention is effective in preventing postoperative complications, increasing independence, reducing the length of stay in the hospital and improving the quality of life of patients after laparoscopic hepatectomy surgery. The ambulation intervention is easy to do, requires no tools and easy for patient and their family to redemonstrate. Ambulation intervention was carried out for four days with four sessions of meetings. The results obtained showed a decrease in the level of pain, an increase in the patients independence score with the Barthel Index questionnaire, there were no signs of infection in the patients incision wound and reduced bleeding. So author recommend giving ambulation intervention to prevent complications after laparoscopic hepatectomy surgery.