his/MD/architecture/PHASE_A_PATHOLOGY_DESIGN.md

# 病理管理模块 — 深度设计文档

> **版本**: v1.0 | **编制日期**: 2026-06-07
> **依据**: 《病理科建设与管理指南》+ 《临床病理质量控制标准》

---

## 一、业务背景

病理诊断是手术后诊断的"金标准"，三甲医院必须具备:
- 病理标本全流程追溯(从手术室到病理科)
- 三级审核制度(住院医师→主治→副主任)
- 病理报告质量控制
- 肿瘤登记上报

## 二、业务流程

```
[手术/活检/穿刺] → 病理申请单
  ↓
[标本采集] ←→ [条码打印] ←→ [标本固定(10%福尔马林)]
  ↓ (运送至病理科)
[标本接收] ←→ [标本核对(条码扫码)]
  ↓ (不合格退回)
[取材描述] ←→ [组织处理(脱水/包埋)]
  ↓
[切片制作] ←→ [染色(HE/免疫组化/特殊染色)]
  ↓
[初诊阅片] ←→ [上级医师审核]
  ↓ (疑难病例会诊)
[病理会诊] ←→ [最终诊断]
  ↓
[报告编写] ←→ [三级审核]
  ↓
[报告签发] ←→ [临床科室领取]
  ↓
[肿瘤登记] ←→ [随访]
```

## 三、数据模型

```sql
-- 病理申请
CREATE TABLE pathology_order (
    id BIGSERIAL PRIMARY KEY,
    patient_id BIGINT NOT NULL,
    patient_name VARCHAR(50),
    encounter_id BIGINT,
    specimen_type VARCHAR(50), -- 手术标本/活检/穿刺/细胞学
    clinical_diagnosis TEXT,
    sample_site VARCHAR(100),
    urgency VARCHAR(20) DEFAULT 'NORMAL', -- URGENT/NORMAL
    order_status VARCHAR(20) DEFAULT 'PENDING',
    apply_doctor VARCHAR(64),
    apply_time TIMESTAMP DEFAULT CURRENT_TIMESTAMP,
    tenant_id BIGINT DEFAULT 0,
    is_deleted INT NOT NULL DEFAULT 0,
    create_time TIMESTAMP DEFAULT CURRENT_TIMESTAMP
);

-- 病理标本
CREATE TABLE pathology_specimen (
    id BIGSERIAL PRIMARY KEY,
    order_id BIGINT NOT NULL,
    barcode VARCHAR(100) NOT NULL,
    specimen_desc TEXT,
    collection_site VARCHAR(100),
    fixative VARCHAR(50),
    fixative_time TIMESTAMP,
    receive_time TIMESTAMP,
    receiver VARCHAR(64),
    is_qualified BOOLEAN DEFAULT TRUE,
    reject_reason TEXT,
    tenant_id BIGINT DEFAULT 0,
    is_deleted INT NOT NULL DEFAULT 0,
    create_time TIMESTAMP DEFAULT CURRENT_TIMESTAMP
);

-- 病理处理
CREATE TABLE pathology_process (
    id BIGSERIAL PRIMARY KEY,
    specimen_id BIGINT NOT NULL,
    process_type VARCHAR(30), -- 取材/脱水/包埋/切片/染色/免疫组化
    process_desc TEXT,
    operator VARCHAR(64),
    operate_time TIMESTAMP DEFAULT CURRENT_TIMESTAMP,
    tenant_id BIGINT DEFAULT 0,
    create_time TIMESTAMP DEFAULT CURRENT_TIMESTAMP
);

-- 病理诊断
CREATE TABLE pathology_diagnosis (
    id BIGSERIAL PRIMARY KEY,
    order_id BIGINT NOT NULL,
    specimen_id BIGINT,
    diagnosis_type VARCHAR(30), -- 初诊/复诊/会诊/最终
    diagnosis_result TEXT,
    immunostain_result TEXT,
    doctor_name VARCHAR(64),
    doctor_title VARCHAR(20),
    diagnose_time TIMESTAMP DEFAULT CURRENT_TIMESTAMP,
    tenant_id BIGINT DEFAULT 0,
    create_time TIMESTAMP DEFAULT CURRENT_TIMESTAMP
);

-- 病理报告
CREATE TABLE pathology_report (
    id BIGSERIAL PRIMARY KEY,
    order_id BIGINT NOT NULL,
    patient_id BIGINT,
    specimen_desc TEXT,
    macroscopic_desc TEXT, -- 肉眼所见
    microscopic_desc TEXT, -- 镜下所见
    diagnosis_result TEXT, -- 病理诊断
    suggestion TEXT,
    report_doctor VARCHAR(64),
    report_time TIMESTAMP,
    audit_doctor VARCHAR(64),
    audit_time TIMESTAMP,
    final_doctor VARCHAR(64),
    final_time TIMESTAMP,
    status VARCHAR(20) DEFAULT 'DRAFT',
    tenant_id BIGINT DEFAULT 0,
    is_deleted INT NOT NULL DEFAULT 0,
    create_time TIMESTAMP DEFAULT CURRENT_TIMESTAMP
);
```

## 四、接口设计

| API | 方法 | 说明 |
|-----|------|------|
| /pathology/order/page | GET | 病理申请列表 |
| /pathology/order/add | POST | 新建病理申请 |
| /pathology/specimen/scan | POST | 标本扫码接收 |
| /pathology/specimen/reject/{id} | PUT | 标本拒收 |
| /pathology/process/record | POST | 记录处理过程 |
| /pathology/diagnosis/add | POST | 录入诊断 |
| /pathology/report/page | GET | 病理报告列表 |
| /pathology/report/add | POST | 新建报告 |
| /pathology/report/audit/{id} | PUT | 审核报告 |
| /pathology/stats | GET | 病理统计(标本数/诊断分布/周转时间) |