Garg Pankaj
Garg Fistula Research Institute, Panchkula, India.
Indus International Hospital, Mohali, India.
Ann Med Surg (Lond). 2020 Sep 19;59:122-126. doi: 10.1016/j.amsu.2020.09.022. eCollection 2020 Nov.
AIM/BACKGROUND: The commonly used fistula-in-ano classifications, Park or St. James's University hospital(SJUH), neither grade fistulas as per their severity nor guide regarding their management. A new classification(NC), published in 2017, proposed to classify fistulas as per their severity and also guided in its management. The early grades (NC grade I & II) were simple fistulas and were amenable to fistulotomy whereas higher grades (NC grade III-V) were complex fistulas and were not amenable to fistulotomy.
Lower grades of all the three classifications were classified as simple (Parks: I, SJUH:I-II, NC:I-II) whereas higher grades were classified as complex (Parks: II-IV, SJUH: III-V, NC: III-V) fistulas. Fistulotomy should be possible in simple fistulas but not in complex fistulas. This was analysed for all these classifications. The long-term follow-up of continence was done by an objective scoring system (Vaizey's scores).
The SJUH & Parks classifications categorized 504/828 fistulas as 'complex' which was quite inaccurate as 42.7%(215/504) of these fistulas were safely amenable to fistulotomy. On the other hand, the New classification (NC) classified 282/828 fistulas as 'complex' which was very accurate as 99% (279/282) of these were actually complex and were not amenable to fistulotomy. The change in the preoperative and the postoperative continence scores in the patients who underwent fistulotomy, as per these classifications, Parks & SJUH vs NC, was 0.064 ± 0.62 and 0.089 ± 0.85 respectively and was not significantly different(p = 0.80, Mann-Whitney test).
The New classification(NC) seems better than the existing classifications for grading the disease as well as in guiding the management of the disease.
目的/背景：常用的肛瘘分类法，如帕克（Park）分类法或圣詹姆斯大学医院（SJUH）分类法，既没有根据肛瘘的严重程度进行分级，也没有在其治疗方面提供指导。2017年公布的一种新分类法（NC），提议根据肛瘘的严重程度进行分类，并在其治疗方面提供指导。早期分级（NC I级和II级）为简单肛瘘，适合进行瘘管切开术，而较高分级（NC III - V级）为复杂肛瘘，不适合进行瘘管切开术。
将所有三种分类法中的较低分级归类为简单肛瘘（帕克分类法：I级；SJUH分类法：I - II级；NC分类法：I - II级），而较高分级归类为复杂肛瘘（帕克分类法：II - IV级；SJUH分类法：III - V级；NC分类法：III - V级）。简单肛瘘应可行瘘管切开术，而复杂肛瘘则不行。对所有这些分类法进行了分析。通过客观评分系统（韦齐（Vaizey）评分）对控便情况进行长期随访。
SJUH分类法和帕克分类法将828例肛瘘中的504例归类为“复杂”，这相当不准确，因为这些肛瘘中有42.7%（215/504）可安全地进行瘘管切开术。另一方面，新分类法（NC）将828例肛瘘中的282例归类为“复杂”，这非常准确，因为其中99%（279/282）实际上是复杂肛瘘，不适合进行瘘管切开术。根据这些分类法，接受瘘管切开术的患者术前和术后控便评分的变化，帕克分类法和SJUH分类法与NC分类法相比，分别为0.064 ± 0.62和0.089 ± 0.85，差异无统计学意义（p = 0.80，曼 - 惠特尼检验）。
新分类法（NC）在疾病分级以及指导疾病治疗方面似乎优于现有分类法。
