第 2 頁放射 / 造影服務部經頸靜脈肝內門體靜脈支架分流術 (TIPS) 食道下腔靜脈食道下腔靜脈分流支架肝靜脈肝靜脈肝臟胃胃脾脾門靜脈冠狀靜脈脾靜脈肝臟門靜脈冠狀靜脈脾靜脈左邊顯示的是健康的肝臟右邊顯示的是放入了一個分流支架的肝臟肝門脈高壓引起 2 個主

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1 Transjugular Intrahepatic Portosystemic Shunt (TIPS) Chinese - Traditional 病人教育放射 / 造影服務部經頸靜脈肝內門體靜脈支架分流術 (TIPS) 關於你的手術本手冊解釋什麽是經頸靜脈肝內門體靜脈支架分流術, 以及接受這種手術的預期步驟 TIPS 是什麽意思? TIPS 代表經頸靜脈肝內門體靜脈支架分流術 : 經頸靜脈經過頸部內的頸靜脈肝內在肝臟內門體靜脈從門靜脈到肝靜脈 ( 門靜脈將血液輸入肝臟肝靜脈將血液導出肝臟 ) 分流支架一根用織物包裹住的金屬管, 用來讓血液從一個血液系統流到另一個血液系統我爲何需要做經頸靜脈肝內門體靜脈支架分流術? 正常情況下, 血液從腸和脾流出, 經門靜脈進入肝臟健康的肝臟對血細胞進行處理, 並吸收腸內的營養物質 ( 見第 2 頁左上圖 ) 然後, 血液經肝臟組織過濾並流進肝靜脈, 然後流入心臟你的肝臟有問題, 引起肝門脈高壓, 從而導致負責排出胃部食道脾臟和腸道血液的靜脈網壓力增加肝硬化是最常引起這個問題的原因, 肝硬化是肝臟中佈滿疤痕

2 第 2 頁放射 / 造影服務部經頸靜脈肝內門體靜脈支架分流術 (TIPS) 食道下腔靜脈食道下腔靜脈分流支架肝靜脈肝靜脈肝臟胃胃脾脾門靜脈冠狀靜脈脾靜脈肝臟門靜脈冠狀靜脈脾靜脈左邊顯示的是健康的肝臟右邊顯示的是放入了一個分流支架的肝臟肝門脈高壓引起 2 個主要問題 : 靜脈曲張出血肝內靜脈的高壓可能會導致門靜脈內的血流回流因而血液必須透過稱爲靜脈曲張的新通道流出當靜脈充滿太多血液時, 靜脈便變弱這會導致大量出血腹水腹水是腹部有積水産生腹水可能有許多不同的原因 TIPS 能夠治好這些病嗎? TIPS 手術只能幫助控制這些病它不會使你的肝臟功能有任何好轉分流支架在門靜脈和肝靜脈之間建立一條新通道, 讓血液不會積聚在肝臟中 ( 見右上圖 ) 這種手術還可以改善其他疾病你的醫生將會告訴你這種治療會如何幫助你唯一可以長期治好肝門脈高壓的方法是進行肝臟移植如果你的醫生告訴你肝臟移植可以幫助你, 你可以先做 TIPS, 以後仍然可以做移植手術

3 第 3 頁放射 / 造影服務部經頸靜脈肝內門體靜脈支架分流術 (TIPS) TIPS 手術如何進行? TIPS 是由一名介入放射專家做的, 這是專門從事以 X 光或其他影像進行導引定位手術的醫生整個手術大約需要 2 至 3 小時, 但可能要長達 5 至 6 小時你要接受全身麻醉, 這意味著你將完全睡著麻醉師將會用一根呼吸管幫助你呼吸醫生將從你頸內的大頸靜脈進入靜脈醫生將使用一些金屬線和導管 ( 薄塑膠管 ) 從你的頸靜脈進入肝靜脈然後建立一條穿過肝組織到達門靜脈的通道在這條通道中將放置一個人工血管支架 ( 見下圖 ), 以保持通道的暢通血液將直接從你的門靜脈系統流入你的腔靜脈 ( 一條大靜脈, 將你上半身和下半身的血液排出, 並注入到右心房 ( 心室 )) 這可緩解肝門脈高壓人工血管支架手術後, 我們會叫醒你你的頸部將會有一條約 0.5 英寸長的疤痕你在當天剩下的時間裏會感到昏昏欲睡, 但是第二天便會感覺正常, 你應該能夠恢復你正常的活動 TIPS 手術後我可能會出現什麽情況? 大約 90% 的病人 (100 個中有 90 個 ) 可以建立分流支架有些人 (10%, 或 100 個中有 10 個 ) 不能建立分流支架

4 第 4 頁放射 / 造影服務部經頸靜脈肝內門體靜脈支架分流術 (TIPS) 如果你的醫生能夠爲你建立分流支架, 而你原先有 : 靜脈曲張出血, 你有 80 至 90% 的機會不會再出現靜脈曲張出血腹水, 有大約 65% 的機會你的腹水會在 1 個月內消失或減少經過一段時間, 你的身體可能會在分流支架周圍形成疤痕組織這可能會導致部分 ( 或罕見的完全 ) 堵塞爲此, 你需要時常做超聲波檢查, 以確保分流支架工作正常如果分流支架工作不正常, 你可能需要做 1 次或多次修復支架的手術與原先的 TIPS 手術相比, 這些手術沒有那麽複雜和危險做這些手術時, 只使用輕微鎮靜劑, 不需要全身麻醉有任何危險嗎? 大多數人做完 TIPS 手術後情況良好約有 ⅓ 人 (100 個中有 33 個 ) 放入分流支架後會産生新的或更嚴重的腦病 ( 輕微的意識錯亂精神難以集中, 或改變了你的睡 - 醒周期 ) 大多數情況下, 這些症狀可以用藥物改善但是, 做 TIPS 是一個重大的醫療手術大約有 5 至 10% 的人 (100 個中有 5 至 10 個 ) 會有嚴重的並發症這些並發症包括 : 可能會導致生命危險的腹部出血嚴重感染肝病惡化在最初幾天裏, 手術本身導致的死亡率約爲 1% (100 個人中有 1 個死於 TIPS 手術 ) 而在手術後最初幾個月內, 死亡率可能會高許多你的醫生在手術前會向你講述有關這種手術的危險性請確保你的疑問和擔憂都得到解答手術前在做 TIPS 手術之前, 你需要進行一次麻醉前諮詢, 或者在醫院, 或者在門診我們將會爲你安排這次諮詢的時間如果你是門診病人, 會有一個護士協調員在你手術前一天的下午打電話給你如果你的手術是在星期一做, 該護士會在上一個星期五打電話給你該護士將會給你重要指示, 並回答你提出的任何問題

5 第 5 頁放射 / 造影服務部經頸靜脈肝內門體靜脈支架分流術 (TIPS) 如果你的英語不是很好, 不能明白這些指示或手術細節, 請立即告訴我們我們將會安排一個醫院翻譯員協助你家人或朋友也許不能爲你翻譯如果你有過敏史或對顯影劑 (X 光染色劑 ) 有不良反應, 請致電我們的護士協調員 ( 見本手冊最後一頁上的電話號碼 ) 你可能需要在手術前服用防止這種過敏的藥物如果你的腎功能不正常, 而我們需要將 X 光染色劑注射入你的血管, 我們會爲你開出處方藥, 讓你在手術前後服用, 以幫助保護你的腎臟如果你在服用任何血液稀釋藥物 ( 例如 Coumadin Lovenox Fragmin 或 Plavix), 你可能需要在手術前 3 至 9 天停服用這些藥物你將獲得有關這方面的指示如果你患有糖尿病並在注射胰島素或甲福明二甲雙胍 ( 二甲雙胍 ), 你將在放置分流支架那天獲得有關控制或調整劑量的指示手術前一天你必須在手術前嚴格遵守以下指示 : 手術前一天, 你可以如常進食要飲大量的液體從手術前 6 小時開始, 你只能飲清流質 ( 透明的液體, 例如水雪碧紅莓汁或淡茶 ) 從手術前 2 小時開始 : - 不能用口進食任何東西 - 如果你必須服藥, 只能飲一口水送藥 - 切勿服用維他命或其他營養補充藥空腹服用這些藥會引起腹部不適手術當天手術當天, 服用所有你常用的其他藥物切勿漏服這些藥物, 除非你的醫生或護士叫你停止服用隨身攜帶一份你服用的所有藥物的清單

6 第 6 頁放射 / 造影服務部經頸靜脈肝內門體靜脈支架分流術 (TIPS) 如果手術要延遲開始, 這是經常發生的, 因爲我們需要治療其他突發的和急症的病人如果出現這種情況, 謝謝你的耐心等待除非已告訴你, 否則你必須遵循以下指示 : - 如果你是華盛頓大學醫療中心 (UWMC) 的病人, 請到醫院大樓 3 樓 ( 主層 ) 的入院部報到入院部位於大廳右側, 詢問台後面 - 如果你是 Harborview 醫療中心 (HMC) 的病人, 請到 Maleng 大樓 8 樓的門診手術區 (APA) 報到將會有一個醫護助理給你一件醫院衣服穿上, 並給你一個袋裝你的私人物品這時你可能要去如厠排清大小便開始靜脈注射 (IV) 將透過靜脈注射給你注射液體和藥物介入放射科醫生將會向你介紹這次手術, 並要求你簽署一份同意書, 如果你尚未簽署的話這時你可以向醫生問問題然後, 麻醉師將對你進行麻醉讓你睡著麻醉師會在整個手術過程以及你從麻醉中恢復的期間監視著你手術後當你清醒後你能夠立即飲用液體, 然後進食固體食物你要留院一晚我們將密切觀察你, 看你是否有任何出血或感染的迹象大多數人可以在第二天回家不需要其他恢復回家後你可以恢復服用你常用的藥物只能服用你的醫生開給你或同意你服用的藥物你會被安排在手術後約 1 周內做一次超聲波檢查請確保按時去做這次檢查

7 第 7 頁放射 / 造影服務部經頸靜脈肝內門體靜脈支架分流術 (TIPS) 有任何問題嗎? 你的問題很重要如果你有任何問題或疑慮, 請致電你的醫生或保健提供者 UWMC 診所的醫護人員也可以隨時提供幫助放射 / 造影服務部 : 何時打電話給你的醫生如果你出現以下情況, 立即打電話給我們 : 發燒超過 101 F (38.3 C) 或發冷出現新的腹痛意識混亂或瞌睡變得更加嚴重眩暈眼睛和皮膚變黃呼吸急速加劇打電話給誰華盛頓大學醫療中心 (UWMC) 的病人介入放射科護士協調員手術安排處下班時間 ( 下午 5 點至上午 7 點 ), 周末和假節日找值班的介入放射科醫護人員 Harborview 醫療中心 (HMC) 的病人病人護理協調員或下班時間 ( 下午 5 點至上午 7 點 ), 周末和假節日找值班的介入放射科醫護人員如果你是看急診直接去最近的急診室, 或致電切勿等待聯繫我們的某個醫護人員 Box N.E. Pacific St. Seattle, WA University of Washington Medical Center Transjugular Intrahepatic Portosystemic Shunt (TIPS) Chinese - Traditional Published/Clinician Review: 02/2012 Reprints on Health Online:

8 Patient Education Transjugular Intrahepatic Portosystemic Shunt (TIPS) About your procedure This handout explains what a transjugular intrahepatic portosystemic shunt is and what to expect when you have this procedure. What does TIPS mean? TIPS stands for transjugular intrahepatic portosystemic shunt: Transjugular through the jugular vein in your neck Intrahepatic within your liver Portosystemic from the portal vein to the hepatic vein (The portal vein carries blood into the liver. The hepatic vein drains blood from the liver.) Shunt a metal tube covered with fabric that allows flow from one blood system to another Why do I need a TIPS procedure? Normally, blood flows from your intestines and spleen through the portal vein into your liver. A healthy liver processes the blood cells and absorbed nutrients from the gut (see picture on left on page 2). The blood then filters through the liver tissue and drains into the hepatic veins and then into the heart. You have a problem with your liver that has caused portal hypertension. This condition causes increased pressure in the network of veins that drain your stomach, esophagus, spleen, and bowel. The most common reason for this problem is cirrhosis of the liver, which is widespread scarring in your liver.

9 Page 2 Transjugular Intrahepatic Portosystemic Shunt (TIPS) A healthy liver is shown on the left. A liver with a shunt in place is shown on the right. Portal hypertension causes 2 major problems: Variceal Bleeding High pressure in the veins in the liver can cause the blood flow in the portal veins to back up. The blood must then drain through new pathways called varices. When too much blood fills the veins, they weaken. This can cause a lot of bleeding. Ascites Ascites is a buildup of fluid in the abdomen. This may occur for many different reasons. Can TIPS cure these problems? The TIPS procedure only helps control these problems. It does not make your liver function any better than it already does. The shunt creates a new path between the portal vein and hepatic veins to keep blood from building up in the liver (see picture on the right, above). Other problems can also be improved with this procedure. Your doctor will talk with you about how this treatment may help you. The only long-term cure for portal hypertension is to have a liver transplant. If your doctor has told you that a liver transplant could help you, you can have TIPS done and still get a transplant later.

10 Page 3 Transjugular Intrahepatic Portosystemic Shunt (TIPS) How is TIPS done? TIPS is done by an interventional radiologist, a doctor who specializes in procedures that are guided by X-rays or other imaging. The entire procedure usually takes about 2 to 3 hours, but it can last as long as 5 to 6 hours. You will have general anesthesia, which means that you will be completely asleep. You will have a breathing tube to help you breathe. Your doctor will access your veins through the large jugular vein in your neck. From there, your doctor will use wires and catheters (thin plastic tubes) to enter your hepatic veins. Then, a passageway is created across the liver tissue to your portal vein. A stent-graft (see the picture below) will be placed to keep this passageway open. The blood will flow directly from your portal system into your vena cava (a large vein that drains blood from the upper body and the lower body, and empties into the right atrium (chamber) of the heart). This will relieve the portal hypertension. A stent-graft After the procedure, we will wake you up. You will have a scar about ½ inch long on your neck. You will feel sleepy for the rest of the day, but you should feel normal by the next day. After that, you should be able to return to your normal activities. What should I expect after my TIPS procedure? A shunt can be created in about 90% of patients (90 out of 100). For some people (10%, or 10 out of 100), it is not possible to create the shunt.

11 Page 4 Transjugular Intrahepatic Portosystemic Shunt (TIPS) If your doctor was able to create your shunt and you had: Variceal bleeding, there is an 80 to 90% chance that you will not have any more bleeding from the varices. Ascites, there is about a 65% chance that your belly fluid will go away or be reduced within about 1 month. Over time, your body may form scar tissue around the shunt. This can cause partial (or rarely, complete) blockage. Because of this problem, you will need ultrasound tests from time to time to make sure the shunt is working well. If the shunt stops working well, you may need 1 or more procedures to repair it. These procedures are less complicated and risky than the original TIPS procedure. They are done with mild sedation only, not general anesthesia. Are there risks involved? Most people do well after the TIPS procedure. About ⅓ of people (33 out of 100) who get a shunt develop new or worsened encephalopathy (mild confusion, trouble concentrating, or changes in your sleep-wake cycle). Most times, these symptoms can be managed with medicines. But, creating TIPS is a serious medical procedure. About 5 to 10% of people (5 to 10 out of 100) have a serious complication. These can include: Bleeding in the abdomen that may be life-threatening Serious infection Liver disease gets much worse In the first several days, the death rate from the procedure itself is about 1% (1 out of 100 people die from a TIPS procedure). And, the death rate in the first few months after the procedure can be much higher. Your doctor will talk with you about your risks before you have the procedure. Please be certain that all of your questions and concerns are addressed. Before Your Procedure You will need a pre-anesthesia consult, either in the hospital or in a clinic, before you have the TIPS procedure. We will schedule this visit for you. If you are an outpatient, a nurse coordinator will call you the afternoon before your procedure. If your procedure is on a Monday, the nurse will call you the Friday before. The nurse will give you important instructions and answer any questions you have.

12 Page 5 Transjugular Intrahepatic Portosystemic Shunt (TIPS) If you do not understand English well enough to understand these instructions or the details of the procedure, tell us as soon as possible. We will arrange for a hospital interpreter to assist you. A family member or friend may not interpret for you. If you have had an allergy or bad reaction to contrast (X-ray dye) in the past, please call our nurse coordinators (see numbers on the last page). You may need medicine for this allergy before the procedure. If your kidney function is not normal and we need to give X-ray dye into your blood vessels, we may prescribe a medicine for you to take before and after your procedure to help protect your kidneys. If you take any blood-thinning medicines (such as Coumadin, Lovenox, Fragmin, or Plavix), you may need to stop taking the medicine for 3 to 9 days before the procedure. You will receive instructions about this. If you have diabetes and take insulin or metformin (Glucophage), you will receive instructions about holding or adjusting your dose for the day your port is placed. Day Before Your Procedure You must closely follow these instructions before your procedure: The day before the procedure, you may eat as usual. Drink lots of fluids. Starting 6 hours before the procedure, you may only have clear liquids (liquid you can see through, such as water, Sprite, cranberry juice, weak tea). Starting 2 hours before your procedure: - Take nothing at all by mouth. - If you must take medicines, take them with only a sip of water. - Do not take vitamins or other supplements. They can upset an empty stomach. On the Day of Your Procedure Take all of your other usual medicines on the day of the procedure. Do not skip them unless your doctor or nurse tells you to. Bring a list of all the medicines you take with you.

13 Page 6 Transjugular Intrahepatic Portosystemic Shunt (TIPS) If there is a delay in getting your procedure started, it is usually because we need to treat other people with unexpected and urgent problems. Thank you for your patience if this occurs. Unless you are told otherwise: - If you are a patient at University of Washington Medical Center (UWMC), check in at Admitting on the 3rd (main) floor of the hospital. Admitting is to the right and behind the Information Desk in the lobby. - If you are a patient at Harborview Medical Center (HMC), check in at the Ambulatory Procedure Area (APA) on the 8th floor of the Maleng Building. A medical assistant will give you a hospital gown to put on and a bag for your belongings. You may use the restroom at that time. An intravenous (IV) line will be started. You will be given fluids and medicines through the IV. An interventional radiology doctor will talk with you about the procedure and ask you to sign a consent form if that has not already been done. You will be able to ask questions at that time. You will then be put to sleep by an anesthesiologist. This person will monitor you throughout the entire procedure and while you recover from anesthesia. After Your Procedure Soon after you are awake, you will be able to have liquids and then solid food. You will stay in the hospital overnight. We will watch you closely for any signs of bleeding or infection. Most people go home the next day. There is no other recovery needed. When You Get Home You may resume taking your normal medicines. Take only the medicines that your doctors prescribed or approved. You will be scheduled for an ultrasound of your abdomen about 1 week after your procedure. Be sure to keep this appointment.

14 Page 7 Transjugular Intrahepatic Portosystemic Shunt (TIPS) Questions? Your questions are important. Call your doctor or health care provider if you have questions or concerns. UWMC clinic staff are also available to help. Radiology/Imaging Services: When to Call Call us right away if you have: Fever higher than 101 F (38.3 C) or chills New abdominal pain Confusion or sleepiness that gets worse Dizziness Yellowing of your eyes or skin Shortness of breath that gets worse Who to Call University of Washington Medical Center (UWMC) Patients Interventional Radiology nurse coordinator Procedure Scheduling After hours (between 5 p.m. and 7 a.m.), and on weekends and holidays Ask for the Interventional Radiology Fellow on call Harborview Medical Center (HMC) Patients Patient Care Coordinators or After hours (between 5 p.m. and 7 a.m.), and on weekends and holidays Ask for the Interventional Radiology Fellow on call If You Have an Emergency Go directly to the nearest Emergency Room or call Do not wait to contact one of our staff. Box N.E. Pacific St. Seattle, WA University of Washington Medical Center Published/Clinician Review: 02/2012 Reprints on Health Online:

UTI (Urinary Tract Infection) - Traditional Chinese

UTI (Urinary Tract Infection) Urinary tract infection, also called UTI, is an infection of the bladder or kidneys. Urethra Kidney Ureters Bladder Vagina Kidney Ureters Bladder Urethra Penis Causes UTI