143 lines
4.2 KiB
Markdown
143 lines
4.2 KiB
Markdown
# 病理管理模块 — 深度设计文档
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> **版本**: v1.0 | **编制日期**: 2026-06-07
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> **依据**: 《病理科建设与管理指南》+ 《临床病理质量控制标准》
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---
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## 一、业务背景
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病理诊断是手术后诊断的"金标准"，三甲医院必须具备:
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- 病理标本全流程追溯(从手术室到病理科)
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- 三级审核制度(住院医师→主治→副主任)
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- 病理报告质量控制
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- 肿瘤登记上报
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## 二、业务流程
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```
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[手术/活检/穿刺] → 病理申请单
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↓
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[标本采集] ←→ [条码打印] ←→ [标本固定(10%福尔马林)]
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↓ (运送至病理科)
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[标本接收] ←→ [标本核对(条码扫码)]
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↓ (不合格退回)
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[取材描述] ←→ [组织处理(脱水/包埋)]
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↓
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[切片制作] ←→ [染色(HE/免疫组化/特殊染色)]
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↓
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[初诊阅片] ←→ [上级医师审核]
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↓ (疑难病例会诊)
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[病理会诊] ←→ [最终诊断]
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↓
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[报告编写] ←→ [三级审核]
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↓
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[报告签发] ←→ [临床科室领取]
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↓
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[肿瘤登记] ←→ [随访]
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```
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## 三、数据模型
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```sql
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-- 病理申请
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CREATE TABLE pathology_order (
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id BIGSERIAL PRIMARY KEY,
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patient_id BIGINT NOT NULL,
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patient_name VARCHAR(50),
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encounter_id BIGINT,
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specimen_type VARCHAR(50), -- 手术标本/活检/穿刺/细胞学
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clinical_diagnosis TEXT,
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sample_site VARCHAR(100),
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urgency VARCHAR(20) DEFAULT 'NORMAL', -- URGENT/NORMAL
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order_status VARCHAR(20) DEFAULT 'PENDING',
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apply_doctor VARCHAR(64),
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apply_time TIMESTAMP DEFAULT CURRENT_TIMESTAMP,
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tenant_id BIGINT DEFAULT 0,
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is_deleted INT NOT NULL DEFAULT 0,
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create_time TIMESTAMP DEFAULT CURRENT_TIMESTAMP
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);
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-- 病理标本
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CREATE TABLE pathology_specimen (
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id BIGSERIAL PRIMARY KEY,
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order_id BIGINT NOT NULL,
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barcode VARCHAR(100) NOT NULL,
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specimen_desc TEXT,
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collection_site VARCHAR(100),
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fixative VARCHAR(50),
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fixative_time TIMESTAMP,
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receive_time TIMESTAMP,
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receiver VARCHAR(64),
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is_qualified BOOLEAN DEFAULT TRUE,
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reject_reason TEXT,
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tenant_id BIGINT DEFAULT 0,
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is_deleted INT NOT NULL DEFAULT 0,
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create_time TIMESTAMP DEFAULT CURRENT_TIMESTAMP
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);
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-- 病理处理
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CREATE TABLE pathology_process (
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id BIGSERIAL PRIMARY KEY,
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specimen_id BIGINT NOT NULL,
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process_type VARCHAR(30), -- 取材/脱水/包埋/切片/染色/免疫组化
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process_desc TEXT,
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operator VARCHAR(64),
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operate_time TIMESTAMP DEFAULT CURRENT_TIMESTAMP,
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tenant_id BIGINT DEFAULT 0,
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create_time TIMESTAMP DEFAULT CURRENT_TIMESTAMP
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);
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-- 病理诊断
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CREATE TABLE pathology_diagnosis (
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id BIGSERIAL PRIMARY KEY,
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order_id BIGINT NOT NULL,
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specimen_id BIGINT,
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diagnosis_type VARCHAR(30), -- 初诊/复诊/会诊/最终
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diagnosis_result TEXT,
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immunostain_result TEXT,
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doctor_name VARCHAR(64),
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doctor_title VARCHAR(20),
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diagnose_time TIMESTAMP DEFAULT CURRENT_TIMESTAMP,
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tenant_id BIGINT DEFAULT 0,
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create_time TIMESTAMP DEFAULT CURRENT_TIMESTAMP
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);
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-- 病理报告
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CREATE TABLE pathology_report (
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id BIGSERIAL PRIMARY KEY,
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order_id BIGINT NOT NULL,
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patient_id BIGINT,
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specimen_desc TEXT,
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macroscopic_desc TEXT, -- 肉眼所见
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microscopic_desc TEXT, -- 镜下所见
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diagnosis_result TEXT, -- 病理诊断
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suggestion TEXT,
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report_doctor VARCHAR(64),
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report_time TIMESTAMP,
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audit_doctor VARCHAR(64),
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audit_time TIMESTAMP,
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final_doctor VARCHAR(64),
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final_time TIMESTAMP,
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status VARCHAR(20) DEFAULT 'DRAFT',
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tenant_id BIGINT DEFAULT 0,
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is_deleted INT NOT NULL DEFAULT 0,
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create_time TIMESTAMP DEFAULT CURRENT_TIMESTAMP
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);
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```
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## 四、接口设计
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| API | 方法 | 说明 |
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|-----|------|------|
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| /pathology/order/page | GET | 病理申请列表 |
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| /pathology/order/add | POST | 新建病理申请 |
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| /pathology/specimen/scan | POST | 标本扫码接收 |
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| /pathology/specimen/reject/{id} | PUT | 标本拒收 |
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| /pathology/process/record | POST | 记录处理过程 |
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| /pathology/diagnosis/add | POST | 录入诊断 |
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| /pathology/report/page | GET | 病理报告列表 |
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| /pathology/report/add | POST | 新建报告 |
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| /pathology/report/audit/{id} | PUT | 审核报告 |
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| /pathology/stats | GET | 病理统计(标本数/诊断分布/周转时间) |
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