会阴瘘型克罗恩病（CD）是克罗恩病的严重表型，与严重的发病率和生活质量降低相关。会阴瘘型克罗恩病的发生与遗传易感性、免疫调节失调、肠道菌群失调以及多种未知的生理和机械因素之间的复杂相互作用有关。因此，需要多学科协作来进行最佳管理。详细的解剖描述和会阴瘘分类，包括全面的临床、内镜和放射学的诊断工作，是治疗的重要先决条件。对于简单的会阴瘘，使用抗生素和免疫调节剂，可选择行瘘切除术或不行瘘切除术，都是适当的措施。另一方面，复杂会阴瘘的药物治疗需要在充分控制感染之后才能开始使用免疫调节剂进行治疗。在活动性复杂会阴瘘中，抗肿瘤坏死因子仍然是最常用的治疗方法，抗生素或免疫调节剂的联合使用增强了疗效。对于对抗肿瘤坏死因子无效的患者，正在评估使用抗整合素、抗白介素和小分子进行治疗。间充质干细胞、高压氧疗法和独家肠外营养也作为辅助治疗方法进行了研究。尽管医疗防护装备得到了拓展，但仍有很大一部分患者需要手术干预。在本综述中，我们提供了关于会阴瘘型克罗恩病的病理生理学、临床表现、诊断和药物治疗的最新概述。还提供了会阴瘘型克罗恩病手术治疗的简要概述。© 2023年作者。由牛津大学出版物代表克罗恩病与结肠炎基金会出版。版权所有。如需权限，请发送电子邮件至：journals.permissions@oup.com。

Perianal fistulizing Crohn's disease (CD) represents a severe phenotype of CD that is associated with significant morbidity and reduction in quality of life. Perianal fistulizing CD is caused by a complex interplay of genetic predisposition, immune dysregulation, gut dysbiosis, and various unknown physiological and mechanical factors. A multidisciplinary approach is hence required for optimal management . A detailed anatomical description and classification of perianal fistula, including comprehensive clinical, endoscopic, and radiological diagnostic workup, is an important prerequisite to treatment. For simple perianal fistulas, use of antibiotics and immunomodulators, with or without fistulotomy, are appropriate measures. The medical management of complex perianal fistula, on the other hand, requires adequate control of infection before initiation of therapy with immunomodulators. In active complex perianal fistula, anti-tumor necrosis factors remain the most accepted therapy, with concomitant use of antibiotics or immunomodulators enhancing the efficacy. For patients refractory to anti-tumor necrosis factors, treatment with anti-integrins, anti-interleukins, and small molecules is being evaluated. Mesenchymal stem cells, hyperbaric oxygen therapy, and exclusive enteral nutrition have also been investigated as adjunct therapies. Despite the expansion of the medical armamentarium, a large proportion of the patients require surgical interventions. In this review, we provide an up-to-date overview of the pathophysiology, clinical presentation, diagnosis, and medical management of perianal fistulizing CD. A brief overview of the surgical management of perianal fistulizing CD is also provided.© The Author(s) 2023. Published by Oxford University Press on behalf of Crohn’s & Colitis Foundation. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.