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.	楊月欣, 主編. 中國食物成分表標準版. 北京: 北京大學醫學出版社, 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.	趙峻, 張德超, 汪良駿, 等. 肺癌與食管癌術后乳糜胸的比較. 中華外科雜志, 2003, 41(1): 47-49.
9.	薛志強, 溫佳新, 劉毅, 等. 肺癌切除術后乳糜胸的早期診斷和治療. 中華肺部疾病雜志(電子版), 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, 孫玉鶚. 肺切除術后乳糜胸的診斷和治療. 中華外科雜志, 2003, 41(9): 713.
16.	杜娜, 饒志勇, 車國衛, 等. 肺癌術后短期中鏈甘油三酯飲食臨床效果的前瞻性隨機研究. 中國肺癌雜志, 2016, 19(12): 821-826.
17.	劉金榮, 趙順英, 沈文彬. 乳糜性胸腔積液診斷及處理. 中國實用兒科雜志, 2017, 32(3): 186-190.
18.	辛向兵, 賈建博, 盧強, 等. 46 例肺癌肺葉切除術后乳糜胸回顧性分析. 臨床外科雜志, 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.	張國超, 趙格非, 高樹庚, 等. 肺癌術后乳糜胸保守治療與手術治療的臨床療效比較. 癌癥進展, 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. 楊月欣, 主編. 中國食物成分表標準版. 北京: 北京大學醫學出版社, 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. 趙峻, 張德超, 汪良駿, 等. 肺癌與食管癌術后乳糜胸的比較. 中華外科雜志, 2003, 41(1): 47-49.
9. 薛志強, 溫佳新, 劉毅, 等. 肺癌切除術后乳糜胸的早期診斷和治療. 中華肺部疾病雜志(電子版), 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, 孫玉鶚. 肺切除術后乳糜胸的診斷和治療. 中華外科雜志, 2003, 41(9): 713.
16. 杜娜, 饒志勇, 車國衛, 等. 肺癌術后短期中鏈甘油三酯飲食臨床效果的前瞻性隨機研究. 中國肺癌雜志, 2016, 19(12): 821-826.
17. 劉金榮, 趙順英, 沈文彬. 乳糜性胸腔積液診斷及處理. 中國實用兒科雜志, 2017, 32(3): 186-190.
18. 辛向兵, 賈建博, 盧強, 等. 46 例肺癌肺葉切除術后乳糜胸回顧性分析. 臨床外科雜志, 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. 張國超, 趙格非, 高樹庚, 等. 肺癌術后乳糜胸保守治療與手術治療的臨床療效比較. 癌癥進展, 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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