通讯作者: 成青鉴, qfqsjq@163.com

DOI：10.12201/bmr.202602.00026

Comparison of therapeutic effects of ultrasound-guided radiofrequency ablation and high ligation and stripping of great saphenous vein in the treatment of varicose veins of lower limbs and analysis of recurrence factors

• 摘要：目的：探讨射频消融术(Radiofrequency Ablation，RFA)和大隐静脉高位结扎剥脱(High ligation/Stripping，HL/S) 治疗下肢静脉曲张(Lower extremities varicose vein , LEVV)的临床疗效，并基于沙普利加性解释（SHapley Additive exPlanations , SHAP）分析术后复发因素。方法：选取2023年12月至2024年12月我院收治的240例LEVV患者为研究对象,根据治疗方法不同分为RFA 组120 例，HL/S 组120 例,将两组与手术有关的指标比较，术后 VAS 评分，术后凝血功能指标，VCSS，VAVQ 评分，以及术后 12个月的合并症及复发等指标进行比较。结果：RFA组术中出血量、手术时间、住院时间均低于HL/S组(P<0.05); RAF组术后VAS评分均低于HL/S组(P<0.05)，术前两组PAI-1和FIB水平无显著性差异(P>0.05)，术后第3天RFA组PAI-1和FIB水平明显低于HL/S组(P<0.05)。两组手术方式对VCSS评分均有明显改善，术后6月两组VCSS无统计学差异（P>0.05），12个月RFA组VCSS低于HL/S组(P<0.05)。术后两组的AVVQ评分相比于术前显著降低，术后相比无明显差异(P>0.05)。RFA总并发症发生率为10.83%，较HL/S组的30.83%明显降低 (P < 0.05)。术后6个月、9个月两组复发率无明显差异，对比RFA术后12个月复发率11.77%，明显低于HL/S组的25.0% (P <0.05)。SHAP分析特征重要性前五的变量为凝血功能异常、BMI、年龄、大隐静脉直径、CEAP分类。其中高风险组为凝血功能异常、BMI>26、年龄< 45岁，中风险组为CEAP C4-C5、大隐静脉直径> 9mm、低风险组为年龄>60 岁、凝血正常、BMI正常。结论：RFA在治疗LLEV中效果优于HL/S，改善了相关临床指标，减少了并发症和复发率。加强术前评估和术后康复策略有助于降低复发风险。基金项目：河西学院校长基金资助项目（2025YB054）；张掖市市级科技计划项目（ZY2024BJ04）通讯作者：成青鉴，副主任医师，E-mail：qfqsjq@163.com

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  Abstract: Objective: The purpose of this research is to assess the clinical effectiveness of radiofrequency ablation (RFA) versus high ligation and stripping (HL/S) in the management of lower extremity varicose veins (LEVV), and to explore the factors contributing to recurrence using SHAP analysis. Methods: A total of 240 LEVV patients admitted to our hospital between December 2023 and December 2024 were recruited and allocated into two cohorts: the RFA group (n = 120) and the HL/S group (n = 120). The two groups were compared with respect to surgery-related parameters, postoperative Visual Analog Scale (VAS) scores, coagulation indices after surgery, Venous Clinical Severity Score (VCSS), Venous Appearance and Quality of Life Questionnaire (VAVQ) scores, as well as the incidence of complications and recurrence at 12 months following the operation. Results: Compared with the HL/S group, the RFA group exhibited notably less intraoperative blood loss, shorter operation duration, and reduced hospital stay (P<0.05). Postoperative VAS scores were lower in the RFA group than in the HL/S group, indicating milder postoperative pain. No significant differences were observed in the levels of plasminogen activator inhibitor-1 (PAI-1) and fibrinogen (FIB) between the two groups preoperatively; however, the RFA group had substantially lower PAI-1 and FIB levels on the 3rd postoperative day. At 6 months after surgery, there was no statistically significant difference in VCSS scores between the two groups, but at 12 months, the VCSS of the RFA group was significantly lower than that of the HL/S group (P<0.05). Both groups showed marked improvements in VAVQ scores after surgery, with no significant intergroup difference (P>0.05). The total complication rate in the RFA group was 10.83%, which was significantly lower than the 30.83% in the HL/S group (P<0.05). There were no significant differences in recurrence rates between the two groups at 6 and 9 months postoperatively; however, at 12 months, the recurrence rate of the RFA group was 11.77%, significantly lower than the 25.0% in the HL/S group (P<0.05). SHAP analysis revealed the top five key variables affecting recurrence risk: (1) Coagulation dysfunction: Impaired coagulation status was associated with an elevated recurrence risk; (2) Body Mass Index (BMI): Higher BMI correlated with increased recurrence risk; (3) Age: Patients younger than 45 years had a lower recurrence risk, while those older than 60 years faced a higher risk; (4) Great saphenous vein diameter: A vein diameter exceeding 9mm heightened the recurrence risk; (5) CEAP classification: Patients with CEAP C4-C5 (moderate-risk group) had a higher recurrence risk compared to those with lower classifications. Conclusion: In the treatment of LEVV, RFA is more effective than HL/S. It remarkably enhances clinical outcomes, reduces the incidence of complications, and lowers the recurrence rate. Strengthening preoperative assessments and optimizing postoperative rehabilitation protocols can further help mitigate the risk of recurrence.

  Key words: varicose; veins of; lower limbs, radiofrequency; ablation, high; ligation and; stripping, SHAP; analysis, recurrence

  提交时间：2026-02-08

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• 序号	提交日期	编号	操作
  1	2026-01-22	10.12201/bmr.202602.00026V1	下载

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