Objective To investigate the clinical effect of tension-free hernia repair in the treatment of inguinal hernia combined with ascites.Methods The retrospective cross-sectional study was conducted.The clinical data of 81 inguinal hernia patients with ascites who were admitted to the West China Hospital of Sichuan University from June 2008 to June 2014 were collected.Patients with peritoneal effusion received restriction of sodium in take and diuretic therapy,and patients with severe hypoproteinemia received intravenous injection of albumin.All the patients underwent tension-free hernia repair (Gilbert way).Observation indicators:(1) surgical and postoperative situations:operation time,diameter of hernia ring,defect area of hernia,postoperative plasma drainage,removal time of plasma drainage-tube,postoperative complications and duration of hospital stay;(2) follow-up situation:recurrence and long-term complications of inguinal hernia.Follow-up using telephone interview,outpatient examination and inpatient examination was performed to detect the hernia recurrence and long-term complications for 24 months up to June 2016.Measurement data with normal distribution were represented as (x)±s.Results (1) Surgical and postoperative situations:81 inguinal hernia patients with ascites underwent successful tension-free hernia repair.The operation time,diameter of hernia ring and defect area of hernia were respectively (46± 19) minutes,(3.1-± 0.7) cm and (25 ± 13) cm2.Sixty-five patients received indwelling plasma drainage-tube after repair,volume of light bloodstained fluid was respectively ≥ 100 mL in 39 patients and ＜ 100 mL in 26 patients at 24 hours postoperatively,with a removal time of plasma drainage-tube of (3.2± 1.0)days.Sixteen patients didn't receive indwelling plasma drainage-tube.Of 81 patients,9 and 4 were respectively complicated with mild seroma of incision and scrotal swelling,they were improved and then out of hospital after adequate drainage,with a duration of hospital stay (6.7-± 1.7)days.(2) Follow-up situation:of 81 patients,76 were followed up for 24 months,without recurrence and related complications of inguinal hernia.Conclusion The tension-free hernia repair in the treatment of inguinal hernia combined with ascites is safe and feasible,with good clinical effects.

Objective To explore the clinical feasibility of ambulatory surgery for inguinal hernia in 70 years of age or older patients.Methods The retrospective cohort study was adopted.The clinical data of 675 patients undergoing ambulatory surgery for inguinal hernia and 464 patients (age ≥ 70 years) undergoing inpatient surgery for inguinal hernia who were admitted to the West China Hospital of Sichuan University from January 2015 to May 2016 were collected.Of 675 patients undergoing ambulatory surgery,594 patients with age ＜ 70 years and 81 with age≥70 years were respectively allocated into the under 70 years group and 70 years or older group.Four hundred sixty-four patients undergoing inpatient surgery with age ≥ 70 years were allocated into the inpatient surgery group.Observation indicators included:(1) efficacies of patients undergoing ambulatory surgery:① type of anesthesia,surgical procedures and operation time,② cases with delayed discharge and cases with unplanned readmission,③postoperative complications,including wound infection and dehiscence,edema of scrotum,urinary retention,chronic pain and patch infection.(2) Efficacies of patients with inpatient surgery:①type of anesthesia,surgical procedures and operation time,② postoperative complications,including wound infection and dehiscence,edema of scrotum,urinary retention,chronic pain and patch infection,③ duration of postoperative hospital stay.(3) Follow-up.Patients were regularly followed up using telephone interview at postoperative day 1,2,3,and using outpatient examination and telephone interview at postoperative week 2 and month 3,6,12 up to July 2016.Follow-up included the survival of patients,recurrence of hernia and number of readmission.Measurement data with normal distribution were represented as （x） ± s and comparison between groups was evaluated with the t test.Comparison of count data were analyzed using the chi-square or Fisher exact probability.Results (1) Efficacies of patients undergoing ambulatory surgery:① type of anesthesia,surgical procedures and operation time:patients in the under 70 years group and 70 years or older group underwent tensionfree repair under local anesthesia.The operation time in the under 70 years group and 70 years or older group was respectively (29 ± 11) minutes and (28 ± 10) minutes,with no statistically significant difference between 2 groups (t =0.378,P ＞ 0.05).② The cases with delayed discharge and with unplanned readmission:there were 2 patients with delayed discharge and 1 with unplanned readmission in the under 70 years group and no case in the 70 years older group,with no statistically significant difference between the 2 groups (x2=0.601,0.137,P ＞ 0.05).③ The postoperative complications:wound infection and dehiscence,edema of scrotum,urinary retention and chronic pain were detected in 4,2,1,3 patients in the under 70 years group and 1,0,0,1 patients in the70 years or older group,respectively,showing no statistically significant difference between the 2 groups (P ＞ 0.05).No patch infection occurred.(2) Efficacies of patients undergoing inpatient surgery:① type of anesthesia,surgical procedures and operation time:patients in the inpatient surgery group underwent tension-free repair under local anesthesia and operation time was (29 ± 10) minutes.There was no statistically significant difference in operation time between the inpatient surgery group and 70 years or older group (t =0.806,P ＞ 0.05).② The wound infection and dehiscence,edema of scrotum,urinary retention and chronic pain in the inpatient surgery group were respectively detected in 3,1,1,2 patients,showing no statistically significant difference between the inpatient surgery group and 70 years or older group (P ＞ 0.05).No patch infection occurred.③ Duration of postoperative hospital stay was less than 1 day in 439 patients and more than 1 day in 25 patients in the inpatient surgery group,respectively.(3) Follow-up:625 of 675 patients undergoing ambulatory surgery were followed up for a median time of 9 months (range,2-18 months).One patient in the under 70 years group was complicated with recurrence of hernia and then was cured by reoperation.There was no recurrence of hernia in the 70 years or older group.Of 464 patients in the inpatient surgery group,432 were followed up for a median time of 9 months (range,2-18 months),and 1 patient with recurrence of hernia was cured by reoperation.Conclusion Ambulatory surgery for inguinal hernia is feasible in 70 years or older patients.

OBJECTIVETo observe the clinical efficacy differences between different needling methods for dry eye syndrome.

METHODSSixty patients of dry eye syndrome were randomly divided into an observation group and a control group, 30 cases (60 eyes) in each group. Shangjingming (Extra), Xiajingming (Extra), Tongziliao (GB 1), Cuanzhu (BL 2), Fengchi (GB 20), Hegu (LI 4), Sanyinjiao (SP 6), Taixi (KI 3) and Taichong (LR 3) were selected in the two groups. The control group was treated with conventional acupuncture, while the observation group was treated with guiding-acupuncture. Electroacupuncture (EA) was used at bilateral Tongziliao (GB1) and Cuanzhu (BL 2), 30 min per treatment. The treatment was given three times per week. Totally 1-month treatment (12 treatments) was given. The eye symptom score, breakup time of tear film (BUT), Schirmer Ⅰ test (SⅠT) and visual analogue scale (VAS) score were compared before and after treatment in the two groups. The clinical efficacy was compared between the two groups.

RESULTSCompared before treatment, the eye symptom score, BUT, SⅠT and VAS score were improved after treatment in the two groups (all<0.001); the improvements of eye symptom score and SⅠT in the observation group were superior to those in the control group (both<0.05). The differences of BUT and VSA score between the two groups were not significant (both>0.05). The total effective rate was 86.7% (52/60) in the observation group, which was superior to 73.3% (44/60) in the control group (<0.05). .

CONCLUSIONThe conventional EA and guiding-acupuncture combined with EA are both effective for dry eye syndrome, and the efficacy of guiding-acupuncture combined with EA is superior to that of conventional EA.