Inflammatory bowel diseases are a group of chronic, nonspecific inflammatory diseases of the intestine whose etiology is not well understood, including ulcerative colitis and Crohn’s disease. Traditionally both are internal diseases, but a large number of patients with inflammatory bowel disease require one or several surgical procedures during the course of the disease. Today we are concerned with the surgical treatment of ulcerative colitis. I. Diagnosis and drug treatment of ulcerative colitis Ulcerative colitis occurs in young adults between the ages of 20 and 50, and may develop in both men and women. The most typical symptom is mucopurulent stool, and common manifestations also include diarrhea, abdominal pain, and a feeling of incomplete defecation. Some patients may develop complications such as toxic megacolon, intestinal perforation, and lower gastrointestinal hemorrhage during the course of the disease. Colonoscopy is an important basis for the diagnosis of ulcerative colitis. Ulcerative colitis appears on colonoscopy as a continuous, diffusely distributed mucosal lesion extending upward from the rectum. Inflammatory manifestations such as blurred, disturbed or absent vascular texture of the colonic mucosa, congestion, edema, and signs of mucosal destruction such as diffuse, multiple erosions or ulcers are often found, and shallow, blunted or absent colonic pockets as well as pseudo-polyps and mucosal bridges can be seen in patients or sites with severe disease. Ulcerative colitis may be confined to the rectum or may involve the rectum and the entire colon. A thorough examination and examination, combined with colonoscopy along with biopsy and, if necessary, barium enema, CT, MRI, etc. often allow for a thorough diagnosis and evaluation of ulcerative colitis. The commonly used drugs for ulcerative colitis include 1. Aminosalicylates: such as salazosulfapyridine, mesalazine, dosage forms including oral preparations, anal suppositories, enemas, etc. Anal suppositories and enemas can be used for distant colitis, and oral preparations can be used in combination with anal suppositories and enemas for those with more extensive lesions. The aminosalicylic acid class is used for some mild patients with good results, for moderate to severe patients alone is often not effective. 2, glucocorticoids: such as hydrocortisone, prednisone, etc., used to induce remission in patients with moderate to severe disease, but the use of glucocorticoids before surgery will significantly increase the risk of surgical complications. 3.Immunosuppressants: commonly used such as azathioprine, raglan polysaccharide, etc. These drugs may have the toxicity of bone marrow suppression, with side effects such as leukopenia and anemia. 4, biological agents: commonly used in China is infliximab, which has a better therapeutic effect on patients who are ineffective with the above drugs, but is expensive. Follow-up visits should be conducted frequently during drug therapy in order to observe the efficacy, assess side effects, and adjust drug therapy if necessary. The timing of surgery for ulcerative colitis Currently, the rate of surgery for patients with ulcerative colitis is over 30%, and the timing of surgery has a great impact on patient safety and treatment outcomes. Traditionally ulcerative colitis patients are operated when there is hemorrhage, intestinal perforation, toxic megacolon, carcinoma or suspected carcinoma, which is the absolute indication for surgery in ulcerative colitis patients. However, such patients often undergo emergency surgery when medical treatment fails and life-threatening complications arise, and a Danish cohort study showed a high complication rate of such emergency surgery with a mortality rate of even more than 5%! The reasons for this include the following: First, the disease activity causes the patient’s intestine and the whole body to be in a state of inflammatory activation, making the intestine and other tissues of the body edematous, with changes in vascular permeability and abnormal protein synthesis in the organism. The incidence of local and occurrence of both anastomosis and abdominal cavity or systemic complications such as sepsis and shock are significantly increased at this time; secondly, the intestinal symptoms of patients with ulcerative colitis affect digestion and absorption for a long time, and diarrhea and fever lead to increased consumption, resulting in malnutrition in patients with ulcerative colitis. This not only hinders wound healing and increases the incidence of incisional infections, fissures, hernias and anastomotic fistulas, but also increases the likelihood of lung infections due to decreased immune function and reduced skeletal muscle, prolonged bed rest and weak coughing after surgery, while emergency surgery is often not possible to improve the nutritional status before surgery; third, inappropriate use of glucocorticoids, immune preparations, infliximab, etc. Glucocorticoids affect protein synthesis, immune preparations and infliximab affect incision healing, and theoretically, the use of the above drugs should have a certain time interval with surgery, while emergency surgery after failed medical treatment often has a short time interval with drug therapy or is even in the middle of the drug course, making it difficult to avoid some complications. To reduce the impact of the above on patients, a more appropriate timing of surgery should be chosen: first, gastrointestinal surgeons experienced in the treatment of ulcerative colitis should participate in the comprehensive treatment of patients as early as possible, communicate effectively with physicians and patients in a timely manner, participate in the development of treatment plans, and identify patients who need surgery as early as possible. Second, it is important to actively intervene in combined infections, malnutrition, internal environmental disorders and other abnormalities during the treatment of ulcerative colitis. This not only relates to the effectiveness of medical therapy, but also reduces the occurrence of adverse outcomes when surgery is required. Third, in cases such as extensive lesions, active phase, and acute severe ulcerative colitis, it is important to promptly identify patients who are not responding well to medical therapy or who are drug dependent. Blindly prolonging the duration of drug therapy not only does not help remission and delay surgery, but also drugs such as glucocorticoids themselves have adverse effects on surgical outcomes. For patients with poor drug therapy or drug dependence, surgeons should be courageous and aggressive in surgery, and pay attention to the necessary comprehensive treatment measures in the perioperative period to ensure patient safety. In general, for patients with life-threatening complications such as hemorrhage and intestinal perforation, timely emergency surgery should be performed; for toxic megacolon, acute severe ulcerative colitis, and ineffective drug therapy in the active phase, patients with poor response to drug therapy should be promptly identified and actively operated after short-term correction of internal environmental disorders and other conditions; for patients with more extensive lesions especially combined with drug dependence and easy recurrence, as well as combined For patients with extensive lesions, especially those with drug dependence and recurrence, as well as those with cancerous lesions and suspected cancerous lesions, surgery should be performed at a time when the disease is more stable and after adequate preparation through nutritional support and other transitional treatments. For elective surgery with adequate preparation, the aforementioned Danish study compared its mortality rate to less than 1%. The surgical approach to ulcerative colitis The lesion of ulcerative colitis extends upward from the rectum, and the majority of patients involve only the colorectum. According to its characteristics, the disease can be cured by removing the entire colorectum, which is the theoretical basis for surgical treatment of ulcerative colitis. However, after resection of the colorectum, its function of absorbing water and storing feces is still lost, and if the small intestine and anal canal anastomosis is performed directly, more serious watery diarrhea will occur after surgery, which not only affects the healing of the anastomosis, but also has a greater negative impact on the long-term quality of life of the patient. It should be noted that diarrhea after colorectal resection is fundamentally different from that of ulcerative colitis: the former is caused by the loss of water absorption and stool storage function of the colorectum, resulting in watery stools, which mainly affect the loss of water and electrolytes and inconvenience of life; while the latter is caused by inflammation and mucosal destruction of the colorectum, and its mucopurulent stools not only lead to the loss of protein, blood and other important components, but also It can lead to fever, systemic inflammatory reaction, etc. To alleviate postoperative diarrhea, the current standard procedure for the treatment of ulcerative colitis is colorectal resection with ileal pouch anastomosis. In this procedure, after removing the entire large intestine, a J-shaped pouch is constructed from the terminal ileum, and then the pouch is anastomosed to the anal canal. After a certain period of postoperative recovery, the ileum can compensate for the increased absorption of water, and the J-shaped pouch can partially replace the stool storage and control ability of the rectum, which can greatly improve the postoperative recovery and quality of life. In this procedure, a protective temporary stoma is routinely made in the ileum proximal to the anastomosis in the early stage of application, and a second surgery is performed to restore the stoma after the pouch and anastomosis have healed, which reduces the risk of early postoperative anastomotic fistula, but the patient has to suffer from a second surgery. In our experience, a protective stoma is necessary for patients undergoing emergency surgery, active disease, and short intervals between medical medications; for patients undergoing elective surgery in remission or with corrected malnutrition, a protective stoma may not be performed.