referat Karsinoma-Nasofaring(1)

8/14/2019 referat Karsinoma-Nasofaring(1)

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REFERAT

KARSINOMA NASOFARING

Disusun Oleh :

Antonius Silalahi (07 - )

Putu Gede Ary Sanjaya (07 - )

Myske Mona Tresnalia Bakara (07 !7")

KEPANITERAAN KLINIK ILMU PENYAKIT THT

PERIODE 9 JULI 4 AGUSTUS 2012

FAKULTAS KEDOKTERAN

UNIVERSITAS KRISTEN INDONESIA

JAKARTA

1


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DAFTAR ISI

KATA PENGANTAR..3

I. PENDAHULUAN.4

II TINJAUAN PUSTAKA...5

A. DEFINISI..5

B. EPIDEMIOLOGI DAN ETIOLOGI.5

C. ANATOMI DAN FISIOLOGI NASOPHARING9

D. GEJALA DAN TANDA KNF.12

E. PATOFISIOLOGI KARSINOMA NASOFARING...13

F. DIAGNOSIS...15

G. DIAGNOSIS BANDING18

H. STADIUM..20

I. KOMPLIKASI21

J. PENATALKSANAAN...23

K. PENCEGAHAN..29

III. PENUTUP.30

A. KESIMPULAN...30

B. SARAN...30

DAFTAR PUSTAKA..312


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KATA PENGANTAR

S!"#" $%&' (") *+%,%- ,"' $")&"/,") ,"('-") T%") ")! M"" E*" +")! /#"

)#)! (") -,"/' ,"' )+#*"',") --"/ ')' ()!") "',. T")$" $-/#)!") D'"

%)!,') ,"' /'(", ",") *")!!%$ )+#*"',") ')' ()!") "',. R-"/ ')' ('*%*%) *"!"'

*+"-"/ %)/%, )!',%/ %&'") *#"') '/% "!"- $"" ("$"/ $-#%"* '#% /)/")!

KARSINOMA NASOFARING6 +")! ,"' *"&',") -("*"-,") $)!""/") ("-' -"!"'*%- +")! "(".

R-"/ ')' %"/ /)/")! KARSINOMA NASOFARING +")! *")!"/ -""+" "!'

,*"/") **-")!. K"' &%!" )!%"$,") /-'" ,"*' ,$"(" (*) $'')! THT

+"'/% (-. S%(&"-7"('6 S$. THT KL +")! /#" '')! ,"' "!"- ("$"/ )!-/' /)/")!

"!"'")" "-" ,"' )+%*%) --"/ (") )!-/' /)/")! '#% (' '(")! THT.

S!" --"/ ')' ("$"/ -',") 7"7"*") +")! #' #%"* ,$"(" $""."#"%$%) --"/ ')' '#',' ,#'") (") ,,%-")!"). K"' ) %)/%, *"-") (")

,-'/',)+". T-'" ,"*'.

J","-/"6 1: J%#' 2012

P)+%*%)

3


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5/33

#'$%/' (')'*'6 ")"/' '*'#!' )"*"-')!6 $'('#!' (") /'#!'6 !&"#" (") /")("6

$"/'*'#!'6 ('"!)*'*6 ,$#',"*'6 /-"$' "%$%) $)!"")+". P)%#'* -%*"" %)/%,

)%#'*,") *%" "*$, /-*%/ ("#" /')&"%") $%*/"," -"-"/ ')' (") ('"-"$,") ("$"/

-")""/.

II TINJAUAN PUSTAKA

A. DEFINISI

C"-')" "("#" $-/%%") "-% +")! !")"* /-('-' ("-' *#*# $'/#'"# +")!

)(-%)! )!')'#/-"*' &"-')!") *,'/"-)+" (") )'%#,") /"*/"*'*.

;DORLAND.2002-/-" ->'"#'* I (") II

F"*'" *$" -)!!" +")! -'*' &"-')!") #)!!"

M%,*" #")&%/") ("-' %,*" "/"*

L"/-"# %,*" #")&%/") ("-' %,*" "/"* (") #",")!

M%"-" /%" %*/"''

F**" -*)%##-'

9


10/33

Bangunan yang penting paa na!"p#a$ing

O*/'% /%" %*/"'' $"-* $"-+)!"#

T%" %*/"'' -%$",") ,")"# +")! )!%%)!,") ,">% )"*' ("))"*$"-+)! ()!") -)!!" /#')!" /)!". M%,*" */'% /%" /'(", ("/"- //"$'

)) *$-/' )"-"6 ('*%/ /-%* /%"-'%*.

T-%* /%"-'%*

F**" -*) %##-'

A("#" ("/"-") ,'# ('#",")! /-%* /%"-'%*. D"-" ')' -%$",") /$"/

$-('#,*' ,"-*')" )"*"-')!6 *%"/% /%- +")! "/',") )- 1 (' THT.

F-)' )"*"-')!

A("#" ("/"-") ('*#" "/"* /-%* /%"-'%*6 -%$",") /$"/ /%-

")!''-" )"*$"-')!

10


11/33

A()'( /)*'# $"-+)!"##%*,"

S"-" /-'/'* "()'( ",") '#")! */#" $%-/"* ,"-)" "(")'( ",") )"$"' /'/',

$/'"# $"(" %%- 1214 /"%). L,"*' $"(" (')(')! *%$-'- (") (-*"# )"*$"-')!

*#" #"/-"# %-*" $"-+)!". F%)!*')+" *"!"' ,")'* $-/"")") /%%

/-"("$ ,%") ,%") +")! #7"/ &"#") )"$"* '(%)!.

N"*$"-')! ",") /-/%/%$ '#" $"#"/% ## #,"/ , (')(')! $*/-'- $"(" 7",/%

)#")6 %)/"6 )!%"$,") ,"/","/" /-/)/% *$-/' ",.

F%)!*' )"*$"-')!

S"!"' &"#") %("-" $"(" -*$'-"*'

J"#") %("-" , /%" %*/"''

R*)"/-

S"!"' (-"')"! *')%* $"-")"*"# ,">% /'$")' (") '(%)!

S-/ ("-' )"*$"-')! ("$"/ -!-", , "7" ,"-)"

11


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G"+" !-">'/"*'

G-",") )#")

G-",") *'#'" ;,')*'#'"'-%* *')!!" *# ,"#' )&"(' )-"# "/"% ("$"/ /-&"('

/-")*-"*' *# +"'/% ')/-",*' ")/"-" *# (") >'-%* *')!!" )!",'"/,") /-&"(')+"

14


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$-%"") *'"/ *# *')!!" /-&"(' /-")*-*' *# )&"(' !")"* *')!!" /-)/%, *#

,"),-.

G) EB +")! (',*$-*',") $"(" $)(-'/" KNF "("#" !) #"/)6 +"'/% EBER*6

EBNA16 LMP16 LMP2A (") LMP2B. P-/') EBNA1 -$-") ("#" $-/""),")

>'-%* $"(" '),*' #"/). P-/') /-")*-") LMP2A (") LMP2B )!""/ *')+"#

/+-*') ,')"* +")! ('$-"+" ("$"/ )!""/ *',#%* #'/', >'-%*. D'")/"-" !)!)

/-*%/6 !) +")! $"#')! -$-") ("#" /-")*-"*' *# "("#" !) LMP1. S/-%,/%-

$-/') LMP1 /-('-' "/"* 3:8 "*" "') +")! /-"!' )&"(' 20 "*" "') $"(" %&%)!

N6 : *!) $-/') /-")*-") ;1:: "*" "')< (") 200 "*" "') $"(" %&%)!

,"-,*' ;C )) (")

'#',' "!-!"*' "'#'"#. A)"#'*'* ,-#"*' )%)&%,,") !) HLA ;%") #%,+/

")/'!)< (") !) $)!( )' *'/,- $450 2E1 ;CP2E1< ,%)!,')") "("#" !)

,-)/")") /-"("$ ,"-*')" )"*"-')!. S'/,- $450 2E1 -/")!!%)! &"7" "/"*

",/'>"*' /"#', +")! /-,"'/ )'/-*"') (") ,"-*')!)

3< F",/- #')!,%)!")

S&%#" *"- */%(' ,"*%* +")! ('#",%,") $"(" $$%#"*' +")! -"(" (' -"!"'

("-" (' "*'" (") "-'" %/"-"6 /#" (',)'-"*',") "7" ',") "*') (") ",")") #"')

+")! "7/,") )!")(%)! *&%#" *"- )'/-*('/+"') ;NDMA


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F. DIAGNOSIS

J'," ('/%,") "(")+" ,%-'!"") +")! )!"-" $"(" *%"/% ,"-*')" )"*"-')!6 $-/,#

('"7" ')' ("$"/ ")/% %)/%, )!",,") ('"!)*'* $"*/' *-/" */"('% /%-

1. A)")*'* $-',*"") '*',

A)")*'* -("*"-,") ,#%") +")! ('-"*",) $"*') ;/")(" (") !&"#" KNF*',%#-6 -)/%, >"# "/"%

%#"/ ()!") )%,##' +")! "*. P"(" %%)+" "/"* *# /'(", /-#'"/ ()!")

"*.

T'$ /")$" ('-)*'"*' (") /")$" ,-"/')'*"*' $%)+"' *'"/ +")! *""6 +"'/% -*'"/

-"('*)*'/'. S(")!,") &)'* ()!") ,-"/')'*"*' /'(", !'/% -"('*)*'/'. K#"*'',"*'

!""-") '*/$"/#!' /-"-% +")! ('-,)("*',") # HO $"(" /"%) 19916

")+" ('"!' "/"* 2 /'$6 +"'/%

K"-*')" *# *,%"*" -,-"/')'*"*' ;Keratinizing Squamous Cell

Carcinoma


18/33

P*'*' L"/-"# ()!") /,)', / %)/%, &"-')!") #%)", ;soft tissue

tec"nique-/,*

T!-" L"/-"# ("-" )"*"-')!

T!-") A)/-$*/-'- ("-" )"*"-')!

'% C.T.S(an

P"(" %%)+" KNF +")! ("$"/ ('(/,*' *"-" "* ()!") -"('!-"' $#*

"("#" &'," /%- /-*%/ %,%$ *"- (") ,*'/',6 *(")!,") %#" ,'#

%)!,') /'(", ",") /-(/,*'. T-#'#' &'," $-#%"*") /%- "("#"

*%%,*"6 "," "# ')' ",") *%,"- ('#'"/ ()!") $-',*"") -"('!-"' $#*.

D','") $%#" &'," $)+"-") , &"-')!") *,'/"-)+" #% /-#"#% #%"* ",")

/-("$"/ ,*%,"-"),*%,"-") ("#" )(/,*' "# /-*%/. K%)!!%#") C.T.

S") ('")(')!,") ()!") / $#* '"#" ,"$%")+" %)/%, (",")

-"""" ()*'/"* $"(" ("-" )"*"-')!6 "', '/% $"(" &"-')!") #%)",

"%$%) $-%"")$-%"") $"(" /%#")!6 !)!") -'/-'" /-/)/% ("$"/ (')'#"'

*%"/% /%- )"*"-')! +")! "*' ,'#. S#"') '/% ()!") #' ",%-"/ ("$"/

(')'#"' $"," *%(" "(" $-#%"*") /%- , &"-')!)" *,'/"-)+"6 )'#"' "("

/'(",)+" (*/-%,*' /%#")! *-/" "(" /'(",)+" $)+"-") ')/-"-")'"#.

A(" -"$" $*'*' ()!") / $#* +")! $-#% ('%"/ ("#" )"-'

,%)!,')" "(")+" /%- $"(" ("-" )"*"-')! +"'/%

P*'*' L"/-"# ()!") /,)', / %)/%, &"-')!") #%)", ;soft tissue

tec"nique-/,*

T!-" L"/-"# ("-" )"*"-')!

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T!-") A)/-$*/-'- ("-" )"*"-')!

:. P-',*"") )%-/"##!'

K"-)" )"*"-')! -%%)!") (,"/ ()!") -)!!" /)!,-", #"#%' -"$" #")!6

"," !")!!%") -"$" *"-" /", ("$"/ /-&"(' *"!"' !&"#" #")&%/ KNF ')'.

. P-',*"") *-#!'.

P-',*"") *-#!' I!A ")/' EA ;"-#+ ")/'!)< (") '!A ")/' CA ;"$*'( ")/'!)'-%* EB /#" )%)&%,") ,"&%") ("#" )(/,*' ,"-*')"

)"*"-')!. T&,- S/'+ ("-' FK UI J","-/" )("$"/,") ("-' 41 $"*') ,"-*')"

)"*"-')! */"('% #")&%/ ;*/"('% III (") I< *)*/'>'/"* I!A CA "("#" 965= (")

*$*''/"* 9168= ()!") /'/- -,'*"- ")/"-" 10 *"$"' 1280 ()!") /-")+", /'/- 1:0.

I!A ")/' EA *)*'/'>'/"*)+" 100= //"$' *$*''/"*)+" ")+" 3060=6 *')!!"

$-',*"") ')' ")+" ('!%)",") %)/%, )/%,") $-!)*'* $)!"/")6 /'/- +")!

('($"/ -,'*"- ")/"-" 80 *"$"' 1280 (") /-")+", 1:0.

G. DIAGNOSIS BANDING

1. H'$-$#"*'" "()'(

B'"*")+" /-("$"/ $"(" ")",")",6 &"-)"! $"(" -")! (7"*"6 $"(" ")",")",

+$-$#"*'" ')' /-&"(' K"-)" '),*' -%#")!. P"(" / $#* ",") /-#'"/ *%"/% "**"

&"-')!)" #%)", $"(" ""/"$ )"*"-')! %%)+" -"/"* /!"* (") %%)+" *'/-'* *-/"

*/-%,/%-*/-%,/%- *,'/"-)+" /", /"$", /")(" /")(" ')'#/-"*' *$-/' /"$", $"("

,"-*')".

2. A)!''-" &%)'#'*

B"'*")+" ('/%' $"(" %*'" -#"/'> %(" ()!") !&"#"!&"#" )+-%$"' KNF.

T%- ')' ,"+" ",") $%#% ("-" (") '"*)+" /'(", ')'#/-"/'>. P"(" / $#* ",")

19


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('("$"/ *%"/% "**" $"(" "/"$ )"*"'-)! +")! -"/"* /!"*. P-** ("$"/ #%"*

*$--/' $"(" $)+"-") ,"-*')"6 7"#"%$%) &"-")! )'%#,") (*/-%,*' /%#")!

")"+ -*' *"&" ,"-)" $),")") /%-. B'"*")+" "(" $#)!,%)!") , "-" ($") ("-'

(')(')! #",")! *')%* ",*'#"-'*+")! (',)"#* !"' antral sign. K"-)" /%- ')' ,"+"

",") >"*%#"- "," "-/-'!-"' "-/'* ,*/-)" *")!"/ ('$-#%,") *" !""-")+"

*")!"/ ,"-",/-'*/',. K"(")!,"(")! *%#'/ $%#" (",") ")!''-" &%>)'#*

()!") $#'$ '(%)! $"(" / $#*.

3. T%- *')%* *$)'("#'*

T%- !")"* $-'- *')%* *$)'("#'* "("#" *")!"/ &"-")! (") '"*")+" /%-

*%(" *"$"' */"('% "!", #")&%/ 7",/% $"*') ("/')! %)/%, $-',*"") $-/"".

4. N%-'-"

K#$, /%- ')' *-')! /'%# $"(" -%")! "-')! #"/-"# *')!!" )+-%$"'

,!")"*") ('()(')! #"/-"# )"*"-')!. *"-" C.T. S")6 $)(*",") -%")! $"-" "-')!

," -" ('"# ("$"/ ")/% (",") ,#$, /%- ')' ()!") KNF.

5. T%- ,#)&"-- $"-/'*

T%- ,#)&"- $"-/'* /-%/"" +")! -"*"# ("-' #%* +")! /-#/", "!", ("#"

)!)"' -%")! $"-" "-')! (") )) ,"-" #%) )"*"-')!. $"(" *"!'") *"-

,"*%* /-#'"/ $)(*",") -%")! $"-""-')! ," -" ('"# +")! /"$", $"("

$-',*"") C.T.S").

:. C-("

"#"%$%) /")(" %/"" -(" "("#" (*/-%,*' /%#")!6 //"$' )!')!"/ KNF

$%) *-')! )'%#,") (*/-%,*' /%#")!6 "," *-')! /'%# ,*%#'/") %)/%,

(",")+". D)!") / $#*6 ("$"/ ('#'"/ ,"#*'',"*' "/"% (*/-%,*' /-%/"" ('

20


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22/33

M1 T-("$"/ /"*/"* &"%.2636913

B-("*"-,") TNM /-*%/ (' "/"*6 */"('% $)+",'/ ("$"/ ('/)/%,")

S/"('% I T1 N0 M0

S/"('% II T2 N0 M0

S/"('% III T3 N0 M0

T16T26T3 N1 M0

S/"('% I T4 N06N1 M0

T'"$ T N26N3 M0

T'"$ T T'"$ N M12

M)%-%/ A-'") J')/ C'// C")- /"%) 19886 /%- */"!')! ("-'

)"*"-')! (',#"*'',"*',") *"!"' -',%/

T'* C"-')" ') *'/%

T1 T%- +")! /-("$"/ $"(" *"/% *'*' ("-' )"*"-')! "/"% /%- +")! /", ("$"/ ('#'"/6 //"$'

")+" ("$"/ (',/"%' ("-' "*'# '$*'.

T2 T%- +")! )+-")! (%" /$"/6 +"'/% (')(')! $*/-*%$-'- (") (')(')!#"/-"#.

T3 P-#%"*") /%- *"$"' , ("#" -)!!" '(%)! "/"% -"-')!.

T4 T%- +")! )&"#"- , /)!,-", ,$"#" "/"% )+-")! *"-" -")'"# ;"/"% ,(%")+"


23/33

A(")+" ,#%$%") *"-" /", "(")+" ,-%*",") /%#")! /)!,-",

A(")+" /"*/"*'* &"%

J. KOMPLIKASI

1. P/-*$)'( *')(-

T%- /%% , "/"* , ("*"- /)!,-", #7"/ -") #"*-% *"$"' *')%*

,">-)*%* ),") *"-" N. III6 N. I6 N.I &%!" ),") N.II. +")! -',")

,#"')")

N%-"#!'" /-'!')%* ; N. < T-'!')"# )%-"#!'" -%$",") *%"/% )+-' $"("

7"&" **'*' +")! ('/")("' ()!") -"*" *$-/' /-,)" "#'-") #'*/-', +")! /-"/"*

$"(" ("-" ('*/-'%*' ("-' )->%* /-'!')%*.

P/*'* $"#$-" ; N. III ",%#">",%#" +")! ,"'-)+" -",'"/ *# ",") "/' (") )!'#")!. P"(" *%"/% ,!")"*")

('/")("' # '/*'* *# +")! -#'") */"('% $-"* '/*'* -%$",") */"('% +")!

$"#')! -)/") /-"("$ -"('"*'. D"-" )"*"-')! (") *,'/"-)+" +")! #'$%/' *" *--'('"6 ,") (") ("-" $"-""-')! *$-/'!" #- "!'") "/"*. D"-"("-" #"'))+" +")!

('#')(%)!' ()!") #, /'". A-" $)+')"-") ("-' #"/-"# ,")") (") ,'-'6 ,%"#' '#" "("

$)+-")!") ,-)!!" '(%)! (") *')%* $"-")"*"# "," $-#% $)""") #"$")!") -"('"*' ("-'

($"). P"(" $)(-'/" ()!") */"('% +")! "*' /-"/""* ;T16T2


26/33

D*'* -"('"*' %%)+" -,'*"- ")/"-" :000 000 -"(6 ("#" 7",/% : ')!!% ()!")

$-'( '*/'-""/ 2 3 ')!!% ;?*$#'/ (*@#/"!@-/>#/"!@

R*$) -"('"*'

S/#" ('-',") -"('"*'6 "," ('#",%,") >"#%"*' -%$" -*$) /-"("$ -"('"*'. R*$)

(')'#"' ("-' $)!'#") ,#)&"- !/" )')! #- (") $)!'#") /%- $-'- (' )"*"-')!.

P)'#"'") -*$) -"('"*' -("*"-,") ,-'/-'" HO

C$#/ R*$)* )!'#")!,") *#%-% ,#)&"- !/" )')! +")! *"-.

P"-/'"# R*$)* $)!'#") ,#)&"- !/" )')! *"$"' 50= "/"% #'.

N C")! %,%-") ,#)&"- !/" )')! +")! )/"$. P-!-**'> D'*"* %,%-") ,#)&"- !/" )')! *"- 25= "/"% #'.

K$#',"*' -"('/-"$' ("$"/ -%$"

"< K$#',"*' (')'

B'"*")+" /-&"(' *#"" "/"% -"$" ')!!% */#" -"('/-"$'6 *$-/'

-*/'" M%"#%)/"

M%,*'/'* ;)+-' /#")6 %#%/ ,-')!6 (") '#")!)+" '/" -"*"< ,"(")!

('$-$"-" ()!") '),*' &"%- $"(" %,*" #'(" (") $"#"/%

A)-,*'

-*/"'" ;,,-')!") %,*" %#%/ ",'"/ ('*%)!*' ,#)&"- $"-/'*

+")! /-,)" -"('"*'") /'(", ("$"/ ('-',") !'/% *"&" //"$' '#',' ')(',"*' +"'/% '#"

*/#" )("$"/ /-"$' %/"")+" +")! ",*'"# /-)+"/"

,"),-)+" "*' "("6 ('")" '$*' "*' $*'/'

,%)!,')") *"- ,"),-)+" "*' "("6 *,'$%) /'(", "(" %,/' *"-" ",-*,$'*.

$"(" /%- ()!") (-"&"/ ,!")"*") /')!!' ; # ,"-)" /')!!')+" -*', ,,"%")

(") /"*/"*'* &"%


28/33

3. post definiti$e c"emot"erapy ;*"!"' /-"$' /""") $"*," $("") (") "/"%

radiasi )

E, S"$')! K/-"$'

A!) ,/-"$' /'(", ")+" )+-")! *# /%- /"$' &%!" *# )-"# +")! #"

*"-" $"/ *$-/' *# -"%/6 *%*% /%#")! (") S# $"(" /-",/%* !"*/- ')/*/')"#. A,'"/

+")! /'%# '*" -%$" $-("-"")6 ($-*' *%*% /%#")! +")! %(",") /-&"(')+"

'),*'. P"(" /-",/%* !"*/- ')/*/')"# '*" /-&"(' %"#6 %)/" ")-,*'" (") %#*-"*' *"#%-")

-)". S(")!,") $"(" *# -"%/ )!",'"/,") ,-)/,") -"%/. J"-')!") /%% )-"#

+")! $"/ $-#'-"*' '*"#)+" *%*% /%#")!6 #',# -"%/6 %,*" *"#%-") $)-)"")

%(" /-,)" , "/ *'/*/"/',". U)/%)!)+" *# ,"),- )&"#")' *',#%* #' #"" ("-' *#

)-"#6 *')!!" ("$"/ #' #"" ('$)!"-%' # *'/*/"/'," (") *# )-"# #' $"/ $%#'

("-' $"(" *# ,"),-

E, *"$')! +")! %)%# $"(" &")!," $")&")! "("#" /,*'*'/"* /-"("$ &")/%)!6 +")!

("$"/ ('>"#%"*' ()!") EKG (") /,*'*'/"* $"(" $"-% -%$" ,-)', '-*'* $"(" $"-%.

T,*'*'/"* $"(" $"- (") !')&"# #' *-')! /-&"(' (") *"',)+" ('>"#%*' %)!*' ""# $"-

(") ""# !')&"#)+". K#"')") )%-#!' &%!" -%$",") *"#" *"/% , *"$')! $-'")

,/-"$'.

K-"('/-"$' ,')"*' "("#" $-'") ,/-"$' -*""") ()!") -"('/-"$' ("#"

-")!," )!)/-# /%- *"-" #,-!')"# (") )')!,"/,") sur$i$al $"*') ()!") "-"

)!"/"*' *# ,"),- *"-" *'*/', #7"/ ',-*'-,%#"*'.

M")""/ K-"('/-"$' "("#"

1. M)!'#,") "**" /%-6 ,"-)" ()!") )!'#,") /%- ",") -',") "*'#

/-"$' -"('"*' #' ,/'. T#" (',/"%' "7" $%*"/ /%- /-'*' *# '$,*', (")

-"('/-"$' ,)>)*')"# /'(", ,/' &'," /'(", /-("$"/ ,*'!). P)!%-")!") "**"

/%- ",") )+",") $%#" -,%-")!)+" &%#" *# '$,*'".

2. M)!)/-# /"*/"*'* &"% (") )!)/-# ',-/"*/"*.

28


29/33

3. M('',"*' #,%# DNA # ,/-"$' )+",") *# #' *)*'/' /-"("$

-"('"*' +")! ('-',") ;-"('*)*'/'*-


30/33

B-"$" #'/-"/%- )+"/",") "7" $-'") ,/-"$' *"-" -*""") ()!")

-"('"*' ()!") *+"-"/ (*'* -"('"*' /'(", /-#"#% -"/ (") &"(7"# $-'") /'(", ('$-$")&")!6

"," *"',)+" !%)",") -!') ,/-"$' +")! *(-")" **%"' &"(7"# $-'").

U)/%, )!%-")!' , *"$')! ("-' ,-"('/-"$' ('-',") ,/-"$' /%)!!"# ;single

agent c"emot"erapy< (*'* -)(" ()!") /%&%") ,%*%* %)/%, )')!,"/,") *)*'/'>'/"* *#

,"),- /-"("$ -"('/-"$' ;-"('*)*'/'-",*') *$*'', -") !#',$-/') >'-%* E$*/') B"--

+")! ('%-)',") $"(" $)(%(%, +")! -/$"/ /')!!"# (' ("-" ()!") -*', /')!!'.

M')(",") ;'!-"*'< $)(%(%, ("-' ("-" -*', /')!!' , /$"/ #"'))+".

P)-")!") ",") ,'"*"") '(%$ +")! *"#"6 )!%" "-" "*", ",")") %)/%,

)!" ",'"/ +")! /'%# ("-' "")"") +")! -""+".

P)+%#%") )!)"' #')!,%)!") '(%$ +")! /'(", *"/6 )')!,"/,") ,"("") **'"#

,)' (") -"!"' "# +")! -,"'/") ()!") ,%)!,')"),%)!,')") ",/-

$)+".

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M#",%,") /* *-#!', I!A ")/' CA (") I!A ")/' EA *"-" "**"# (' "*" +")! ",")

("/")! -")""/ ("#" )%,") ,"-*')" )"*"-')! *"-" #' (')'.

PENUTUP

I. KESIMPULAN

K"-*')" )"*"-')! -%$",") /%- !")"* )- *"/% +")! "/',") (")

)$"/' %-%/") , 10 ("-' *#%-% /%- !")"* (' /%%.

B")+", ",/- +")! ('(%!" -%%)!") ()!") KNF6 +"'/%

;1


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