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已发表论文
特发性乳糜尿患者行颈胸导管探查术的评估：一项回顾性对比研究
Authors Xin J, Dong C, Xia S, Sun Y, Dong J, Chang K, Su W, Hao K, Qian Y, Shen W
Received 13 April 2025
Accepted for publication 16 August 2025
Published 22 October 2025 Volume 2025:17 Pages 437—447
DOI https://doi.org/10.2147/RRU.S532806
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Guglielmo Mantica
Jianfeng Xin,1,* Chao Dong,2,* Song Xia,1 Yuguang Sun,1 Jian Dong,3 Kun Chang,1 Wanchun Su,1 Kun Hao,1 Youlei Qian,1 Wenbin Shen1
1Department of Lymphatic Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, People’s Republic of China; 2Department of Ultrasound, Sanfine International Hospital, Beijing, People’s Republic of China; 3Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Wenbin Shen, Department of Lymphatic Surgery, Beijing Shijitan Hospital, Capital Medical University, No. 10 Tieyi Road, Haidian District, Beijing, 100038, People’s Republic of China, Email shenwb@bjsjth.cn Jianfeng Xin, Department of Lymphatic Surgery, Beijing Shijitan Hospital, Capital Medical University, No. 10 Tieyi Road, Haidian District, Beijing, 100038, People’s Republic of China, Email xinjianfeng@bjsjth.cn
Purpose: The purpose of this study is to evaluate a novel surgical method for idiopathic chyluria.
Methods: Data from 63 patients with idiopathic chyluria who underwent direct lymphangiography (DLG) were retrospectively analyzed. Of these, 50 patients received cervical thoracic duct exploration (CTDE) as a treatment, while 13 were managed with a low-fat diet. The treatment efficacy of the two groups was compared, and a univariate analysis of the CTDE treatment effect was performed.
Results: DLG revealed that the contrast agent passed upwards and outwards through paravertebral lymphatics into the region of the renal hilum and pelvis (left: 38.10%; right: 33.33%; bilateral: 28.57%). Dilatation of retroperitoneal lymphatics was found in 90.47% of cases. Additionally, 47.6% of patients demonstrated contrast agent reflux into lymphatic trunks in the neck (the percentage of contrast agent reflux to the jugular trunk, subclavian trunk, and broncho-mediastinal trunk being 28.57%, 38.09%, and 6.34%, respectively). The effective rate in the CTDE group was higher than in the low-fat diet group (χ² = 5.893, p=0.015). Univariate analysis of the patients who underwent CTDE demonstrated that younger age (p=0.036) and Grade III chyluria were risk factors for ineffective treatment, while patients with Grade I had better treatment outcomes (p=0.029).
Conclusion: Obstruction of the cervical thoracic duct may be a significant cause of idiopathic chyluria. Alleviating this obstruction may be an effective treatment strategy for idiopathic chyluria.
Plain Language Summary: Dr Xin’s team wanted to find a better way to help patients with idiopathic chyluria—a condition where milky fluid (called chyle) leaks into urine for unknown reasons. Current treatments like low-fat diets often do not fully solve the problem. The team suspected blockages in lymph vessels might be the cause, especially in the neck area. First, they used a special X-ray technique (Direct Lymphangiography) to examine the lymphatic system of the patients. They found that almost all people in the study had dilated retroperitoneal lymphatics (90.47%) and about half (47.6%) had contrast agent reflux to cervical lymphatic trunks. Then, they compared two treatments: A low-fat diet (the usual approach) and Cervical Thoracic Duct Exploration (CTDE), a surgery to find and fix blockages in key lymph vessels in the neck. Finally, they found that the surgery (CTDE) was significantly more effective at stopping the idiopathic chyluria than the low-fat diet management. They also found that people with milder symptoms (Grade I) especially benefited from the surgery, and younger people and those with more severe symptoms (Grade III) generally had a harder time getting better, regardless of treatment. These Results Mean: 1. Blockages in Cervical Thoracic Duct are a key cause of the idiopathic chyluria. 2. Surgery (CTDE) to alleviate these blockages is a promising new treatment, offering better results than just low-fat diet control. 3. This surgery could be especially helpful for people with milder symptoms. 4. The findings give doctors a clearer target for treatment and offer new hope to people who have not found relief with diets alone.
Keywords: chyluria, idiopathic, thoracic duct, direct lymphangiography, DLG, lymphovenous anastomosis, LVA
1Department of Lymphatic Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, People’s Republic of China; 2Department of Ultrasound, Sanfine International Hospital, Beijing, People’s Republic of China; 3Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Wenbin Shen, Department of Lymphatic Surgery, Beijing Shijitan Hospital, Capital Medical University, No. 10 Tieyi Road, Haidian District, Beijing, 100038, People’s Republic of China, Email shenwb@bjsjth.cn Jianfeng Xin, Department of Lymphatic Surgery, Beijing Shijitan Hospital, Capital Medical University, No. 10 Tieyi Road, Haidian District, Beijing, 100038, People’s Republic of China, Email xinjianfeng@bjsjth.cn
Purpose: The purpose of this study is to evaluate a novel surgical method for idiopathic chyluria.
Methods: Data from 63 patients with idiopathic chyluria who underwent direct lymphangiography (DLG) were retrospectively analyzed. Of these, 50 patients received cervical thoracic duct exploration (CTDE) as a treatment, while 13 were managed with a low-fat diet. The treatment efficacy of the two groups was compared, and a univariate analysis of the CTDE treatment effect was performed.
Results: DLG revealed that the contrast agent passed upwards and outwards through paravertebral lymphatics into the region of the renal hilum and pelvis (left: 38.10%; right: 33.33%; bilateral: 28.57%). Dilatation of retroperitoneal lymphatics was found in 90.47% of cases. Additionally, 47.6% of patients demonstrated contrast agent reflux into lymphatic trunks in the neck (the percentage of contrast agent reflux to the jugular trunk, subclavian trunk, and broncho-mediastinal trunk being 28.57%, 38.09%, and 6.34%, respectively). The effective rate in the CTDE group was higher than in the low-fat diet group (χ² = 5.893, p=0.015). Univariate analysis of the patients who underwent CTDE demonstrated that younger age (p=0.036) and Grade III chyluria were risk factors for ineffective treatment, while patients with Grade I had better treatment outcomes (p=0.029).
Conclusion: Obstruction of the cervical thoracic duct may be a significant cause of idiopathic chyluria. Alleviating this obstruction may be an effective treatment strategy for idiopathic chyluria.
Plain Language Summary: Dr Xin’s team wanted to find a better way to help patients with idiopathic chyluria—a condition where milky fluid (called chyle) leaks into urine for unknown reasons. Current treatments like low-fat diets often do not fully solve the problem. The team suspected blockages in lymph vessels might be the cause, especially in the neck area. First, they used a special X-ray technique (Direct Lymphangiography) to examine the lymphatic system of the patients. They found that almost all people in the study had dilated retroperitoneal lymphatics (90.47%) and about half (47.6%) had contrast agent reflux to cervical lymphatic trunks. Then, they compared two treatments: A low-fat diet (the usual approach) and Cervical Thoracic Duct Exploration (CTDE), a surgery to find and fix blockages in key lymph vessels in the neck. Finally, they found that the surgery (CTDE) was significantly more effective at stopping the idiopathic chyluria than the low-fat diet management. They also found that people with milder symptoms (Grade I) especially benefited from the surgery, and younger people and those with more severe symptoms (Grade III) generally had a harder time getting better, regardless of treatment. These Results Mean: 1. Blockages in Cervical Thoracic Duct are a key cause of the idiopathic chyluria. 2. Surgery (CTDE) to alleviate these blockages is a promising new treatment, offering better results than just low-fat diet control. 3. This surgery could be especially helpful for people with milder symptoms. 4. The findings give doctors a clearer target for treatment and offer new hope to people who have not found relief with diets alone.
Keywords: chyluria, idiopathic, thoracic duct, direct lymphangiography, DLG, lymphovenous anastomosis, LVA