胸腔积液乳糜定性试验在胸外科术后的诊断价值与影响因素

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

目的分析胸外科术后胸腔积液乳糜定性试验结果和诊断价值,以及影响乳糜试验结果的临床病理因素。方法回顾性分析2020年5~8月华西医院上锦院区胸外科连续265例择期手术患者的临床资料,其中男106例、女159例,平均年龄(53.0±12.2)岁。根据手术当日及术后第1 d、第2 d乳糜试验结果,将患者分为阳性和阴性两个亚组,比较两组临床资料。计算乳糜定性试验的敏感性和特异性。并采用logistic多因素分析乳糜定性试验的影响因素。结果患者手术当日及术后第1 d、第2 d的乳糜试验阳性率分别为91.7%、95.8%、87.9%。乳糜试验阳性/阴性两个亚组患者的年龄、性别、手术种类、手术入路、手术部位、手术时间、淋巴结清扫数量、胸导管处理、对应24 h胸腔引流量、对应24 h蛋白脂肪食物摄入量等指标,差异均无统计学意义(P>0.05)。乳糜试验的诊断敏感性和特异性分别为100.0%和4.0%。Logistic多因素分析显示手术部位(左胸/右胸)可能是乳糜试验结果的影响因素(P=0.043,OR=0.458,95%CI 0.216~0.974)。结论胸外科术后胸腔积液乳糜定性试验阳性率极高。乳糜定性试验产生了极高的乳糜胸误诊率。手术部位(左胸/右胸)可能是乳糜试验结果的影响因素。乳糜定性试验阳性不建议作为术后乳糜胸的直接诊断依据,以及据此指导下一步治疗。

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.