Hepatobiliary manifestations following two-stages elective laparoscopic restorative proctocolectomy for patients with ulcerative colitis:A prospective observational study

BACKGROUND Hepatobiliary manifestations occur in ulcerative colitis(UC)patients.The effect of laparoscopic restorative proctocolectomy(LRP)with ileal pouch anal anastomosis(IPAA)on hepatobiliary manifestations is debated.AIM To evaluate hepatobiliary changes after two-stages elective laparoscopic restorative proctocolectomy for patients with UC.METHODS Between June 2013 and June 2018,167 patients with hepatobiliary symptoms underwent two-stage elective LRP for UC in a prospective observational study.Patients with UC and having at least one hepatobiliary manifestation who underwent LRP with IPAA were included in the study.The patients were followed up for four years to assess the outcomes of hepatobiliary manifestations.RESULTS The patients'mean age was 36±8 years,and males predominated(67.1%).The most common hepatobiliary diagnostic method was liver biopsy(85.6%),followed by Magnetic resonance cholangiopancreatography(63.5%),Antineutrophil cytoplasmic antibodies(62.5%),abdominal ultrasonography(35.9%),and Endoscopic retrograde cholangiopancreatography(6%).The most common hepatobiliary symptom was Primary sclerosing cholangitis(PSC)(62.3%),followed by fatty liver(16.8%)and gallbladder stone(10.2%).66.4%of patients showed a stable course after surgery.Progressive or regressive courses occurred in 16.8%of each.Mortality was 6%,and recurrence or progression of symptoms required surgery for 15%.Most PSC patients(87.5%)had a stable course,and only 12.5%became worse.Two-thirds(64.3%)of fatty liver patients showed a regressive course,while one-third(35.7%)showed a stable course.Survival rates were 98.8%,97%,95.8%,and 94%at 12 mo,24 mo,36 mo,and at the end of the follow-up.CONCLUSION In patients with UC who had LRP,there is a positive impact on hepatobiliary disease.It caused an improvement in PSC and fatty liver disease.The most prevalent unchanged course was PSC,while the most common improvement was fatty liver disease.

Laparoscopic restorative proctocolectomy with ileal pouch-anal anastomosis for Peutz-Jeghers syndrome with synchronous rectal cancer

We report on a patient diagnosed with PeutzJeghers syndrome(PJS) with synchronous rectal cancer who was treated with laparoscopic restorative proctocolectomy with ileal pouch-anal anastomosis(IPAA). PJS is an autosomal dominant syndrome characterized by multiple hamartomatous polyps in the gastrointestinal tract, mucocutaneous pigmentation, and increased risks of gastrointestinal and nongastrointestinal cancer. This report presents a patient with a 20-year history of intermittent bloody stool, mucocutaneous pigmentation and a family history of PJS, which together led to a diagnosis of PJS. Moreover, colonoscopy and biopsy revealed the presence of multiple serried giant pedunculated polyps and rectal adenocarcinoma. Currently, few options exist for the therapeutic management of PJS with synchronous rectal cancer. For this case, we adopted an unconventional surgical strategy and ultimately performed laparoscopic restorative proctocolectomy with IPAA. This procedure is widely considered to be the first-line treatment option for patients with ulcerative colitis or familial adenomatous polyposis. However, there are no previous reports of treating PJS patients with laparoscopic IPAA. Since the operation, the patient has experienced no further episodes of gastrointestinal bleeding and has demonstrated satisfactory bowel control. Laparoscopic restorative proctocolectomy with IPAA may be a safe and effective treatment for patients with PJS with synchronous rectal cancer.

Cumulative incidence and risk factors for pouch adenomas associated with familial adenomatous polyposis following restorative proctocolectomy

BACKGROUND The emergence of restorative total proctocolectomy has significantly reduced the lifetime colorectal cancer risk associated with familial adenomatous polyposis(FAP).However,adenomas may develop in the ileal pouch over time and may even progress to carcinoma.We evaluated the cumulative incidence,time to development,and risk factors associated with ileal pouch adenoma.AIM To evaluate the cumulative incidence,time to development,and risk factors associated with pouch adenoma.METHODS In this retrospective,observational study conducted at a tertiary center,95 patients with FAP who underwent restorative proctocolectomy at our center between 1989 and 2018 were consecutively included.The mean follow-up period was 88 mo.RESULTS Pouch adenomas were found in 24(25.3%)patients,with a median time of 52 mo to their first formation.Tubular adenomas were detected in most patients(95.9%).There were no high-grade dysplasia or malignancies.Of the 24 patients with pouch adenomas,13 had all detected adenomas removed.Among the 13 patients who underwent complete adenoma removal,four(38.5%)developed recurrence.Among 11(45.8%)patients with numerous polyps within the pouch,seven(63.6%)exhibited progression of pouch adenoma.The cumulative risks of pouch adenoma development at 5,10,and 15 years after pouch surgery were 15.2%,29.6%,and 44.1%,respectively.Severe colorectal polyposis(with more than 1000 polyps)was a significant risk factor for pouch adenoma development(hazard ratio,2.49;95% confidence interval:1.04-5.96;P=0.041).CONCLUSION Pouch adenomas occur at a fairly high rate in association with FAP after restorative proctocolectomy,and a high colorectal polyp count is associated with pouch adenoma development.

Postoperative changes of manometry after restorative proctocolectomy in Korean ulcerative colitis patients

AIM To investigate the changes of postoperative anal sphincter function and bowel frequency in Korean patients with ulcerative colitis(UC).METHODS A total of 127 patients with UC who underwent restorative proctocolectomy(RPC) during 20 years were retrospectively analyzed. The parameters of anal manometry and bowel frequency were compared according to the 6-mo intervals until 24 mo postoperatively. Manometry was used to measure the maximal squeezing pressure(MSP) and maximal resting pressure(MRP).RESULTS MSP decreased after surgery until 6 mo(157 to 142 mm Hg); thereafter, it improved and was recovered to and maintained at the preoperative value at 12 mo postoperatively(142-170 mm Hg, P < 0.001). Although the decreased MRP(65 to 56 mm Hg) improved after 18 mo(62 mm Hg), it did not completely recover to the preoperative value. The decreased rectal capacity after surgery(90 to 82 m L) gradually increased up to 150 m L at 24 mo. Although bowel frequency showed significant gradual decreases at each interval, it was stabilized after 12 mo postoperatively(6.5 times/d).CONCLUSION Postoperative changes of manometry and bowel frequency after restorative proctocolectomy in Korean patients with UC were not different from those in Western patients with UC.

Pouchitis and pre-pouch ileitis developed after restorative proctocolectomy for ulcerative colitis:A case report

We report a case of pouchitis and pre-pouch ileitis, and inflammation in the neo-terminal ileum proximal to the pouch, developed after restorative proctocolectomy for ulcerative colitis. A 35-year old female presented with fever and abdominal pain five weeks after ileostomy closure following proctocolectomy. Computed tomography showed collection of feces in the pouch and proximal ileum. A drainage tube was placed in the pouch perianally, and purulent feces were discharged. With antibiotic treatment, her symptoms disappeared, but two weeks later, she repeatedly developed fever and abdominal pain along with anal bleeding. Pouchscopy showed mucosal inflammation in both the pouch and the pre-pouch ileum. The mucosal cytokine production was elevated in the pouch and pre-pouch ileum. With antibiotic and corticosteroid therapy, her symptoms were improved along with improvement of endoscopic inflammation and decrease of mucosal cytokine production. The fecal stasis with bacterial overgrowth is the major pathogenesis of pouchitis and pre-pouch ileitis in our case.

Role of ileostomy in restorative proctocolectomy

Restorative proctocolectomy(RP) is the treatment of choice in patients affected with refractory ulcerative colitis or familial adenomatous polyposis.Surgery in elective settings is often performed in 2 stages,fashioning an ileostomy which is closed 2-3-mo later.It is still debated whether omitting ileostomy could offer advantages in the management of patients undergoing RP.

Risk factors for postoperative stoma outlet obstruction in ulcerativecolitis

BACKGROUND Current medical treatments can achieve remission of ulcerative colitis (UC).Surgery is required when potent drug treatment is ineffective or when coloncancer or high-grade dysplasia develops. The standard procedure is restorativeproctocolectomy (RPC) with ileal pouch-anal anastomosis, commonly performedas two- or three-stage RPC with diverting ileostomy. Postoperative stoma outletobstruction (SOO) is frequent, but the causes are not well known.AIM To identify the risk factors for SOO after stoma surgery in patients with UC.METHODS We retrospectively reviewed the files of 148 consecutive UC patients whounderwent surgery with stoma construction. SOO was defined as small bowelobstruction symptoms and intestinal dilatation just below the penetrating part ofthe stoma on computed tomography. Patients were divided into two groups:Those who developed SOO within 30 d after surgery and those who did not.Patient characteristics, intraoperative parameters, the stoma site, and rectusabdominis muscle thickness were collected. Moreover, we identified the patientswho repeatedly developed SOO. Univariate and multivariate analyses wereperformed to identify risk factors for SOO and recurring SOO.RESULTS Eighty-nine patients who underwent two-stage RPC were included betweenJanuary 2008 and March 2020. Postoperatively, SOO occurred in 25 (16.9%)patients after a median time of 9 d (range 2-26). Compared to patients withoutSOO, patients with SOO had a significantly higher rate of malignant tumors ordysplasia (36.0% vs 17.1%, P = 0.032), lower total glucocorticoid dose one monthbefore surgery (0 mg vs 0 mg, P = 0.026), higher preoperative total protein level(6.8 g/dL vs 6.3 g/dL, P = 0.048), higher rate of loop ileostomy (88.0% vs 55.3%, P= 0.002), and higher maximum stoma drainage volume (2300 mL vs 1690 mL, P =0.004). Loop ileostomy (OR = 6.361;95%CI 1.322–30.611;P = 0.021) and maximumstoma drainage volume (OR = 1.000;95%CI 1.000–1.001;P = 0.015) wereconfirmed as independent risk factors for SOO. Eighteen patients with SOO weretreated conservatively without recurrence (sSOO group). Seven (28.0%) patientsrepeatedly developed SOO (rSOO group) during the observation period. Asignificant difference was observed in the rectus abdominis muscle thicknessbetween the two groups (sSOO 9.3 mm, rSOO 12.7 mm, P = 0.006). Musclethickness was confirmed as an independent risk factor for recurring SOO (OR =2.676;95%CI 1.176-4.300;P = 0.008).CONCLUSION In this study, high maximum stoma drainage volume and loop ileostomy areindependent risk factors for SOO. Additionally, among patients with a thickrectus abdominis muscle, the risk of SOO recurrence is high.

Anal transition zone in the surgical management of ulcerative colitis

Preservation of the anal transition zone has long been a significant source of controversy in the surgical management of ulcerative colitis.The two techniques for restorative proctocolectomy and ileal pouch anal anastomosis(RPC IPAA) in common practice are a stapled anastomosis and a handsewn anastomosis;these techniques differ in the amount of remaining rectal mucosa and therefore the presence of the anal transition zone following surgery.Each technique has advantages and disadvantages in long-term functional outcomes,operative and postoperative complications,and risk of neoplasia.Therefore,we propose a selective approach to performing a stapled RPC IPAA based on the presence of dysplasia in the preoperative endoscopic evaluation.

Surgical treatment of ulcerative colitis in the biologic therapy era

Recently introduced in the treatment algorithms and guidelines for the treatment of ulcerative colitis,biological therapy is an effective treatment option for patients with an acute severe flare not responsive to conventional treatments and for patients with steroid dependent disease.The reduction in hospitalization and surgical intervention for patients affected by ulcerative colitis after the introduction of biologic treatment remains to be proven.Furthermore,these agents seem to be associated with increase in cost of treatment and risk for serious postoperative complications.Restorative proctocolectomy with ileal pouch-anal anastomosis is the surgical treatment of choice in ulcerative colitis patients.Surgery is traditionally recommended as salvage therapy when medical management fails,and,despite advances in medical therapy,colectomy rates remain unchanged between 20% and 30%.To overcome the reported increase in postoperative complications in patients on biologic therapies,several surgical strategies have been developed to maintain long-term pouch failure rate around 10%,as previously reported.Surgical staging along with the development of minimally invasive surgery are among the most promising advances in this field.

高龄低位直肠癌的外科治疗68例报告

目的分析高龄低位直肠癌临床特点、外科治疗方式及围手术期处理。方法回顾性分析75岁以上行手术治疗的68例低位直肠癌患者的临床资料。结果全组病例入院前误诊率高(47.1%),并存病多(67.6%),肿瘤切除率高(94.1%),术后并发症发生率高(42.7%)。结论早期诊断治疗,积极处理并存病,恰当的手术方式,充分的围手术期处理,对于减少手术风险、获得长期存活率、提高术后生活质量极为重要。

超声引导腹横肌平面阻滞在直肠癌加速康复外科手术中的应用

目的观察超声引导腹横肌平面(TAP)阻滞联合静脉自控镇痛对腹腔镜直肠癌术后镇痛及患者恢复情况的影响,探讨其在直肠癌加速康复外科手术中的临床意义。方法择期行腹腔镜直肠癌手术患者60例,性别不限,ASAⅠ或Ⅱ级,年龄30~65岁,体质量45~90 kg,采用随机数字表法均分为两组(n=30):A组:全身麻醉后切皮前超声引导0.375%罗哌卡因行双侧腹横肌平面阻滞,每侧20 m L,术毕行静脉自控镇痛;B组:全身麻醉后切皮前不做任何躯干神经阻滞处理,术毕行静脉自控镇痛。观察并记录患者术后1 h(T0)、4 h(T1)、8 h(T2)、12 h(T3)、24 h(T4)、48 h(T5)时疼痛视觉模拟评分(VAS),第1次使用补救性非甾体类镇痛药时间和术后患者满意度,及患者胃肠道恢复时间、下床活动时间、该阻滞部位腹腔内脏器损伤、穿刺部位感染、血肿等并发症的发生情况。结果两组患者年龄、性别、体质量、ASA分级及手术时间比较无统计学意义。与B组比较,T0~T4时A组疼痛VAS评分明显降低(P<0.05);A组患者术后第1次使用补救性非甾体类镇痛药时间[(11.7±1.3)h]较B组[(4.3±1.2)h]明显延长(P<0.05);A组术后满意度(93.3%)比B组(70.0%)显著提高(P<0.05);两组患者术后胃肠功能恢复时间和下床活动时间差异均无统计学意义;A组无一例患者出现阻滞部位腹腔内脏器损伤、穿刺部位感染及血肿等并发症。结论超声引导腹横肌平面阻滞联合静脉自控镇痛基本能满足腹腔镜直肠癌术后镇痛的需要,减少术后镇痛药物使用。

Ileal-anal pouches: A review of its history, indications, and complications

The ileal pouch anal anastomosis(IPAA)has revolutionised the surgical management of ulcerative colitis(UC)and familial adenomatous polyposis(FAP).Despite refinement in surgical technique(s)and patient selection,IPAA can be associated with significant morbidity.As the IPAA celebrated its 40th anniversary in 2018,this review provides a timely outline of its history,indications,and complications.IPAA has undergone significant modification since 1978.For both UC and FAP,IPAA surgery aims to definitively cure disease and prevent malignant degeneration,while providing adequate continence and avoiding a permanent stoma.The majority of patients experience long-term success,but“early”and“late”complications are recognised.Pelvic sepsis is a common early complication with far-reaching consequences of long-term pouch dysfunction,but prompt intervention(either radiological or surgical)reduces the risk of pouch failure.Even in the absence of sepsis,pouch dysfunction is a longterm complication that may have a myriad of causes.Pouchitis is a common cause that remains incompletely understood and difficult to manage at times.10%of patients succumb to the diagnosis of pouch failure,which is traditionally associated with the need for pouch excision.This review provides a timely outline of the history,indications,and complications associated with IPAA.Patient selection remains key,and contraindications exist for this surgery.A structured management plan is vital to the successful management of complications following pouch surgery.

经尾路巨直肠及乙状结肠切除术在治疗肛门成形术后顽固性便秘中的应用

目的 探讨 经尾路行巨直肠及乙状结肠切除术治疗肛门成形术后顽固性便秘的可行性。 方法 患儿6例,年龄2～18岁,均为先天性肛门闭锁行会阴肛门成形术后合并顽固性便秘和充盈性大便失禁。钡灌肠示:直肠及乙状结肠高度扩张,蠕动差。6例患儿均经尾路切除直肠及远端乙状结肠,同时行肛门成形术。 结果 平均手术时间205 min(125min～265min),切除扩张肠管长度23.3cm(10cm～40cm)。术后2月～4月后,6例患儿均可控制排便:12月～30月随访结果示:患儿便秘均消失。6例中4例患1度污便,另2例2度污便,无其他术后并发症。结论 尾路切除巨直肠及乙状结肠是治疗无肛术后顽固性便秘的有效方法。

保护性造口在直肠癌低位前切除术中价值的前瞻性随机对照研究

目的前瞻性评价保护性造口在直肠癌低位前切除术中的价值。方法选择2006年10月～2011年10月间在我院接受择期开腹根治性低位前切除术,并符合入选标准的100例中下段直肠癌患者,随机分为三组:A组33例在完成结直肠吻合后行经升结肠回肠置管造口术;B组35例行横结肠或末段回肠袢式造口术;C组32例不行保护性造口术。观察吻合口漏的发生率以及造口相关的并发症。结果 100例患者术后发生吻合口漏5例,总的吻合口漏发生率为5.0%。A、B、C组的吻合口漏发生率分别为6.1%(2/33)、5.7%(2/35)和3.1%(1/32),组间比较无统计学差异(P=0.838,P>0.05)。68例行保护性造口患者(A+B组)和32例不行保护性造口患者(C组)术后吻合口漏的发生率分别为5.9%(4/68)和3.1%(1/32),无统计学差异(P=0.922,P>0.05)。4例(A、B组)有保护性造口发生吻合口漏的患者症状较轻,而1例(C组)无保护性造口发生吻合口漏患者的症状较重。A组中仅2例在拔除回肠置管后发生腹壁瘘口短暂的溢肠内容物现象,经换药后很快愈合。而B组中肠造口并发症的发生率为25.7%(9/35),后期造口还纳术并发症的发生率为22.9%(8/35)。结论保护性造口不能降低直肠癌低位前切除术后吻合口漏的发生,但能减轻吻合口漏发生后的症状。传统的保护性横结肠或末段回肠袢式造口术造口相关的并发症发生率较高。对具有吻合口漏高危因素患者,经升结肠回肠置管造口术是一种理想的可供选择的方法。

Risk of ileal pouch neoplasms in patients with familial adenomatous polyposis

Restorative proctocolectomy is the most common surgical option for patients with familial adenomatous polyposis(FAP). However,adenomas may develop in the ileal pouch mucosa over time,and even carcinoma in the pouch has been reported. We therefore reviewed the prevalence,nature,and treatment of adenomas and carcinoma that develop after proctocolectomy in the ileal pouch mucosa in patients with FAP. In 25 reports that were reviewed,the incidence of adenomas in the ileal pouch varied from 6.7% to 73.9%. Several potential factors that favor the development of pouch polyposis have been investigated,but many remain controversial. Nevertheless,it seems certain that the age of the pouch is important. The risk appears to be 7%to 16% after 5 years,35% to 42% after 10 years,and75% after 15 years. On the other hand,only 21 cases of ileal pouch carcinoma have been recorded in the literature to date. The diagnosis of pouch carcinoma was made between 3 to 20 years(median,10 years) after pouch construction. Although the risk of malignant transformation in ileal pouches is probably low,it is not negligible,and the long-term risk cannot presently be well quantified. Regular endoscopic surveillance,especially using chromoendoscopy,is recommended.

加速康复外科理论对保留左结肠动脉直肠癌根治术老年病人的干预效果研究

目的探讨加速康复外科理论对老年保留左结肠动脉(LCA)直肠癌根治术病人的干预效果。方法将亳州市人民医院2017年3月至2019年2月行保留LCA腹腔镜直肠癌Dixon根治术治疗的104例老年病人作为研究对象,并按照入院顺序排号,由随机数字表获得随机数,对随机数进行升序排列,从排序后的随机数中规定前52个对应的编号为对照组,其余的52个随机数对应的编号为干预组。对照组采取常规围术期护理,干预组则应用加速康复外科理论干预。对比两组手术相关指标、术后疼痛状况、炎性因子水平及并发症发生率。结果干预组进食时、排便时间、下床活动时间、住院时间分别为(1.24±0.49)d、(1.24±0.49)d、(1.06±0.35)d、(5.69±1.62)d,均较对照组的(3.18±0.55)d、(3.18±0.55)d、(2.84±0.67)d、(10.85±2.41)d少(P<0.05),两组间首次排气时间比较差异无统计学意义(P>0.05);干预组术后12 h、24 h、48 h疼痛数字评分法(NRS)评分分别为(2.56±0.42)分、(1.40±0.37)分、(1.18±0.31)分,均较对照组的(4.19±0.81)分、(3.66±0.75)分、(2.64±0.62)分低(P<0.05);两组术后C反应蛋白(CRP)、白细胞介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)水平均随着时间推移逐渐下降(P<0.05),干预组术后24 h、48 h IL-8水平分别为(36.14±7.25)pg/mL、(16.75±4.26)pg/mL,术后24 h、48 h TNF-α水平分别为(4.60±0.87)pg/mL、(2.01±0.52)pg/mL,术后24h CRP水平为(18.95±6.64)mg/L,均较对照组的(43.82±8.22)pg/mL、(25.51±6.38)pg/mL、(5.34±1.27)pg/mL、(3.96±0.85)pg/mL、(41.06±13.59)mg/L低(P<0.05);干预组术后并发症发生率9.62%低于对照组32.69%(P<0.05)。结论对老年保留LCA直肠癌根治术病人行加速康复外科理论,可明显减轻术后疼痛,显著降低术后炎症程度及并发症发生率,有效缩短术后恢复时间。

治疗重度痔的新方法—吻合器痔上黏膜环切术

目的探讨经肛门吻合器环形切除痔上黏膜(PPH)治疗重度痔的可行性及安全性。方法回顾性分析2003年1月至2005年5月安徽省立医院行PPH治疗的22例重度痔的临床资料。结果手术时间平均27min,术后下腹不适6例,尿潴留12例,肛门轻微疼痛7例,出血1例,术后平均住院3.2d,随访1～30月,无大便失禁、肛周感染、脓肿、吻合口狭窄等并发症。结论与传统手术相比,PPH具有疗程短、痛苦小、并发症少、安全可靠的优点。

TEM缝合技术关闭盆底腹膜在腹腔镜直肠癌腹会阴联合切除术中的应用

目的探讨经肛门内镜微创手术(transanal endoscopic microsurgery,TEM)缝合技术关闭盆底腹膜在腹腔镜直肠癌腹会阴联合切除术(abdominoperineal resection,APR)中应用的可行性和有效性。方法回顾性分析2010年9月～2012年7月间在我院接受择期腹腔镜APR手术的低位直肠癌患者32例。术中在完成淋巴结清扫及肿瘤切除后,借鉴TEM独特的腔内缝合技术,使用TEM持针钳,用可吸收线连续缝合关闭盆底腹膜,两端分别用Hemo-lock夹锁定。分析盆底腹膜缝合的成功率、会阴切口感染与肠梗阻的发生率。结果本组32例患者中29例术中成功关闭盆底腹膜,成功率为90.6%。缝合关闭盆底腹膜所用的时间平均为15(10～30)min。盆底腹膜缝合成功的29例患者,会阴切口感染和肠梗阻的发生率均为3.4%(1/29);而盆底腹膜缝合失败的3例患者,会阴切口感染和肠梗阻的发生率则均为33.3%(1/3)。结论腹腔镜直肠癌APR手术中关闭盆底腹膜是必要的,采用TEM腔内缝合技术关闭盆底腹膜是可行的、有效的。

结肠癌全结肠系膜切除术研究进展

从结肠的胚胎发育解剖学角度指导完整结肠系膜切除手术,可减少出血量和术中肿瘤播散,增加清扫淋巴结的数量,且不增加术后并发症发生率,可改善预后,降低局部复发率。结肠癌手术的规范化、科学化是发展的趋势,完整结肠系膜切除符合精细外科的要求在未来发展的方向,有可能成为一种新的规范化手术。为了解完整结肠系膜切除术在操作要点、适应证及其在腹腔镜下手术等研究进展,该研究收集国内外有关结肠癌完整结肠系膜切除的临床和基础研究文献进行综述。

试论合作式司法在中国刑事实践中的发展趋势

合作式刑事司法已逐渐成为一种不可忽视的世界潮流。无论从刑事历史发展的轨迹和趋势,还是从我国社会制度和思想根源来看,它都在我国现代刑事司法中体现出强大的生命力。重视本土现有优势资源,消除思想上的传统桎梏,理性把握合作限度,处理好与对抗制的关系,合作式司法在我国刑事司法改革与构建和谐社会这个大背景下必将发挥越来越重要的作用。