Mioma Intraligamentary

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MIOMA

INTRALIGAMENTARY

PEMBIMBING : DR. A. HELMY, SP.OG

SAUSAN RASMIYYAH

110.2011.255

OBSGYN RSUD PASAR REBO

12 OKTOBER – 20 DESEMBER 2015



IDENTITAS

• Nama: Ny. SH

• Umur : 48 tahu

• P!"!r#aa : I$u Rumah Ta%%a

• P!&'&'"a : SMP

• A%ama : I()am

• A)amat : *). G%. +'"a% +'-ayu% N. 4 RT /0R1 /2,

+'-ayu%

• Ta%%a) ma(u" : 3 O"t$!r 3/

• Ta%%a) -!m!r'"(aa : 5 O"t$!r 3/



ANAMNESIS

Aam!('( &')a"u"a (!6ara: Autaam!(a

7!)uha Utama : Ny!r' (aat ha'& (!)ama m'%%u

SMRS.

Pa('! &ata% "! RSUD PS R!$ ta%%a) /

S!-t!m$!r 3/ &!%a "!)uha y!r' (aat ha'&,

(!)ama (u&ah "ura% )!$'h 2 tahu $!)a"a%a. Ny!r'

(aat ha'& &'ra(a ma"' m!m$!rat (!#a" 3 tahu

$!)a"a%a '' Ny!r' t!ra(a &' -!rut $a%'a $aah &a

t!r "a&a% t!ra(a (am-a' "! -'%%a%, &a m'%%u

'' mu)a' "am$uh )a%'. R'ayat ha'& t!ratur. Mu)a' t'&a"

t!ratur 3 $u)a ya% )a)u.



RI1. PENYA7IT

DAHULU

• R'ayat H'-!rt!(' 9;

• R'ayat D'a$!t!( M!)'tu( 9<;

• R'ayat A(ma 9<;

• R'ayat a)!r%' $at 9<;

KELUARGA



R'. m!(trua('

• Ha'& -!rtama : 5 tahu

• S'")u( ha'& : T!ratur

• Lama ha'& : 2<= har'

7tra(!-(' :

Pa('! t'&a" m!%%ua"a a)at "tra(!-('

(!#a" 3 tahu )a)u.



STATUS GENERALIS

Kepala: No!o"ep#al

Ma$a: %o&'(&"$)*a a&e!)+ ,-, . Slea

)$e) /-/

Le#e: Taea eaa ) $e&a#3 $)a aape!e+aa& ele&'a e$a# e&)&

Pa4(aa: T)a !e&o&'ol3 ala! a$a+



T#oa:

Pa(/pa(:

I(-!"(': B!tu" &a&a rma), -!r%!ra"a &'&'% &a&a &a)am

"!a&aa (tat'( &a &'am'( ('m!tr'(.Pa)-a(': >r!m'tu( ta"t') &a ?6a) "aa &a "'r' ('m!tr'(, t'&a"t!ra$a ma(a.

P!r"u(': Sr &' (!)uruh )a-a% -aru.

Au("u)ta(': @!('"u)!r 0, rh"' <0<, h!!'% <0<

6a&$(&:

I(-!"(': I"tu( 6r&'( t'&a" t!r)'hat.

Pa)-a(': I"tu( 6r&'( t!ra$a.

P!r"u(': Bata( #atu% &a)am $ata( rma).

Au("u)ta(': B* I0II rma), murmur 9<;, %a))- 9<;



Ao!e& :

• Bu6't

• T'&a" t!r&a-at )'!a '%ra

• Str'a! %ra?'&arum 9<;

• B'('% u(u( 9;

Ge&)$al)a : T!r&a-at (!"at -a&a ?a%'a &a &ua -r('

E$e!)$a+ :

• A"ra) ha%at 0

• E&!ma <<0<<



7!('m-u)a :

H$ 9r!&ah;

)a'ya, &a)am $ata( rma)



USG a$&m!



DIAGNOSA PRA OPERASI

7'(ta O?ar'um

PENATALAKSANAAN

La-aratmy &a H'(t!r!"tm' Sa)-h'%<

O?r!"tm' B')at!ra)





MYOMAINTRALIGAMENT

ARY



DE7INISI

• Tumr #'a" tt -)( : (!)<(!) #ar'%a tt -)(, #ar'%a C$r'& &a ")a%!.

• I(t')ah )a'ya : C$rm'ma, m'C$rma, )!'m'C$rma,C$r)!'m'ma, C$rma &a C$r'&.

EPIDEMIOLOGI

• 3/<3 -!r!m-ua u('a r!-r&u"t'

• '('&!('ya 5<F "a)' )!$'h $aya" -a&a ra( "u)'t $!rara&'$a&'%"a &!%a ra( "u)'t -ut'h.



ETIOLOGI

• B!)um &'"!tahu' -a(t'

• a$rma)'ta( 'tr'('" -a&a m'm!tr'um,

• -!'%"ata r!(!-tr !(tr%! (!6ara"%!'ta) -a&a m'm!tr'um,

• -!ru$aha hrma),

• r!(- "!-a&a "!6!&!raa '("!m'" "!t'"aha'&



7AKTOR RISIKO

< U('a r!-r&u"t' &a "!ham')a 9-a-ara!(tr%! &a "!t'&a"(!'m$a%a -r%!t!r;

< Hrm !&%! 9m!ar6h! aa)m!'%"at"a r'('";

< R'ayat "!)uar%a 93 )'-at r'('" t!r"!a;

< BB 93 r'('" t'a- a'" / "%, "ar!a $!(m!'%"at"a "?!r(' a&r%! m!#a(&'!(tr!, )a)u !(tr%!;



KLASI7IKASI

1. M)o!a )&$a!(al

D'&a)am &'&'% ut!ru(, $!r"!m$a% &' atara mym!tr'um

3. M)o!a +(!(o+a

•.S'(' &a)am &ar' "a?um ut!r' &a t!r)!ta" &'$aah !&m!tr'um

•.Da-at $!rta%"a' -a#a% (!h'%%a &a-at "!)uar m!)a)u' (t!um(!r?'"(

•.Pa)'% (!r'% m!y!$a$"a -!r&araha

8. M)o!a +(+eo+a

a. M'ma %!$urt0-!&u6u)at!&

$. M'ma -ara('t! m!tum

6. M'ma 'tra)'%am!t!r : m!)ua( &'atara 3 )a-'(a -!r't!a) &ar'

)'%am!tum )atum





KARAKTERISTIK

• Mu)t'-)!

• B!r)$u(

• T'&a" t!ratur

• B!r$ata( #!)a( &!%a m'm!tr'um (!"'tarya, 9!u")!a(' mu&ah;

• L!$'h -u6at &'$a&'% m'm!tr'um &'(!"!)')'%ya

• 7!ya)

• B!r&'&'% )'6', ha)u(, &a $'a(aya )!$'h "!ra( &'$a&'% #ar'%a (!"'tar

• T!r&a-at pseudocapsule.





MANI7ESTASI KLINIS

< P!r&araha ut!ru( a$rma)

< Ny!r' -a%%u) 9-!!"aa $a%'a tu)a% -!)?'" ya%&a-at m!!"a (ara (!h'%%a m!y!$a$"a ra(ay!r';

<P!!"aa r%a (!"'tar : %a%%ua BA7, BAB, !&!ma!"(tr!m'ta(, (tra%u)a('



< D'(m!rrh!a 9!!" t!"aa, "m-r!(',t!rma(u" h'-"('a )"a) mym!tr'um ;

< D'(u%(' r!-r&u"('



ANAMNESIS

a; T'm$u) $!#)a &' -!rut $a%'a $aah &a)am a"tu ya% r!)at')ama.

$; 7a&a%<"a&a% &'(!rta' %a%%ua ha'& 9 $'a(aya ha'&

m!ma#a% #'"a u"ura m'ma (u&ah $!(ar;

6; Bua% a'r "!6') atau $ua% a'r $!(ar 9$'a(a t!r#a&' #'"a u"uram'ma 6u"u- $!(ar &a m!!"a "a&u% "!m'h;

&; Ny!r' -!rut 9$')a t!r'!"(', t!r-ut'r, -!6ah;

!; Ny!r' 9t!rutama (aat m!(trua(';

; A&aya -!r&araha a$rma)

%; A&aya ra(a -!uh -a&a -!rut $a%'a $aah &a ta&a ma((a

ya% -a&at "!ya).



PEMERIKSAAN 7ISIK

Palpa+):

&'&a-at"a tumr &' a$&m! $a%'a $aah,"!ra(, )'6', $!r$ata( #!)a(

Pe!e)+aa& )&eolo):

&!%a -!m!r'"(aa $'maua) &'&a-at"atumr t!r(!$ut m!yatu &!%a rah'm ataum!%'(' "a?um Du%)a(



PEMERIKSAAN PENUN6ANG

. La$ : a!m'a

3. USG : %am$ara ma((a -a&at &a hm%! -a&aut!ru(

5. HSG : m!&!t!"(' m'ma ut!r' ya% tum$uh "!arah"a?um ut!r' -a&a -a('! '!rt')

4. Ur%raC 'tra?!a : m!%!tahu'-!!"aa0&!?'a('0ama)' ur!t!r &a tra"tu(ur'ar'u( )a'

. MRI : a"urat utu" )"a(', u"ura, #um)ah



TATALAKSANA

1. Me)a!e&$o+a

a. GRH a%'( :

• m!%ura%' u"ura m'ma &!%a #a)a m!%ura%' -r&u"('!(tr%! &ar' ?ar'um

• m!%ura%' ?a("u)ar'(a(' -a&a tumr

• @)um! m'ma $!r"ura% (!t!)ah -!ma"a'a 5 $u)a

$. 7tra(!-(' ra) &a -r!-arat -r%!(t!r

m!%ura%' %!#a)a -!r&araha ut!ru( ya% a$rma) amut'&a" &a-at m!%ura%' u"ura &ar' m'ma



2. Opea$)9

I&'"a(' :

. P!r&araha ut!ru( ya% t'&a" r!(- t!rha&a- t!ra-'

"(!r?at'.3. Sa%"aa a&aya "!%aa(a.

5. P!rtum$uha m'ma -a&a ma(a m!-au(!.

4. I!rt')'ta( "ar!a %a%%ua -a&a 6a?um ut!r' mau-u"ar!a ")u(' tu$a.

. Ny!r' &a -!!"aa ya% (a%at m!%a%%u.

2. Ga%%ua $!r"!m'h mau-u $(tru"(' tra"tu(ur'ar'u(.

=. A!m'a a"'$at -!r&araha



a. M)o!e$o!)

<. M!m-!rtaha"a u%(' r!-r&u"('

<. S!6ara )a-aratm' : )a-a% -a&a% )ua(, -a(6a-!ra(' )ama 94<2 m%%;, $'(a t!r#a&' -!r)!%"!ta

<. S!6ara h'(t!r("-' : m'ma (u$mu"(a, a)ath'(t!r("- m!)a)u' (!r?'"( &a m!%'(' "a?um ut!r'&!%a 6a'ra utu" m!m-!r)ua( &'&'% ut!ru(, -a(6a

-!ra(' 3 har'

<. S!6ara )a-ara("-' : m'ma $!rta%"a' &')uar 6a?umut!r', (u$(!r(a &' &a!rah -!rmu"aa ut!ru(, '('('"!6'), -a(6a -!ra(' 3<= har'



. H)+$ee$o!)

I&'"a(' :

7!)uha m!rrha%'a, m!trrrha%'a, "!)uha$(tru"(' -a&a tra"tu( ur'ar'u( &a u"uraut!ru( (!$!(ar u('a "!ham')a 3 4 m'%%u



1. Lapaa$o!)

Su$tta) :

7!utu%a : m!%h'&ar' -!r&araha ya% $aya",trauma -!ra(' r%a )a'

7!ru%'a m!'%%a)"a (!r?'"(, m!mu%"'"at'm$u)ya "ar('ma (!r?'"(

Tta) :

#ar'%a %rau)a(' ya% t'm$u) &a-at m!#a&' (um$!rt'm$u)ya (!"r!t ?a%'a &a -!r&araha -a("a -!ra(',&'(-ar!u'a



2. Ta&+*a)&al

• -!r't!um ya% &'$u"a (a%at m''ma)(!h'%%a trauma ya% mu%"' t'm$u) -a&au(u( &a-at &'m''ma)'(a('

• -!r)!%"!ta -a("a -!ra(' #u%a )!$'hm''ma)

• ma(a -!y!m$uha )!$'h 6!-at &'$a&'%"a)a-aratm'



8. Lapaa+op)

• Teknik miolisis : (um$!r !!r%' &ar' )a(!r Th!!&y'um:yttr'um a)um''um %ar!t9N&:YAG; m'ma &!atura(' -rt!'"a%u)a(' &a !"r('( &'&a)am #ar'%aya% &'t!ra-'

• !!"t' utu" m!%ura%' u"ura m'ma

• m!'m$u)"a &!?a("u)ar'(a(' m'ma



T!"'" :

a. Laparoscopically Assisted VaginalHysterectomy 0LA@H

b. Classic Intrafascial Serrated EdgedMacromorcellated Hysterectomy 9+ISH;



PEN%EGAHAN

Pr'mr&'a): (!$!)um m!ar6h!, ma"aa t'%%'(!rat (!-!rt' (ayur &a $uah

Pr'm!r : T'&a"a -!%aa(a -!m$!r'ahrm !(tr%! &a -r%!(t!r &!%am!m')'h 7B "m$'a('

S!"u&!r: M!%h'&ar' t!r#a&'ya "m-)'"a('.M!)a"u"a &'a%(a &''



KOMPLIKASI

<D!%!ra(' %aa(

< Tr('

P!%aruh t'm$a) $a)'" m'ma ut!r' &a "!ham')a:a; T!rh&a- "!ham')a

I!rt')'ta(, a$rtu(, -!r(a)'a -r!matur'ta( &a"!)a'a ta", '!r('a ut!r', %a%%ua #a)a -!r(a)'a,

-!r&araha -(t-artum, r!t!(' -)a(!ta

$; T!rha&a- m'ma

M'ma 6!-at m!m$!(ar "ar!a -!%aruh !(tr%!,

"!mu%"'a tr(' m'ma ut!r' $!rta%"a'.



PROGNOSIS

• Myma ya% "am$uh "!m$a)' 9r!"ur!(;(!t!)ah mym!"tm' t!r#a&' -a&a <4/-a('!

• H'(t!r!"tm' &!%a m!%%a%"at (!)uruhm'ma a&a)ah "urat'



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Mioma Intraligamentary