METHODS: An international group of perianal clinicians participated in an expert consensus to define how the TOpClass system can be incorporated into real-life practice. This included gastroenterologists, inflammatory bowel disease surgeons, and radiologists specialized in PFCD. The process was informed by the multi-disciplinary team management of 8 high-volume fistula centres in North America, Europe, and Australia.
RESULTS: The process produced position statements to accompany the classification system and guide PFCD management. The statements range from the management of patients with quiescent perianal disease to those with severe PFCD requiring diverting-ostomy and/or proctectomy. The optimization of medical therapies, as well as the use of surgery, in fistula closure and symptom management is explored across each classification group.
CONCLUSIONS: This article provides an overview of the system\'s use in clinical practice. It aims to enable clinicians to have a pragmatic and patient goal-centered approach to medical and surgical management options for individual patients with PFCD.
方法:一组国际肛周临床医生参与了一项专家共识,以确定如何将TOpClass系统纳入现实生活中。这包括胃肠病学家,IBD外科医生,和专门从事PFCD的放射科医生。北美八个高容量瘘管病中心的多学科团队管理为这一过程提供了信息,欧洲,和澳大利亚。
结果:该过程产生了职位陈述,以伴随分类系统并指导PFCD管理。陈述范围从静止的肛周疾病患者的管理到需要分流造口术和/或前切除术的严重PFCD患者。医学疗法的优化,以及手术的使用,在瘘管闭合和症状管理方面,我们对每个分类组进行了探讨.
结论:本文概述了该系统在临床实践中的应用。它的目的是使临床医生有一个务实的和患者目标为中心的方法,以医疗和外科管理选择PFCD的个体患者。