Diagnostic value and influencing factors of chylous test of pleural effusion after thoracic surgery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

NIU Lingli ¹ , QIU Li ² , YANG Maodan ² , DENG Qian ² , TIAN Conglin ² ,  WANG Wenping ¹

1. Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;
2. Department of Thoracic Surgery, Shangjin Nanfu Hospital, Shangjin Branch of West China Hospital, Chengdu, 611743, P.R.China;

Corresponding author：

WANG Wenping, Email: drwangwp@163.com

Keywords：

Pleural effusion; chylous test; thoracic surgery

DOI：

10.7507/1007-4848.202010099

Video：

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Objective To analyze the results and diagnostic value of postoperative chylous test of pleural effusion and to verify the clinicopathological factors affecting the results of chylous test.Methods The clinical data of 265 consecutive patients undergoing selective surgery at the Department of Thoracic Surgery, Shangjin Nanfu Hospital between May and August 2020 were retrospectively analyzed, including 106 males and 159 females with an average age of 53.0±12.2 years. According to the results of the chylous test on the operation day and postoperative first and second days, the patients were divided into two subgroups, including a positive group and a negative group, and the clinical data of the two groups were compared. Sensitivity and specificity of the chylous test were calculated. The influencing factors for chylous test were analyzed by multiple logistic regression analysis.Results The positive rate of chylous test was 91.7%, 95.8% and 87.9% on the operation day and postoperative first and second days, respectively. There was no statistical difference in age, sex, surgical type, surgical approach, surgical site, surgical time, degree of lymph node dissection, treatment of thoracic duct, 24 hours pleural fluid drainage or 24 hours protein and fat food intake between the positive group and the negative group (P>0.05). The diagnostic sensitivity and specificity of the chylous experiment were 100.0% and 4.0%, respectively. Multiple logistic regression analysis showed that the surgical site (left/right chest) might be an influencing factor for the results of the chylous test (P=0.043, OR=0.458, 95%CI 0.216-0.974).Conclusion The positive rate of chylous test of pleural effusion after thoracic surgery is very high. The chylous test produces a high misdiagnosis rate of chylothorax. The surgical site (left/right chest) may be an influencing factor for chylous test. The positive result of chylous test is not recommended as the direct diagnostic basis for postoperative chylothorax and guidance of the subsequent treatment.

Citation： NIU Lingli, QIU Li, YANG Maodan, DENG Qian, TIAN Conglin, WANG Wenping. Diagnostic value and influencing factors of chylous test of pleural effusion after thoracic surgery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(9): 1037-1043. doi: 10.7507/1007-4848.202010099 Copy

1.	Doerr CH, Miller DL, Ryu JH. Chylothorax. Semin Respir Crit Care Med, 2001, 22(6): 617-626.
2.	Soto-Martinez M, Massie J. Chylothorax: Diagnosis and management in children. Paediatr Respir Rev, 2009, 10(4): 199-207.
3.	Riley LE, Ataya A. Clinical approach and review of causes of a chylothorax. Respir Med, 2019, 157: 7-13.
4.	Wang H, Gao J, Zhang R, et al. Chyle test is not a valuable laboratory index in identifying chylothorax after pulmonary resection and lymph node dissection for primary non-small cell lung cancer. J Cancer Res Ther, 2019, 15(2): 324-328.
5.	杨月欣, 主编. 中国食物成分表标准版. 北京: 北京大学医学出版社, 2018. 122-138.
6.	Fujita T, Sato T, Sato K, et al. Clinical manifestation, risk factors and managements for postoperative chylothorax after thoracic esophagectomy. J Thorac Dis, 2019, 11(Suppl 3): S198-S201.
7.	Ohkura Y, Ueno M, Shindoh J, et al. Risk factors for postoperative chylothorax after radical subtotal esophagectomy. Ann Surg Oncol, 2018, 25(9): 2739-2746.
8.	赵峻, 张德超, 汪良骏, 等. 肺癌与食管癌术后乳糜胸的比较. 中华外科杂志, 2003, 41(1): 47-49.
9.	薛志强, 温佳新, 刘毅, 等. 肺癌切除术后乳糜胸的早期诊断和治疗. 中华肺部疾病杂志(电子版), 2017, 10(4): 395-397.
10.	Itkin M, Rabinowitz DA, Nadolski G, et al. Abnormal pulmonary lymphatic flow in patients with lymphatic anomalies and respiratory compromise. Chest, 2020, 158(2): 681-691.
11.	Petrella F, Casiraghi M, Radice D, et al. Treatment of chylothorax after lung resection: Indications, timing, and outcomes. Thorac Cardiovasc Surg, 2020, 68(6): 520-524.
12.	Chen C, Wang Z, Hao J, et al. Chylothorax after lung cancer surgery: A key factor influencing prognosis and quality of life. Ann Thorac Cardiovasc Surg, 2020, 26(6): 303-310.
13.	Takuwa T, Yoshida J, Ono S, et al. Low-fat diet management strategy for chylothorax after pulmonary resection and lymph node dissection for primary lung cancer. J Thorac Cardiovasc Surg, 2013, 146(3): 571-574.
14.	Schurink B, Mazza E, Ruurda JP, et al. Low-fat tube feeding after esophagectomy is associated with a lower incidence of chylothorax. Ann Thorac Surg, 2019, 108(1): 184-189.
15.	李捷, 孙玉鹗. 肺切除术后乳糜胸的诊断和治疗. 中华外科杂志, 2003, 41(9): 713.
16.	杜娜, 饶志勇, 车国卫, 等. 肺癌术后短期中链甘油三酯饮食临床效果的前瞻性随机研究. 中国肺癌杂志, 2016, 19(12): 821-826.
17.	刘金荣, 赵顺英, 沈文彬. 乳糜性胸腔积液诊断及处理. 中国实用儿科杂志, 2017, 32(3): 186-190.
18.	辛向兵, 贾建博, 卢强, 等. 46 例肺癌肺叶切除术后乳糜胸回顾性分析. 临床外科杂志, 2018, 26(7): 524-526.
19.	Zabeck H, Muley T, Dienemann H, et al. Management of chylothorax in adults: When is surgery indicated? Thorac Cardiovasc Surg, 2011, 59(4): 243-246.
20.	张国超, 赵格非, 高树庚, 等. 肺癌术后乳糜胸保守治疗与手术治疗的临床疗效比较. 癌症进展, 2018, 16(13): 1597-1600.

1. Doerr CH, Miller DL, Ryu JH. Chylothorax. Semin Respir Crit Care Med, 2001, 22(6): 617-626.
2. Soto-Martinez M, Massie J. Chylothorax: Diagnosis and management in children. Paediatr Respir Rev, 2009, 10(4): 199-207.
3. Riley LE, Ataya A. Clinical approach and review of causes of a chylothorax. Respir Med, 2019, 157: 7-13.
4. Wang H, Gao J, Zhang R, et al. Chyle test is not a valuable laboratory index in identifying chylothorax after pulmonary resection and lymph node dissection for primary non-small cell lung cancer. J Cancer Res Ther, 2019, 15(2): 324-328.
5. 杨月欣, 主编. 中国食物成分表标准版. 北京: 北京大学医学出版社, 2018. 122-138.
6. Fujita T, Sato T, Sato K, et al. Clinical manifestation, risk factors and managements for postoperative chylothorax after thoracic esophagectomy. J Thorac Dis, 2019, 11(Suppl 3): S198-S201.
7. Ohkura Y, Ueno M, Shindoh J, et al. Risk factors for postoperative chylothorax after radical subtotal esophagectomy. Ann Surg Oncol, 2018, 25(9): 2739-2746.
8. 赵峻, 张德超, 汪良骏, 等. 肺癌与食管癌术后乳糜胸的比较. 中华外科杂志, 2003, 41(1): 47-49.
9. 薛志强, 温佳新, 刘毅, 等. 肺癌切除术后乳糜胸的早期诊断和治疗. 中华肺部疾病杂志(电子版), 2017, 10(4): 395-397.
10. Itkin M, Rabinowitz DA, Nadolski G, et al. Abnormal pulmonary lymphatic flow in patients with lymphatic anomalies and respiratory compromise. Chest, 2020, 158(2): 681-691.
11. Petrella F, Casiraghi M, Radice D, et al. Treatment of chylothorax after lung resection: Indications, timing, and outcomes. Thorac Cardiovasc Surg, 2020, 68(6): 520-524.
12. Chen C, Wang Z, Hao J, et al. Chylothorax after lung cancer surgery: A key factor influencing prognosis and quality of life. Ann Thorac Cardiovasc Surg, 2020, 26(6): 303-310.
13. Takuwa T, Yoshida J, Ono S, et al. Low-fat diet management strategy for chylothorax after pulmonary resection and lymph node dissection for primary lung cancer. J Thorac Cardiovasc Surg, 2013, 146(3): 571-574.
14. Schurink B, Mazza E, Ruurda JP, et al. Low-fat tube feeding after esophagectomy is associated with a lower incidence of chylothorax. Ann Thorac Surg, 2019, 108(1): 184-189.
15. 李捷, 孙玉鹗. 肺切除术后乳糜胸的诊断和治疗. 中华外科杂志, 2003, 41(9): 713.
16. 杜娜, 饶志勇, 车国卫, 等. 肺癌术后短期中链甘油三酯饮食临床效果的前瞻性随机研究. 中国肺癌杂志, 2016, 19(12): 821-826.
17. 刘金荣, 赵顺英, 沈文彬. 乳糜性胸腔积液诊断及处理. 中国实用儿科杂志, 2017, 32(3): 186-190.
18. 辛向兵, 贾建博, 卢强, 等. 46 例肺癌肺叶切除术后乳糜胸回顾性分析. 临床外科杂志, 2018, 26(7): 524-526.
19. Zabeck H, Muley T, Dienemann H, et al. Management of chylothorax in adults: When is surgery indicated? Thorac Cardiovasc Surg, 2011, 59(4): 243-246.
20. 张国超, 赵格非, 高树庚, 等. 肺癌术后乳糜胸保守治疗与手术治疗的临床疗效比较. 癌症进展, 2018, 16(13): 1597-1600.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Diagnostic value and influencing factors of chylous test of pleural effusion after thoracic surgery

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