目的 探讨腹直肌面积（rectus abdominis area，RAA）、内脏脂肪面积（visceral to subcutaneous fat area， VFA）以及内脏脂肪与皮下脂肪面积比值（visceral to subcutaneous fat area ratio， V/S 比值）对肝癌开腹根治手术后手术切口感染（surgical site infection， SSI）风险的影响及其在围手术期预测与干预中的价值。 方法 本研究为回顾性病例对照研究，纳入了2019年12月至2024年10月期间接受肝癌开腹手术的280例患者。根据预先设定的排除标准，排除了17例患者。剩余患者分为SSI组（n = 66）和非SSI组（n = 197）。通过腹部CT测量VFA、皮下脂肪面积（subcutaneous fat area，SFA）及RAA。随后采用倾向评分匹配（PSM）方法，得到两个匹配后各59例患者的平衡队列。通过多因素logistic回归和ROC曲线分析对SSI的危险因素进行识别和评估。并基于这些危险因素构建列线图，并使用ROC曲线分析、校准曲线和决策曲线分析评估其预测性能。 结果 术前实验室结果显示，SSI组的白细胞计数、C反应蛋白及降钙素原水平更高，血红蛋白更低，血清白蛋白显著降低（P = 0.003）。在影像学测量中，SSI组的RAA（P = 0.032）、VFA（P = 0.015）和V/S比值（P = 0.002）均显著增高。单因素及多因素logistic回归分析进一步确定RAA、VFA和V/S比值为SSI的重要危险因素。ROC曲线分析表明，V/S比值（AUC = 0.88）和RAA（AUC = 0.79）对SSI具有较强的预测能力。基于这些指标构建的列线图预测模型在ROC曲线分析中的AUC为0.836，具有良好的区分度；校准曲线表明模型预测发生率与实际观察值吻合度较高；决策曲线分析显示，在常见决策阈值范围内应用该预测模型可获得更大的临床净收益。 结论 RAA、VFA和V/S比值均为肝癌开腹根治术后SSI的重要预测因素。基于这些指标构建的列线图模型在区分度、校准度及临床决策收益方面表现优异，可帮助临床医师术前识别高风险人群并实施个体化干预，从而降低 SSI 的发生率并改善患者预后。

Objective To investigate the effects of rectus abdominis area （RAA）， visceral fat area （VFA）， and the ratio of visceral to subcutaneous fat area （V/S ratio） on the risk of surgical site infection （SSI） following open radical surgery for hepatocellular carcinoma （HCC） and their predictive value in the perioperative period and potential utility for intervention. Methods In this retrospective case-control study， 280 patients who underwent open radical HCC surgery between December 2019 and October 2024 were included. After excluding 17 patients due to incomplete data or other exclusion criteria， the remaining 263 patients were categorized into two groups： 66 in the SSI group and 197 in the non-SSI group. VFA， subcutaneous fat area （SFA）， and RAA were quantified using preoperative abdominal computed tomography （CT） scans. Propensity score matching was performed to create two well-balanced cohorts， each consisting of 59 patients. Multivariate logistic regression analysis and receiver operating characteristic （ROC） curve analysis were conducted to identify and evaluate potential risk factors for SSIs. Additionally， a nomogram was developed to assess the predictive performance of these risk factors through ROC curve analysis， calibration plots， and decision curve analysis. Results Preoperative laboratory results revealed significantly elevated white blood cell counts， C-reactive protein levels， and procalcitonin in the SSI group， along with reduced hemoglobin and serum albumin levels compared to the control group （P = 0.003）. Imaging analyses demonstrated markedly increased RAA （P = 0.032）， VFA （P = 0.015）， and V/S ratio （P = 0.002） in the SSI group. Univariate and multivariate logistic regression analyses identified RAA， VFA， and the V/S ratio as critical risk factors for SSIs. ROC curve analyses further confirmed the robust predictive capacity of the V/S ratio （AUC = 0.88） and RAA （AUC = 0.79）. A nomogram constructed based on these indicators achieved an AUC of 0.836， indicating excellent discrimination ability， strong concordance between predicted and observed outcomes， and clinically significant net benefit across a range of common threshold probabilities. Conclusions RAA， VFA， and the V/S ratio are critical predictors of SSI following open radical HCC surgery. The nomogram constructed based on these factors exhibits robust discrimination， calibration， and clinical utility， allowing clinicians to accurately identify high-risk patients and implement targeted interventions to reduce SSI incidence and enhance patient outcomes.