Scott N A, Nair A, Hughes L E
University Department of Surgery, University of Wales College of Medicine, Heath Park, Cardiff, UK.
Br J Surg. 1992 Dec;79(12):1379-80. doi: 10.1002/bjs.1800791247.
Between 1971 and 1991, details of 67 women with perianal Crohn's disease were recorded prospectively using the Cardiff classification. Two groups were identified according to the presence (n = 29) or absence (n = 38) of anorectal Crohn's fistula involving the vagina. Patients in both groups were of a similar age and had had Crohn's disease for a similar period before diagnosis of perianal involvement. The incidence of associated perianal lesions, superficial ulcers, cavitating ulcers, other fistulas and strictures was not significantly different between the two groups. A greater proportion of patients with anorectal-vaginal fistulation (n = 15) had distal intestinal Crohn's disease (rectal or contiguous colorectal) compared with women with no vaginal fistulation (n = 14). A range of therapies was used to manage women with perianal Crohn's disease, from local surgery to a defunctioning stoma and/or proctectomy. Only 13 of 38 women with perianal Crohn's disease but no vaginal fistula required a defunctioning stoma or proctectomy, whereas 18 of 29 with anorectal-vaginal fistulation underwent these procedures (P < 0.05). A vaginal fistula has a considerable adverse effect on the outcome of perianal Crohn's disease.
1971年至1991年期间，采用加的夫分类法前瞻性记录了67例肛周克罗恩病女性患者的详细情况。根据是否存在累及阴道的肛门直肠克罗恩瘘管，将患者分为两组，其中存在瘘管的有29例，不存在瘘管的有38例。两组患者年龄相仿，在诊断肛周受累之前患克罗恩病的时间也相近。两组患者相关肛周病变、浅表溃疡、空泡性溃疡、其他瘘管和狭窄的发生率无显著差异。与无阴道瘘管的女性（n = 14）相比，有肛门直肠-阴道瘘管的患者（n = 15）中远端肠道克罗恩病（直肠或相邻结直肠）的比例更高。从局部手术到造口减压术和/或直肠切除术，一系列治疗方法被用于治疗肛周克罗恩病女性患者。38例无阴道瘘管的肛周克罗恩病女性患者中，只有13例需要造口减压术或直肠切除术，而29例有肛门直肠-阴道瘘管的患者中有18例接受了这些手术（P < 0.05）。阴道瘘管对肛周克罗恩病的治疗结果有相当大的不良影响。
