7/25/2019 Koran Per Spv
1/3
WH
No. Identitas Diagnosis Modalitas Planning
1. K415 A
Sofian(43 thn)01-05-1972M 0473!9
MS" 24-11-2015WH
S" #el" $en%olan di &'ngg'ng anan
" sait sedang*sada+
," i+osa+/oa s/a&'la det+a &ost
+adiote+a&i e-22
13/1/2016
$ 4.12$ 2.45 !.! 21.5
P6 279
8/12/2015:
$ 1204
$ 415 107 349
P6 4!7
28/11/2015:
$ 18 39
$ 2!4 71 241
P6 539S 15*SP 5
29/11/2015:
P 14.7*,P 35.9aa 391
,6P 548$ili+'in di+e 93$ili+'in total 94,l 2.7DS 12!
,P 0.91
13/12/2015:
:+*+ 135*118
15/12/2015:
$ 1027$ 329$ !! 277
P6 22!
17/12/2015:
$ 978
$ 372$ 105 313
P6 193
01/01/2016
$ 8.0!
$ 2.98$ !.4 25.3
P6 349
03/01/2016
$ 7.7!
$ 4.14 11.5
34.!P6 400S 13SP 4:+ 28
+ 0.8
USG Abdomen (27/11/2015):
- e&atos&lenoegal;
- Nef+olith det+a- ida ta&a etastasis
- +ansf'si P 2 ag
- < ha+i ini- Moilisasi %alan
DJF
3. 401
,li%a a+a%3-10-1998
022701MS 14-1-2018D=
S" $en%olan di lengan i+i
" ai*sada+
," 'o+ +a/hiin1*3 distal
1382015
$ 10.05$ 5.78
14.9 43.1P6 255P*,P 15.3*34.2IN 1.29
*P 14*10,l. 4.9DS 105
,s. :+at 5.4:+*+ 13*1.0
Na*#*l 143*4.8*91
Men'ngg' %ad>al o&.
7/25/2019 Koran Per Spv
2/3
!"# (1382015)
o+ dan &'lo no+al- ida ta&a tanda-tanda etastasisi
4. 423
+?a 6ona25-10-1943049532MS 14*1*2018
D=
S" $en%olan &ada aae det+a
" 6'a &'s @
," a. aae det+a
6/1/2016
$ 4.25$ 3.80 10.0 30.0
P6 17.1s,g +eatif
4/1/2016
*P 42*32DS 109,s. :+at 3.4:+*+ 34*0.7
Na*#*l 137*3.!*111
I
5. 431S+i S'sant+i
(32 thn) 12*2*19!3M" 051375MS"
12*1*2015$G
S" $en%olan die&ala elaang
" $ai*sada+
," S +egion &a+ietoo/i&ital
12/1/2016
$ 10.07
$ 4.82
12.9
3!.8
P6 2!1
P*,P14.7*23*2
IN 1.23
*P 12*10
DS 9!
,s.:+at 2.8
:+ 13
en/ana o& %'at tanggal 15*1*2018 %a !
&agi
- Info+ed /onsent
- #ons'l anestesi
- 6a&o+ #
- P 1 ag sia&
- ,ntiioti &+o&hlais /eft+iaone 1g+*i?
8. 419
D%&' *d
2491981
051197
S" en%olan di etia anan
" $ai*sada+
,",deno/a+/inoa ailla deta
+b en/ana o&e+asi senin 1!*1*2018
Info+ed /onsent
- #ons'l anestesi
- 6a&o+ #
- P 1 ag sia&
- ,ntiioti &+o&hlais /eft+iaone 1g+*i?
7.S&,m-.*
851972
053068
S"$en%olan di &a;'da+a i+i se%a 5
'lan lal'
" 6, @*@ S1@*@
," 'o+ aae sinist+a s's&alignan/;
+b
W! 105
Hb 89
+ 97000
6 2!t&
et+iaon 1g+*12%a*i?#eto+ola/ 30g*!%a*i?anitidine 50g*!%a*i?
dHen S(K)n,
!. 408S+i S'da+ti
0503!714*7*1982MS" 11*1*2018dHen
S(K)n,
S" $en%olan di lengan i+i atas
" $ai*sada+
," 'o+ +a/hii sinist+a 1*3&+oial
12/1/2016
$ 8.3!
$ 4.57 13.2 3!.9P6 300
P*,P 13*29.5
Pe+sia&an o&. %'at (tgl. 15*1*2018) &ada %a!
- Info+ed /onsent- 6a&o+ #- #ons'l anestesi- P'asa ! %a
&+eo&e+asi
- Sia& da+ah 1 ag P
