Objective:To observe the clinical features of patients with chronic pain after hernia repair，and to improve their clinical diagnosis and treatment analysis.Methods:A retrospective analysis was implemented from January 2014 to June 2019，and 47 patients of more than 3 months after hernia repair（including inguinal hernia and incisional hernia）still complained pain in surgery area and surgery around（including lower limbs，waist，expanded to the neck and other limb areas）in the outpatient clinic.All patients were treated and analyzed with Consultationliaison psychiatry research，in order to observe the clinical characteristics of patients and improve the relevant clinical diagnosis，further analysis and treatment.Results:Of the 47 patients，1 case of femoral head necrosis patient，1 case of pubic metastasis of prostate cancer patient，and 1 case of infectious patient were diagnosed by imaging diagnosis.The rest were diagnosed with "psychogenic pain".Among them，25 patients were diagnosed with “aggressive（control）personality conflict”（including 19 males and 6 females），12 patients were diagnosed with “dependednt personality conflicts”（including 6 males and 6 females），and 4 patients were diagnosed with “lonely personality conflicts”（including 4 males）.3 patients（2 males and 1 female）refused to be interview treatment.11 patients were treated with antianxiety and antidepression drugs，and they were again referred to the outpatient clinic with pain relief.30 patients lost contact after one interview treatment.3 patients still had repeated outpatient visits and complained that chronic pain persisted without relief.One patient had received three surgical treatments，and the pain was relieved immediately after each operation，but the pain recurred and aggravated after 3 months of surgery.One patient developed pain after TEP for the right inguinal hernia，and was again treated with TAPP for the left inguinal hernia.The postoperative aggravated pain in the patient caused a medical dispute.Conclusion:Patients with chronic psychogenic pain after hernia repair had different degrees of anxiety and depression，and the somatization were diverse.Correct understanding of the nature of psychogenic pain combined with antianxiety and depression treatment can 〖LM〗contribute to treating and improving the chronic psychogenic pain after hernia repair.

Objective:To analyze the treatment methods of the mesh infection after tensionfree repair of inguinal hernia.Methods:The clinical data of 17 patients with mesh infection after tensionfree repair of inguinal hernia from January 2010 to December 2017 in department of gastrointestinal surgery of Wuhan Tongji Hospital were retrospectively analyzed.Results:17 cases were treated with debridement，mesh removing，primary suture and  closed drainage.15 cases were first grade healing，2 case were under reoperation for second debridement and second grade healing finally，no recurrence of hernia was found after 18 months of followup.Conclusion:The treatments of debridement，mesh removing，primary suture and closed drainage are effective means in cases of mesh infection after tensionfree repair of inguinal hernia，in which nonsurgical treatments are failed.

Objective:Discuss the choice of operative methods and difficulties of ipsilateral inguinal hernia after total hip arthroplasty.Methods:From March 2010 to May 2018，21 patients with history of total hip replacement and ipsilateral new inguinal hernia were retrospectively reviewed.The anatomical characteristics and surgical methods of the patients were analyzed and summarized.Results:Laparoscopic transperitoneal extraperitoneal hernia repair（TAPP）was performed in 7 cases and laparoscopic total extraperitoneal hernia repair（TEP）in 2 cases，Open surgery was performed in 12 cases，with Lichtenstein operation.There were 17 patients with different degrees of pubicbladder space adhesion，difficult to separate the anteromedial peritoneal space，difficult to fully expose the pubic ramus.However，Lichtenstein operation has clear clearance and smooth operation.Conclusion:Patients with ipsilateral inguinal hernia after total hip arthroplasty may have different degrees of pubicbladder space adhesion.Lichtenstein was chosen as the main surgical method to reduce the large area separation of pubicbladder space.

Objective:To explore the management measure of enhanced recovery after surgery（ERAS）in patients with pseudocapsule based microsurgery for transsphenoid pituitary adenoma.Methods:From June 2017 to December 2017，122 patients with pituitary adenoma treated with pseudocapsule based extracapsular transsphenoid microsurgery，and 65 patients were in the ERAS group and 57 in control group，clinical materials and followups were retrospectively analyzed.Results:Compared to the control group with classical perioperative management，the ERAS group had better KPS grades（P<0.05）and more satisfaction at inhospital duration（P<0.05），shorter inhospital time（P<0.05）and inbed time（P<0.05），meanwhile less complication rate of epitaxies and diabetes（P<0.05）.Conclusion:The integration of ERAS concept into the pituitary surgery with extrapseudocapsule mode could minimize the surgical trauma and maximize the function protection for neurosurgical patients.The ERAS management was crucial to improve the surgical effect and patients’ experience during hospitalization，it is worthy to generalize it in clinical practice.

Objective:A surgical method should be found to reduce the probability of blockage after ventricle and abdominal shunt.Methods:198 adult patients with hydrocephalus from June 2010 to June 2015，were randomly divided into routine group（137 cases）and improved group（61 cases）.In improved group the depth of the head end of shunt tube is determined by preoperative CT and the tail end is fixed on the abdominal wall.the postoperative blockage of all patients was statistically analyzed.Results:In the routine group，137 cases were operated，21 cases were blocked，61 cases in the improved group and 3 cases in the improved group.There was significant difference in the blocking rate between the two methods（P<0.05）.Conclusion:The depth of individualized placement in ventricle and fixation in abdominal cavity can reduce the probability of blockage after ventriculoperitoneal shunt.

Objective:To investigate the role of nanocarbon in the recognition of parathyroid glands in parathyroidectomy plus autograft.ethods:Seventyfour patients with uremia secondary hyperparathyroidism who underwent surgery were selected as subjects，divided into observation group（39 cases）and control group（35 cases）.Observation group took parathyroidectomy and autografting traced in nanocarbon surgery，Control group underwent conventional parathyroidectomy plus autografting；followup for 6 months，observe all patients' surgical results，pathological diagnosis，serum parathyroid hormone（PTH），serum calcium levels，complications and recurrence.Results:The postoperative symptoms of the two groups were significantly improved compared with those before surgery；the accuracy of excision of parathyroid tissue in the observation group was 100%，which was significantly higher than that in the control group（86.18%），and the difference was statistically significant（P<0.05）； there was no significant difference in the length of the incision and the amount of intraoperative blood loss between the two groups（P>0.05）；the operation time and postoperative hospital stay of the observation group were significantly shorter than the control group，and the difference was statistically significant（P<0.05）；serum PTH and serum calcium levels were significantly lower in the observation group than in the control group at 1 and 6 months after operation（P<0.05）；no recurrent laryngeal nerve injury was found in either group，in the observation group，20 cases of hypocalcemia occurred after operation，the control group showed different degrees of hypocalcemia after surgery，and was relieved after symptomatic treatment；during the followup period，the recurrence rate of the observation group was 0，which was significantly lower than that of the control group（11.43%），and the difference was statistically significant（P<0.05）.Conclusion:Anocarbon has an important recognition function for parathyroidectomy plus abnormal parathyroid gland during autograft transplantation，which is helpful to protect thyroid function and recurrent laryngeal nerve，it is worthy of further research and application.

Objective:To investigate the effect of axillary lymph node status on the prognosis of patients with recurrence after breast conserving surgery.Methods:From April 2012 to May 2015，476 patients with breast cancer who had recurred after breast conserving surgery were selected as the study subjects.According to the status of axillary lymph nodes during breast conserving surgery，152 cases were axillary lymph node positive group and 324 cases axillary lymph node negative group.The clinicopathological manifestations and survival of the two groups were observed and compared，and the prognostic factors after recurrence were analyzed.Results:There was no significant difference in local and regional recurrence between the two groups（P>0.05）.There were no significant differences in age，recurrence site，estrogen receptor（ER）and progesterone receptor（PR），human epidermal growth factor receptor 2（HER2），diseasefree interval，local and systemic treatment between the two groups（all P>0.05）.There was no significant difference in the nondistant metastasis survival rate between the two groups（P>0.05），but the total survival rate in the positive group was significantly lower than that in the negative group（P<0.05）.Cox proportional hazard model multivariate analysis showed that recurrence site was an independent factor for survival without distant metastasis after local recurrence of breast conserving surgery（OR=2.052，P=0.003）.Axillary lymph node status and recurrence site were independent factors for overall survival after local recurrence of breast conserving surgery（OR=3.468，P=0.003；OR=677，P<0.001）.Conclusion:Axillary lymph node status is an independent factor affecting the overall survival of patients with recurrence after breast conserving surgery，but it has little effect on the survival of patients without distant metastasis.

Objective:To evaluate the nutritional status，immune function and clinical effectiveness of early enteral immunonutrition in elderly patients receiving totally endoscopic esophagectomy.Methods:This randomized controlled trial enrolled 96 patients receiving totally endoscopic esophagectomy in Department of Thoracic Surgery of The Fourth Hospital of Hebei Medical University between May 2015 and June 2017.The patients were randomly divided into enteral immunonutrition group（EIN group，n=47）and common enteral nutrition group（EN group，n=49）.Both groups received enteral nutrition through jejunostomy tube.Before operation and 1，3，7day after operation，the levels of nutritional indexes and immune indexes were compared，the time of first postoperative anal exhaust，the number of postoperative infections and the length of hospitalization were also compared between the two groups.Results:On the first day after operation，the nutritional indexes and immune indexes of the two groups were significantly lower than those before operation（all P<0.05）；On the 3th day after operation，the indexes of the two groups were increased（all P<0.05）；On the 7th day after operation，the rate of EIN group was faster than that of EN group（P<0.05）.There were no significant differences in the time of first postoperative anal exhaust and the length of hospitalization（P>0.05）.The number of postoperative pneumonia complications and the length of hospital stay were statistically significant（P<0.05）.Conclusion:Enteral immunonutrition can improve the nutritional status and the immune response，promote the rapid recovery in elderly patients receiving totally endoscopic esophagectomy.

Objective:To explore the content change of IL1β and to investigate the role of IL1β on the hepatic function damage of acute pancreatitis.Methods:Sixty patients of nonbiliary acute pancreatitis with hepatic function damage from Sept 2015 to Sept 2017，according to CT grading divided into mild acute pancreatitis（MAP）with 30 cases and severe acute pancreatitis（SAP）with 30 cases，selected 30 cases of healthy people as the control group.By using automatic bichemical analyzer to test the level of ALT and AST，using  radioimmunoassay to test the level of IL1β，then  statistical analysis was conducted.Results:The level of ALT、AST and IL1β in MAP and SAP group were higher than in the control group（P<0.05），the level of ALT、AST and IL1β in SAP group were higher than in the MAP group，all had statistical significance（P<0.05）.Conclusion:IL1β may be involved in the process of hepatic function damage with acute pancreatitis，and the level of  IL1β is positively correlated with the severity of hepatic function damage.

Objective:To explore the correlation between chronic schistosomiasis and colorectal cancer.Methods:60 patients with single colorectal cancer（group A）and 60 cases of chronic schistosomiasis were selected（group B）.In this paper，two groups of serum CEA levels were obtained by doublesite sandwich chemiluminescence immunoassay，and the two groups were divided according to the TNM stage standard of colorectal cancer； the two groups were classified according to the histological grade standard of colorectal cancer，and the difference was analyzed.Results:In the comparison of high age，the proportion of group A（13.33%）was higher than that of group B（11.67%）（P＞0.05）； and the level of CEA in group A was higher than that of group B in stage Ⅰ，stage Ⅱ and high differentiation stage（P<0.05）.There was no difference in CEA level between group A and group B in stage Ⅲ，stage Ⅳ and middle and low differentiation stages（P>0.05）.Conclusion:The main difference between the single colorectal cancer group and the group with chronic schistosomiasis in the early stage of colorectal cancer，and chronic schistosomiasis affects the occurrence of colorectal cancer.

Objective:To analyze and compare the effect of low ligation and high ligation of inferior mesenteric artery（IMA）and root lymph node dissection in laparoscopic radical resection of low rectal cancer.Methods:The clinical data of 92 patients with low rectal cancer who underwent laparoscopic radical resection from April 2015 to March 2018 were analyzed retrospectively.According to the mode of intraoperative IMA ligation，the patients were divided into high group（n=52）and low group（n=40）.The operation time，blood loss，number of IMA root lymph node dissection，hospitalization time ，postoperative complication rate and defecation function were compared between the two groups.Results:There was no significant difference in operation time [（142.24±20.25）min VS（146.24±22.64）min]，blood loss [（40.36±6.18）ml VS（44.66±7.22）ml]，lymph node dissection number [（14.24±2.18）VS（13.94±2.07）]，hospitalization time [（11.49±3.14）d VS（12.48±3.85）d] between the two groups（P>0.05）.The first exhaust time of the low group was lower than that of the high group [（36.63±2.78）h VS（44.48±4.21）h].The defecation function score of the two groups at 3 months and 6 months after operation was better than that of the high group，and the difference was statistically significant（P<0.05）.The incidence of anastomotic leakage in the low group was 2.5%（1/40），lower than that in the high group [5.78%（3/52）].The difference was statistically significant（P<0.05）.The incidence of urinary incontinence or sexual dysfunction in low group was 17.5%（7/40），higher than that in high group[7.69%（4/52）]，the difference was statistically significant（P<0.05）.There was no significant difference in the incidence of other complications（P＞0.05）.onclusion:The two kinds of ligation have similar curative effect in laparoscopic radical resection of rectal cancer，but low ligation has less influence on defecation function，lower incidence of anastomotic leakage and better shortterm curative effect.

Objective:To compare clinical outcomes of arthroscopic therapy for tibial avulsion fracture with nonabsorbable suture and cannulated screw.Methods:30 cases for tibial avulsion fracture patients were treated with nonabsorbable suture fixation or cannulated screw fixation under arthroscopy.Among these patients，the experimental group was15 knees with nonabsorbable suture fixation under knee arthroscopy，and the control group was 15 knees with traditional hollow screw fixation under knee arthroscopy.Radiographs，anterior drawertest（ADT），Lachman test，Lysholm score，Visual analog Pain Score ，International Knee Documentation Committee（IKDC）subjective score，operation time，analgesic dosage of postoperation 1 week and hospitalization expense were employed to evaluate clinical outcomes in followup.Results:Two groups of patients had improved significantly in knee function and pain relief compared with the preoperative state（P<0.05）.Both Lysholm and IKDC subjective scores improved at the last followup（P<0.05）.Experimental group[（75.40±10.32）min，（19.33±10.33）mg，（7555.56±1643.02）yuan] were less than control group[（88.67±12.84）min，（29.00±10.39）mg，（20127.91±1277.23）yuan] on aspect of operation time，analgesic dosage of postoperation 1 week and hospitalization expense（P＜0.05）.〖WTHZ〗Conclusion:Nonabsorbable suture fixation and cannulated screw fixation areequivalent techniques in terms of the clinical efficacy of arthroscopic tibial avulsion fracture treatment.But，Nonabsorbable suture fixation are less than cannulated screw fixation on aspect of operation time，analgesic dosage of postoperation 1 week and hospitalization expense.

Objective:To explore Clinical effects of low molecular weight heparin for preventing venous thromboembolism after posterior lumbar interbody fusion.Methods:68 patients from January 2015 to January 2017 who had undergone posterior lumbar interbody fusion by the same surgeon group were included in this study.According to the risk factors for deep vein thrombosis（DVT），patients can be divided into highrisk group（29 cases）and lowrisk group（39 cases）.The patients of VTE high risk group were given LMWH as a prophylaxis modality against VTE measures.Lower limb vascular doppler ultrasonography was used to monitor DVT preoperatively and postoperatively.The incidence of DVT in both groups was observed.and wound drainage，epidural and wound hematomas，and neural injury symptoms of the patients in the second group were studied.Results:DVT  incidence of the highrisk group was 3.4％（1/29），and this case was found DVT without symptom by Doppler Ultrasound 1mouth after surgery.There were no patients suffered from DVT in lowrisk group.There was no significant difference in amount of wound drainage between highrisk and lowrisk groups（P＞0.05）.No case caught epidural or wound hematoma，thrombocytopenia caused by low molecular heparin or nerve damage caused by extradural hemorrhage.〖WTHZ〗Conclusion:Individual DVT prophylaxis was taken According to the risk factors after PLIF.There are no complications from prophylaxis happened in two groups.Low molecular weight heparin for preventing venous thromboembolism after PLIF is effective and safe.

Objective:To explore the safety and efficacy of visual puncture micropercutaneous nephrolithotomy for treatment of renal stones in pediatric patients.Methods:The clinical data of 15 pediatric patients with renal stones treated with visual puncture micropercutaneous nephrolithotomy in our department from June 2017 to August 2018 were enrolled.All patients were performed holmium laser lithotripsy of visual puncture micropercutaneous nephrolithotomy under general anesthesia and the operation time，postoperative complications and hospitalization time were evaluated.The urinary CT was reviewed 4 weeks after the operation to evaluate the stonefree rate.Results:All patients were performed holmium laser lithotripsy of visual puncture micropercutaneous nephrolithotomy successfully.The average operation time was（68.43±11.45）min.The average decrease of hemoglobin was（8.50±1.70）g/L，and none of cases required blood transfusion.The average day of postoperative hospitalization was（5.36±0.84）d.Postoperative fever occurred in 2 patients（T＞38.5℃），which was a complication of Clavien grade II，and they were improved after intensive antiinfection treatment according to the drug sensitivity results.The stonefree rate at 4 weeks was 86.67%（13/15）.Conclusion:Visual puncture micropercutaneous nephrolithotomy for the treatment of renal stones in pediatric patients is safe and effective，with low complications，and achieve a satisfactory stonefree rate，which can be popularized in clinical practice.

Objective:To investigate the effect of Solifenacin on detrusor function and prognosis in patients with overactive bladder.Methods:128 cases of patients with overactive bladder admitted to our hospital from March 2016 to December 2018 were selected，and 64 cases were divided into control group and research group according to different treatment methods.The control group was treated with trotrodine and the research group with Solifenacin.The clinical efficacy of the two groups was compared and analyzed.Results:The bladder compliance of the study group，the number of bladder compression inhibition，the initial bladder urination，the maximum bladder volume，and the maximum urine flow rate[（53.1±26.4）ml/cm H2O，（1.5±1.2）times，（177.0±88.0）ml，（298.0±88.0）ml，（53.4±17.1）ml/s]was significantly better than the control group[（58.2±29.5）ml/cm H2O，（1.9±1.5）times，（155.0±90.0）ml，（275.0±98.0）ml，（54.0±20.1）ml/s，and the difference was statistically significant（P<0.05）.The OABSS score（5.9±2.4）scores of the study group before and after medication were better than the control group（6.7±3.4），and the difference was statistically significant（P<0.05）.The incidence of adverse events in the study group was 4.6% significantly lower than that in the control group（14.0%），and the difference was statistically significant（P<0.05）.Conclusion:The use of solifenacin for the treatment of OAB patients，the clinical results are satisfactory，the adverse reactions are mild，it is worthy of clinical use.

Objective:To investigate the efficacy and indications of conservative and surgical treatment of vesicoureteral reflux in children.Methods:One hundred patients with vesicoureteral reflux in our hospital from June 2016 to June 2018 were enrolled in the study.They were randomly divided into a conservative group（50 cases）and a surgical group（50 cases）.At the same time，according to the different reflux grades of the children，the two groups were subdivided into the conservative mild to moderate group（26 cases），the operation mild to moderate group（22 cases）and the conservative severe group（24 cases）and the surgical severe group（28 cases）.The conservative group was treated with conservative（antibiotic treatment and pelvic floor muscle training），〖JP〗and the operation group was treated with laparoscopic ureteral bladder replantation.The therapeutic effects of different treatments and the urodynamic parameters before and after treatment were compared.The incidence of complications was compared between the two treatments.Results:The effective rate of conservative mild and moderate group was 84.62% and 90.91%，respectively（P>0.05）.The effective rate of severe operation group（92.86%）was significantly higher than that of conservative severe operation group（58.33%）P<0.05）.There was no significant difference in urodynamic indexes between the conservative mild and moderate group before treatment，the operation mild and moderate group，the operation severe group and the operation severe group（P>0.05）.The maximum urinary flow rate of the conservative mild to moderate group befor and after treatment were（13.25±6.30）ml/s to（7.34±5.89）ml/s，the maximum bladder volume were（209.82±86.94）ml to（141.36±51.08）ml，which was significantly increased（P<0.05）；the residual urine volume were（14.59±12.17）ml to（84.27±77.24）ml，which was significantly reduced after treatment（P<0.05）.The maximum urinary flow rate of the operation mild to moderate group befor and after treatment were（13.17±6.28）ml/s to（7.41±5.92）ml/s，and the maximum bladder volume were（215.69±87.56）ml to（142.75±51.12）ml，which was significantly increased（P<0.05），and the residual urine volume was（13.28±11.83）ml to（84.03±77.16）ml，which was significantly decrease（P<0.05）.The maximum urinary flow rate of the severe operation group and conservative severe group was（12.93±5.96）ml/s and（7.84±5.85）ml/s，the maximum bladder capacity were（209.36±88.17）ml and（139.58±75.49）ml，the residual urine volume were（19.37±16.70）ml adn（41.29±21.58）ml，the differences between the two groups were statistically significant（P<0.05）.The conservative group and operated groups with recurrent urinary tract infection（16% vs.44%）and ureteral obstruction（8% vs 36%）were significantly lower than the surgical group，the incidence of antibiotic resistance（72% vs.16%）was statistically significant which compared with the operation group（P<0.05），there was no significant difference in the incidence of renal dysfunction（24% vs.32%）and renal scar formation（20% vs.12%）（P>0.05）.Conclusion:Conservative and surgical treatment of vesicoureteral ureteral reflux have advan：tages.For mild to moderate children，conservative treatment is recommended.For severe children，surgical treatment is better.

Inguinal hernia is the mass formed by the abdominal visceral mass protruding through the defect in the inguinal region.Surgical intervention is the most effective method for the treatment of inguinal hernia.With the aging of society，the number of patients with high age inguinal hernia is on the rise.In addition，because of the high age of patients with more than the other basic diseases，this poses certain challenges to the choice of anesthesia and surgical methods.The choice of inguinal hernia repair in elderly patients is still controversial，which makes the Metaanalysis and systematic evaluation of different research results more complicated.This article discusses the choice of inguinal hernia repair in elderly patients with inguinal hernia，and will present the latest research progress in terms of its advantages and disadvantages，postoperative complications.

The development of hernia surgery science has promoted the advancement of materials science.At present，there are a variety of inguinal repair materials.Absorbable mesh especially partially absorbable mesh that is a new inguinal hernia repair material，has been favored by surgeons.In particular，the emergence of biologic mesh has brought the gospel because of its advances in material technology.The question is raised on Longterm effect of biological mesh in postoperative.With rapid development of materials，the surgeon's is attracted by synthetic absorbable mesh because it has more fewer side effects then other.However，whether to truly maximize the benefits of patients，it is still a lack of multicenter，prospective clinical randomized controlled trials to confirm.It is a difficult choice how to choose a suitable mesh for inguinal hernia surgery for surgeons.This is a review of the progress of research on absorbable mesh in recent years.

The incidence and mortality of colorectal cancer in China are on the rise.According to the 2015 China Cancer Statistics，the incidence and mortality of colon cancer are ranked third in malignant tumors worldwide.The clinical manifestations of colon cancer are related to the pathological type and location of the tumor，and the left colon cancer is characterized by intestinal obstruction，diarrhea，constipation and bloody stool.Most patients are already in the advanced or terminal stage when they are diagnosed.Left colon cancer accounts for about 5%6% of all colon cancers.The principle of treatment is comprehensive treatment based on surgical resection.The radical resection of laparoscopic left hemicolectomy includes left transverse colon，descending colon and most sigmoid colon.The current status and related progress of laparoscopic left hemicolectomy were analyzed.

The acid microenvironment of tumor cells is mainly due to the proliferation of tumor cells and the high metabolic capacity，which leads to the stability of the microenvironment and the ability of metabolic acid.They are mainly used to maintain the steady state of their microenvironment by either extruding excess H+ or Intracellular transport of HCO3.The study found that sodium hydrogen exchange 1（NHE1），transport protein of transmembrane，is a widely expressed acidextruding membrane transport protein，upregulation or activation of its expression，which is usually associated with the malignancy of the tumor.This article reviews how altered pH homeostasis，and in particular NHE1，contributes to tumor cell motility，invasion，proliferation，and growth and facilitates evasion of chemotherapeutic cell death.