Merge branch 'master' of https://gitee.com/v_cms/zyt

2026-04-30 14:09:04 +08:00
parent d3003ce0ac d9175cada7
commit 742be6b492
154 changed files with 3606 additions and 22938 deletions
@@ -5,6 +5,7 @@ namespace app\adminapi\controller\doctor;
 use app\adminapi\controller\BaseAdminController;
 use app\adminapi\lists\doctor\AppointmentLists;
 use app\adminapi\logic\doctor\AppointmentLogic;
+use app\adminapi\logic\doctor\DoctorNoteLogic;
 use app\adminapi\validate\doctor\AppointmentValidate;

 /**
@@ -104,4 +105,60 @@ class AppointmentController extends BaseAdminController
        }
        return $this->success('操作成功');
    }
+
+    /**
+     * @notes 接诊台聚合详情（患者信息 + 诊单病例 + 血糖血压记录）
+     * @return \think\response\Json
+     */
+    public function reception()
+    {
+        $params = (new AppointmentValidate())->goCheck('reception');
+        $result = AppointmentLogic::reception($params);
+        return $this->data($result);
+    }
+
+    /**
+     * @notes 通知接诊医助（发企业微信）
+     * @return \think\response\Json
+     */
+    public function notifyAssistant()
+    {
+        $params = (new AppointmentValidate())->post()->goCheck('notifyAssistant');
+        $result = AppointmentLogic::notifyAssistant((int) $params['id']);
+        if (empty($result['ok'])) {
+            return $this->fail($result['message'] ?? '通知失败');
+        }
+        return $this->success('通知已发送');
+    }
+
+    public function addDoctorNote()
+    {
+        $params = (new AppointmentValidate())->post()->goCheck('addDoctorNote');
+        $params['doctor_id'] = $this->adminId;
+        $result = DoctorNoteLogic::addOrAppend($params);
+        if ($result === false) {
+            return $this->fail(DoctorNoteLogic::getError());
+        }
+        return $this->success('保存成功');
+    }
+
+    public function doctorNotes()
+    {
+        $params = (new AppointmentValidate())->goCheck('doctorNotes');
+        return $this->data(DoctorNoteLogic::getByDiagnosis((int) $params['diagnosis_id']));
+    }
+
+    public function deleteDoctorNoteImage()
+    {
+        $params = (new AppointmentValidate())->post()->goCheck('deleteDoctorNoteImage');
+        $result = DoctorNoteLogic::deleteImage(
+            (int) $params['note_id'],
+            $params['image_type'],
+            $params['image_path']
+        );
+        if ($result === false) {
+            return $this->fail(DoctorNoteLogic::getError());
+        }
+        return $this->success('删除成功');
+    }
 }
@@ -11,6 +11,12 @@ use app\common\model\tcm\DiagnosisGuahaoLog;
 use app\common\model\auth\Admin;
 use app\api\logic\ChatNotifyLogic;
 use app\adminapi\logic\tcm\PrescriptionLogic;
+use app\adminapi\logic\tcm\DiagnosisLogic;
+use app\adminapi\logic\tcm\BloodRecordLogic;
+use app\adminapi\logic\doctor\DoctorNoteLogic;
+use app\common\model\tcm\Prescription;
+use app\common\service\wechat\WechatWorkAppMessageService;
+use app\common\model\dict\DictData;
 use think\facade\Db;
 use think\facade\Log;

@@ -489,6 +495,263 @@ class AppointmentLogic extends BaseLogic
        }
    }

+    /**
+     * @notes 接诊台聚合：单次返回挂号信息 + 诊单病例 + 血糖血压记录 + 助理姓名
+     * 数据复用：detail() / DiagnosisLogic::detail() / BloodRecordLogic::getRecordsByPatient()
+     * 备注：appointment.patient_id 实际对应 tcm_diagnosis.id
+     * @param array $params
+     * @return array
+     */
+    public static function reception(array $params): array
+    {
+        // 1) 挂号详情（已包含 patient_name / patient_phone / doctor_name / status_desc 等）
+        $appointment = self::detail($params);
+        if (empty($appointment)) {
+            return [];
+        }
+
+        // 2) 诊单（病例）详情：appointment.patient_id == tcm_diagnosis.id
+        $diagnosisId = (int) ($appointment['patient_id'] ?? 0);
+        $diagnosis = $diagnosisId > 0
+            ? DiagnosisLogic::detail(['id' => $diagnosisId])
+            : [];
+
+        // 3) 血糖血压记录
+        $bloodRecords = $diagnosisId > 0
+            ? BloodRecordLogic::getRecordsByPatient(['diagnosis_id' => $diagnosisId])
+            : [];
+
+        // 4) 补全医助姓名（detail() 未关联 admin 助理表）
+        $assistantName = '';
+        if (!empty($diagnosis['assistant_id'])) {
+            $assistant = Admin::where('id', (int) $diagnosis['assistant_id'])->find();
+            if ($assistant) {
+                $assistantName = $assistant->name ?? '';
+            }
+        }
+        $appointment['assistant_name'] = $assistantName;
+        $appointment['assistant_id'] = $diagnosis['assistant_id'] ?? 0;
+
+        // 5) 是否已开方（与列表口径一致：未删除 & 未作废）
+        $hasPrescription = 0;
+        if ($diagnosisId > 0) {
+            $rxExists = Prescription::where('diagnosis_id', $diagnosisId)
+                ->whereNull('delete_time')
+                ->where('void_status', 0)
+                ->find();
+            $hasPrescription = $rxExists ? 1 : 0;
+        }
+        $appointment['has_prescription'] = $hasPrescription;
+
+        // 6) 对诊单字段进行字典/枚举翻译（产出 *_text 附加字段，不覆盖原 value）
+        $diagnosis = self::enrichDiagnosisLabels($diagnosis);
+
+        // 7) 医生备注
+        $doctorNotes = $diagnosisId > 0
+            ? DoctorNoteLogic::getByDiagnosis($diagnosisId)
+            : [];
+
+        return [
+            'appointment'   => $appointment,
+            'diagnosis'     => $diagnosis,
+            'blood_records' => $bloodRecords,
+            'doctor_notes'  => $doctorNotes,
+        ];
+    }
+
+    /**
+     * 字典翻译：把诊单中以 code 存储的字段（字典/枚举）补一份中文 label 字段，
+     * 便于前端（接诊台等只读场景）直接渲染，无需加载字典。
+     * 原始 code 字段保留不动，edit 场景仍可使用。
+     *
+     * @param array $diagnosis
+     * @return array
+     */
+    private static function enrichDiagnosisLabels(array $diagnosis): array
+    {
+        if (empty($diagnosis)) {
+            return $diagnosis;
+        }
+
+        // 单值字段：value 为字典 value，翻译成字典 name
+        $singleDictFields = [
+            'diagnosis_type'     => 'diagnosis_type',
+            'syndrome_type'      => 'syndrome_type',
+            'diabetes_type'      => 'diabetes_type',
+            'water_intake'       => 'water_intake',
+            'weight_change'      => 'weight_change',
+            'fatty_liver_degree' => 'fatty_liver_degree',
+        ];
+        // 多值字段：value 为数组或逗号分隔字符串
+        $multiDictFields = [
+            'past_history'     => 'past_history',
+            'appetite'         => 'appetite',
+            'diet_condition'   => 'diet_condition',
+            'body_feeling'     => 'body_feeling',
+            'sleep_condition'  => 'sleep_condition',
+            'eye_condition'    => 'eye_condition',
+            'head_feeling'     => 'head_feeling',
+            'sweat_condition'  => 'sweat_condition',
+            'skin_condition'   => 'skin_condition',
+            'urine_condition'  => 'urine_condition',
+            'stool_condition'  => 'stool_condition',
+            'kidney_condition' => 'kidney_condition',
+        ];
+
+        // 一次性查出用到的所有字典
+        $allTypes = array_values(array_unique(array_merge(array_values($singleDictFields), array_values($multiDictFields))));
+        $dictMap = self::buildDictMap($allTypes);
+
+        foreach ($singleDictFields as $field => $type) {
+            if (!array_key_exists($field, $diagnosis)) {
+                continue;
+            }
+            $diagnosis[$field . '_text'] = self::dictLabel($dictMap, $type, $diagnosis[$field]);
+        }
+        foreach ($multiDictFields as $field => $type) {
+            if (!array_key_exists($field, $diagnosis)) {
+                continue;
+            }
+            $v = $diagnosis[$field];
+            $arr = is_array($v)
+                ? $v
+                : (is_string($v) && $v !== '' ? preg_split('/[,，、]/', $v) : []);
+            $labels = [];
+            foreach ($arr as $item) {
+                $item = is_string($item) ? trim($item) : $item;
+                if ($item === '' || $item === null) {
+                    continue;
+                }
+                $labels[] = self::dictLabel($dictMap, $type, $item);
+            }
+            $diagnosis[$field . '_text'] = implode('、', array_filter($labels));
+        }
+
+        // 枚举字段
+        $diagnosis['gender_text']         = isset($diagnosis['gender']) ? self::genderText((int) $diagnosis['gender']) : '';
+        $diagnosis['marital_status_text'] = array_key_exists('marital_status', $diagnosis) ? self::maritalText($diagnosis['marital_status']) : '';
+        foreach (['trauma_history', 'surgery_history', 'allergy_history', 'family_history', 'pregnancy_history'] as $f) {
+            if (array_key_exists($f, $diagnosis)) {
+                $diagnosis[$f . '_text'] = self::yesNoText($diagnosis[$f]);
+            }
+        }
+
+        return $diagnosis;
+    }
+
+    /**
+     * 构建 type_value => [value => name] 的两级查询映射
+     *
+     * @param array $types
+     * @return array
+     */
+    private static function buildDictMap(array $types): array
+    {
+        if (empty($types)) {
+            return [];
+        }
+        $rows = DictData::whereIn('type_value', $types)
+            ->field(['type_value', 'value', 'name'])
+            ->select()
+            ->toArray();
+        $map = [];
+        foreach ($rows as $r) {
+            $tv = (string) ($r['type_value'] ?? '');
+            $v  = (string) ($r['value'] ?? '');
+            $n  = (string) ($r['name'] ?? '');
+            if ($tv === '' || $v === '') {
+                continue;
+            }
+            $map[$tv][$v] = $n;
+        }
+        return $map;
+    }
+
+    /**
+     * 找不到字典项时回显原值（避免空白）
+     */
+    private static function dictLabel(array $dictMap, string $type, $value): string
+    {
+        if ($value === null || $value === '') {
+            return '';
+        }
+        $key = (string) $value;
+        return $dictMap[$type][$key] ?? $key;
+    }
+
+    private static function genderText(int $gender): string
+    {
+        if ($gender === 1) return '男';
+        if ($gender === 0) return '女';
+        return '';
+    }
+
+    private static function maritalText($v): string
+    {
+        if ($v === null || $v === '') return '';
+        $n = (int) $v;
+        if ($n === 0) return '未婚';
+        if ($n === 1) return '已婚';
+        if ($n === 2) return '离异';
+        return '';
+    }
+
+    private static function yesNoText($v): string
+    {
+        if ($v === null || $v === '') return '';
+        return ((int) $v) === 1 ? '有' : '无';
+    }
+
+    /**
+     * @notes 通知接诊医助（按诊单 assistant_id 查企微 userid 后发应用消息）
+     * 文案固定：马上面诊到你对应的患者了，请联系患者进入诊室等待。
+     * @param int $appointmentId
+     * @return array{ok: bool, message?: string}
+     */
+    public static function notifyAssistant(int $appointmentId): array
+    {
+        try {
+            $appointment = Appointment::findOrEmpty($appointmentId);
+            if ($appointment->isEmpty()) {
+                return ['ok' => false, 'message' => '挂号记录不存在'];
+            }
+
+            $diagnosis = Diagnosis::where('id', (int) $appointment->patient_id)->find();
+            if (!$diagnosis) {
+                return ['ok' => false, 'message' => '未找到对应的诊单'];
+            }
+            $assistantId = (int) ($diagnosis->assistant_id ?? 0);
+            if ($assistantId <= 0) {
+                return ['ok' => false, 'message' => '该患者尚未指派医助'];
+            }
+
+            $assistant = Admin::whereNull('delete_time')->find($assistantId);
+            if (!$assistant) {
+                return ['ok' => false, 'message' => '医助账号不存在'];
+            }
+            $wxId = trim((string) ($assistant->work_wechat_userid ?? ''));
+            if ($wxId === '') {
+                Log::warning("接诊台通知医助跳过：医助 admin_id={$assistantId} 未绑定 work_wechat_userid");
+                return [
+                    'ok' => false,
+                    'message' => '该医助未绑定企业微信账号，无法推送消息（请其在后台「扫码绑定企业微信」后再试）',
+                ];
+            }
+
+            $patientName = (string) ($diagnosis->patient_name ?? '患者');
+            $text = "【接诊通知】马上面诊到你对应的患者了，请联系患者进入诊室等待。\n患者：{$patientName}\n时间：" . (string) $appointment->appointment_date . ' ' . (string) $appointment->appointment_time;
+
+            $result = WechatWorkAppMessageService::sendTextToUser($wxId, $text);
+            if (empty($result['ok'])) {
+                Log::warning('接诊台通知医助失败：' . ($result['message'] ?? ''));
+            }
+            return $result;
+        } catch (\Throwable $e) {
+            Log::error('接诊台通知医助异常：' . $e->getMessage());
+            return ['ok' => false, 'message' => '企业微信通知异常：' . $e->getMessage()];
+        }
+    }
+
    /**
     * 诊单列表维度：记录谁在后台发起挂号 / 取消挂号（写入失败不影响主流程）
     */
@@ -0,0 +1,205 @@
+<?php
+
+namespace app\adminapi\logic\doctor;
+
+use app\common\logic\BaseLogic;
+use app\common\model\doctor\DoctorNote;
+use app\common\service\FileService;
+
+class DoctorNoteLogic extends BaseLogic
+{
+    /**
+     * 按 diagnosis_id + 当天 find-or-create，追加 content / tongue_images / report_files
+     */
+    public static function addOrAppend(array $params): bool
+    {
+        try {
+            $diagnosisId = (int) $params['diagnosis_id'];
+            $doctorId    = (int) ($params['doctor_id'] ?? 0);
+            $today       = date('Y-m-d');
+            $time        = date('H:i');
+
+            $existing = DoctorNote::where('diagnosis_id', $diagnosisId)
+                ->where('note_date', $today)
+                ->whereNull('delete_time')
+                ->find();
+
+            $newContent = trim($params['content'] ?? '');
+            $newImages  = array_map([self::class, 'toRelativePath'], self::parseJsonArray($params['tongue_images'] ?? []));
+            $newReports = array_map([self::class, 'toRelativePath'], self::parseJsonArray($params['report_files'] ?? []));
+
+            if ($existing) {
+                $data = [];
+
+                if ($newContent !== '') {
+                    $prev = trim($existing->content ?? '');
+                    $line = "[{$time}] {$newContent}";
+                    $data['content'] = $prev !== '' ? ($prev . "\n" . $line) : $line;
+                }
+
+                if (!empty($newImages)) {
+                    $prev = self::parseJsonArray($existing->tongue_images);
+                    $merged = array_values(array_unique(array_merge($prev, $newImages)));
+                    $data['tongue_images'] = json_encode($merged, JSON_UNESCAPED_UNICODE);
+                }
+
+                if (!empty($newReports)) {
+                    $prev = self::parseJsonArray($existing->report_files);
+                    $merged = array_values(array_unique(array_merge($prev, $newReports)));
+                    $data['report_files'] = json_encode($merged, JSON_UNESCAPED_UNICODE);
+                }
+
+                if (!empty($data)) {
+                    $existing->save($data);
+                }
+            } else {
+                $content = $newContent !== '' ? "[{$time}] {$newContent}" : '';
+                DoctorNote::create([
+                    'diagnosis_id'  => $diagnosisId,
+                    'doctor_id'     => $doctorId,
+                    'note_date'     => $today,
+                    'content'       => $content,
+                    'tongue_images' => !empty($newImages)
+                        ? json_encode($newImages, JSON_UNESCAPED_UNICODE)
+                        : null,
+                    'report_files'  => !empty($newReports)
+                        ? json_encode($newReports, JSON_UNESCAPED_UNICODE)
+                        : null,
+                ]);
+            }
+
+            return true;
+        } catch (\Exception $e) {
+            self::setError($e->getMessage());
+            return false;
+        }
+    }
+
+    /**
+     * 按 diagnosis_id 获取备注列表（note_date DESC）
+     */
+    public static function getByDiagnosis(int $diagnosisId, int $limit = 30): array
+    {
+        try {
+            if ($diagnosisId <= 0) {
+                return [];
+            }
+
+            $records = DoctorNote::where('diagnosis_id', $diagnosisId)
+                ->whereNull('delete_time')
+                ->order('note_date', 'desc')
+                ->limit($limit)
+                ->select()
+                ->toArray();
+
+            foreach ($records as &$record) {
+                $record['tongue_images'] = array_map(function ($url) {
+                    return empty($url) ? $url : FileService::getFileUrl($url);
+                }, self::parseJsonArray($record['tongue_images'] ?? []));
+                $record['report_files'] = array_map(function ($url) {
+                    return empty($url) ? $url : FileService::getFileUrl($url);
+                }, self::parseJsonArray($record['report_files'] ?? []));
+            }
+
+            return $records;
+        } catch (\Exception $e) {
+            self::setError($e->getMessage());
+            return [];
+        }
+    }
+
+    /**
+     * 删除备注中的单张图片
+     */
+    public static function deleteImage(int $noteId, string $imageType, string $imagePath): bool
+    {
+        try {
+            $note = DoctorNote::where('id', $noteId)->whereNull('delete_time')->find();
+            if (!$note) {
+                self::setError('记录不存在');
+                return false;
+            }
+            if (!in_array($imageType, ['tongue_images', 'report_files'])) {
+                self::setError('类型无效');
+                return false;
+            }
+            $images = self::parseJsonArray($note->$imageType);
+            // 统一转为相对路径再匹配
+            $targetPath = self::toRelativePath($imagePath);
+            $images = array_values(array_filter($images, fn($url) => self::toRelativePath($url) !== $targetPath));
+            $note->$imageType = empty($images) ? null : json_encode($images, JSON_UNESCAPED_UNICODE);
+            $note->save();
+            return true;
+        } catch (\Exception $e) {
+            self::setError($e->getMessage());
+            return false;
+        }
+    }
+
+    /**
+     * 聚合某诊单所有备注中的图片（供 DiagnosisLogic::detail 使用）
+     */
+    public static function getAggregatedImages(int $diagnosisId): array
+    {
+        $records = DoctorNote::where('diagnosis_id', $diagnosisId)
+            ->whereNull('delete_time')
+            ->select();
+
+        $tongueImages = [];
+        $reportFiles = [];
+        foreach ($records as $r) {
+            $tongueImages = array_merge($tongueImages, self::parseJsonArray($r->tongue_images));
+            $reportFiles = array_merge($reportFiles, self::parseJsonArray($r->report_files));
+        }
+
+        return [
+            'tongue_images' => array_map(
+                fn($u) => empty($u) ? $u : FileService::getFileUrl($u),
+                array_values(array_unique($tongueImages))
+            ),
+            'report_files' => array_map(
+                fn($u) => empty($u) ? $u : FileService::getFileUrl($u),
+                array_values(array_unique($reportFiles))
+            ),
+        ];
+    }
+
+    /**
+     * 如果 URL 的域名是当前配置的存储域名则去掉，否则原样保留
+     */
+    private static function toRelativePath(string $url): string
+    {
+        if (empty($url)) return $url;
+        if (stripos($url, 'http://') !== 0 && stripos($url, 'https://') !== 0) {
+            return $url;
+        }
+        // 获取当前存储域名
+        $domain = self::getStorageDomain();
+        if ($domain && stripos($url, rtrim($domain, '/')) === 0) {
+            $relative = substr($url, strlen(rtrim($domain, '/')));
+            return ltrim($relative, '/');
+        }
+        // 非当前存储域名，保留完整 URL
+        return $url;
+    }
+
+    private static function getStorageDomain(): string
+    {
+        $default = \app\common\service\ConfigService::get('storage', 'default', 'local');
+        if ($default === 'local') {
+            return request()->domain() . '/';
+        }
+        $storage = \app\common\service\ConfigService::get('storage', $default);
+        return $storage ? ($storage['domain'] ?? '') : '';
+    }
+
+    private static function parseJsonArray($value): array
+    {
+        if (is_array($value)) return $value;
+        if (is_string($value)) {
+            $decoded = json_decode($value, true);
+            return is_array($decoded) ? $decoded : [];
+        }
+        return [];
+    }
+}
@@ -20,6 +20,8 @@ use app\common\model\tcm\DiagnosisGuahaoLog;
 use app\common\model\tcm\DiagnosisAssignLog;
 use app\common\model\tcm\ImChatMessage;
 use app\common\model\DiagnosisViewRecord;
+use app\adminapi\logic\doctor\DoctorNoteLogic;
+use app\common\service\FileService;
 use think\facade\Db;
 /**
 * 中医辨房病因诊单逻辑
@@ -79,23 +81,19 @@ class DiagnosisLogic extends BaseLogic
                }
            }
            
-            // 处理舌苔照片（JSON数组）
-            if (isset($params['tongue_images']) && is_array($params['tongue_images'])) {
-                $params['tongue_images'] = json_encode($params['tongue_images'], JSON_UNESCAPED_UNICODE);
-            }
-            
-            // 处理检查报告（JSON数组）
-            if (isset($params['report_files']) && is_array($params['report_files'])) {
-                $params['report_files'] = json_encode($params['report_files'], JSON_UNESCAPED_UNICODE);
-            }
-            
+            // 图片字段迁移至 doctor_note，从 params 中提取后再写入备注表
+            $newTongueImages = isset($params['tongue_images']) && is_array($params['tongue_images'])
+                ? $params['tongue_images'] : [];
+            $newReportFiles = isset($params['report_files']) && is_array($params['report_files'])
+                ? $params['report_files'] : [];
+            unset($params['tongue_images'], $params['report_files']);
+
            // 处理诊断日期
            if (isset($params['diagnosis_date'])) {
                $params['diagnosis_date'] = strtotime($params['diagnosis_date']);
            }

            // 表未增加 admin_id 列时勿写入，避免 SQL 报错（见 sql/1.9.20260421/add_tcm_diagnosis_admin_id.sql）
-            // 注意：Model::getConnection() 在 think-orm 中返回连接名（string），须用 Db 查询对象取字段
            if (array_key_exists('admin_id', $params)) {
                $fieldNames = Db::name('tcm_diagnosis')->getTableFields();
                if (! is_array($fieldNames) || ! in_array('admin_id', $fieldNames, true)) {
@@ -104,10 +102,19 @@ class DiagnosisLogic extends BaseLogic
            }

            $model = Diagnosis::create($params);
-            
+
+            // 图片写入 doctor_note 表
+            if (!empty($newTongueImages) || !empty($newReportFiles)) {
+                DoctorNoteLogic::addOrAppend([
+                    'diagnosis_id' => (int) $model->id,
+                    'tongue_images' => $newTongueImages,
+                    'report_files' => $newReportFiles,
+                ]);
+            }
+
            // 自动为患者创建 TRTC 账号
            self::createPatientTrtcAccount($model->id);
-            
+
            return $model->id;
        } catch (\Exception $e) {
            self::setError($e->getMessage());
@@ -178,29 +185,22 @@ class DiagnosisLogic extends BaseLogic
                }
            }
            
-            // 处理舌苔照片（JSON数组）
-            if (isset($params['tongue_images']) && is_array($params['tongue_images'])) {
-                $params['tongue_images'] = json_encode($params['tongue_images'], JSON_UNESCAPED_UNICODE);
-            }
-            
-            // 处理检查报告（JSON数组）
-            if (isset($params['report_files']) && is_array($params['report_files'])) {
-                $params['report_files'] = json_encode($params['report_files'], JSON_UNESCAPED_UNICODE);
-            }
-            
+            // 图片字段已迁移至 doctor_note 表管理，不再写入 tcm_diagnosis
+            unset($params['tongue_images'], $params['report_files']);
+
            // 处理诊断日期
            if (isset($params['diagnosis_date'])) {
                $params['diagnosis_date'] = strtotime($params['diagnosis_date']);
            }

            Diagnosis::update($params);
-            
+
            // 如果是编辑，也确保患者有 TRTC 账号
            $diagnosis = Diagnosis::find($params['id']);
            if ($diagnosis) {
                self::createPatientTrtcAccount($diagnosis->patient_id);
            }
-            
+
            return true;
        } catch (\Exception $e) {
            self::setError($e->getMessage());
@@ -256,60 +256,36 @@ class DiagnosisLogic extends BaseLogic
        }
        
 
-        if (!empty($diagnosis['tongue_images'])) {
-    // 先尝试 JSON 解析（兼容旧数据）
-    $files = json_decode($diagnosis['tongue_images'], true);
-    if (is_array($files)) {
-        $diagnosis['tongue_images'] = $files;
-    } else {
-        // JSON 解析失败则按逗号分割
-        $diagnosis['tongue_images'] = array_filter(explode(',', $diagnosis['tongue_images'])) ?: [];
-    }
-    
-    // 为没有 http 前缀的图片添加域名
-    $domain = request()->domain();
-    $diagnosis['tongue_images'] = array_map(function($url) use ($domain) {
-        if (empty($url)) {
-            return $url;
+        // 从 doctor_note 聚合图片（已迁移至备注表统一管理）
+        $noteImages = DoctorNoteLogic::getAggregatedImages((int) $diagnosis['id']);
+        if (!empty($noteImages['tongue_images']) || !empty($noteImages['report_files'])) {
+            $diagnosis['tongue_images'] = $noteImages['tongue_images'];
+            $diagnosis['report_files'] = $noteImages['report_files'];
+        } else {
+            // Fallback: 未迁移的旧数据仍从 tcm_diagnosis 读取
+            if (!empty($diagnosis['tongue_images'])) {
+                $files = json_decode($diagnosis['tongue_images'], true);
+                if (!is_array($files)) {
+                    $files = array_filter(explode(',', $diagnosis['tongue_images'])) ?: [];
+                }
+                $diagnosis['tongue_images'] = array_map(function($url) {
+                    return empty($url) ? $url : FileService::getFileUrl($url);
+                }, $files);
+            } else {
+                $diagnosis['tongue_images'] = [];
+            }
+            if (!empty($diagnosis['report_files'])) {
+                $files = json_decode($diagnosis['report_files'], true);
+                if (!is_array($files)) {
+                    $files = array_filter(explode(',', $diagnosis['report_files'])) ?: [];
+                }
+                $diagnosis['report_files'] = array_map(function($url) {
+                    return empty($url) ? $url : FileService::getFileUrl($url);
+                }, $files);
+            } else {
+                $diagnosis['report_files'] = [];
+            }
        }
-        // 如果已经包含 http:// 或 https://，则跳过
-        if (stripos($url, 'http://') === 0 || stripos($url, 'https://') === 0) {
-            return $url;
-        }
-        // 添加域名前缀
-        return $domain .'/'. $url;
-    }, $diagnosis['tongue_images']);
-} else {
-    $diagnosis['tongue_images'] = [];
-}
-        
-        // 处理检查报告（JSON转数组）
-     if (!empty($diagnosis['report_files'])) {
-    // 先尝试 JSON 解析（兼容旧数据）
-    $files = json_decode($diagnosis['report_files'], true);
-    if (is_array($files)) {
-        $diagnosis['report_files'] = $files;
-    } else {
-        // JSON 解析失败则按逗号分割
-        $diagnosis['report_files'] = array_filter(explode(',', $diagnosis['report_files'])) ?: [];
-    }
-    
-    // 为没有 http 前缀的文件添加域名
-    $domain = request()->domain();
-    $diagnosis['report_files'] = array_map(function($url) use ($domain) {
-        if (empty($url)) {
-            return $url;
-        }
-        // 如果已经包含 http:// 或 https://，则跳过
-        if (stripos($url, 'http://') === 0 || stripos($url, 'https://') === 0) {
-            return $url;
-        }
-        // 添加域名前缀
-        return $domain . $url;
-    }, $diagnosis['report_files']);
-} else {
-    $diagnosis['report_files'] = [];
-}
        // 处理诊断日期格式
        if (!empty($diagnosis['diagnosis_date'])) {
            $diagnosis['diagnosis_date'] = date('Y-m-d', $diagnosis['diagnosis_date']);
@@ -2791,12 +2767,13 @@ class DiagnosisLogic extends BaseLogic
                    $params[$field] = implode(',', $params[$field]);
                }
            }
-            if (isset($params['tongue_images']) && is_array($params['tongue_images'])) {
-                $params['tongue_images'] = json_encode($params['tongue_images'], JSON_UNESCAPED_UNICODE);
-            }
-            if (isset($params['report_files']) && is_array($params['report_files'])) {
-                $params['report_files'] = json_encode($params['report_files'], JSON_UNESCAPED_UNICODE);
-            }
+            // 图片字段迁移至 doctor_note 表
+            $cardTongueImages = isset($params['tongue_images']) && is_array($params['tongue_images'])
+                ? $params['tongue_images'] : [];
+            $cardReportFiles = isset($params['report_files']) && is_array($params['report_files'])
+                ? $params['report_files'] : [];
+            unset($params['tongue_images'], $params['report_files']);
+
            if (isset($params['diagnosis_date'])) {
                $params['diagnosis_date'] = is_numeric($params['diagnosis_date']) ? $params['diagnosis_date'] : strtotime($params['diagnosis_date']);
            }
@@ -2804,6 +2781,15 @@ class DiagnosisLogic extends BaseLogic
            $model = Diagnosis::create($params);
            self::createPatientTrtcAccount($model->patient_id);

+            // 图片写入 doctor_note
+            if (!empty($cardTongueImages) || !empty($cardReportFiles)) {
+                DoctorNoteLogic::addOrAppend([
+                    'diagnosis_id' => (int) $model->id,
+                    'tongue_images' => $cardTongueImages,
+                    'report_files' => $cardReportFiles,
+                ]);
+            }
+
            // 关联 diagnosis_view_records，便于用户通过 User::with('diagnosis') 获取就诊卡
            if ($userId) {
                $now = time();
@@ -2909,8 +2895,6 @@ class DiagnosisLogic extends BaseLogic
                // 临床信息
                'symptoms' => $params['symptoms'] ?? '',
                'tongue_coating' => $params['tongue_coating'] ?? '',
-                'tongue_images' => $params['tongue_images'] ?? '',
-                'report_files' => $params['report_files'] ?? '',
                'pulse' => $params['pulse'] ?? '',
                'treatment_principle' => $params['treatment_principle'] ?? '',
                'prescription' => $params['prescription'] ?? '',
@@ -2923,14 +2907,25 @@ class DiagnosisLogic extends BaseLogic
            if (!empty($params['diagnosis_date'])) {
                $updateData['diagnosis_date'] = strtotime($params['diagnosis_date']);
            } elseif (!empty($params['local_hospital_visit_date'])) {
-                // 如果没有diagnosis_date但有local_hospital_visit_date，则使用local_hospital_visit_date
                $updateData['diagnosis_date'] = strtotime($params['local_hospital_visit_date']);
            }
-      
-           
+
            // 执行更新
            $diagnosis->save($updateData);

+            // 图片写入 doctor_note 表
+            $cardTongueImages = isset($params['tongue_images']) && is_array($params['tongue_images'])
+                ? $params['tongue_images'] : [];
+            $cardReportFiles = isset($params['report_files']) && is_array($params['report_files'])
+                ? $params['report_files'] : [];
+            if (!empty($cardTongueImages) || !empty($cardReportFiles)) {
+                DoctorNoteLogic::addOrAppend([
+                    'diagnosis_id' => (int) $diagnosisId,
+                    'tongue_images' => $cardTongueImages,
+                    'report_files' => $cardReportFiles,
+                ]);
+            }
+
            \think\facade\Log::info('诊单更新成功 - diagnosis_id: ' . $diagnosisId . ', patient_id: ' . $patientId);

            return true;
@@ -19,11 +19,15 @@ class AppointmentValidate extends BaseValidate
        'id' => 'require',
        'patient_id' => 'require|integer',
        'doctor_id' => 'require|integer',
+        'diagnosis_id' => 'require|integer',
        'appointment_date' => 'require|date',
        'period' => 'in:morning,afternoon,all',
        'appointment_time' => 'require',
        'appointment_type' => 'in:video,text,phone',
        'channel_source' => 'require',
+        'note_id' => 'require|integer',
+        'image_type' => 'require|in:tongue_images,report_files',
+        'image_path' => 'require',
    ];

    /**
@@ -34,6 +38,7 @@ class AppointmentValidate extends BaseValidate
        'id' => '预约ID',
        'patient_id' => '患者ID',
        'doctor_id' => '医生ID',
+        'diagnosis_id' => '诊单ID',
        'appointment_date' => '预约日期',
        'period' => '时段',
        'appointment_time' => '预约时间',
@@ -85,4 +90,37 @@ class AppointmentValidate extends BaseValidate
    {
        return $this->only(['id']);
    }
+
+    /**
+     * @notes 接诊台聚合详情场景
+     * @return AppointmentValidate
+     */
+    public function sceneReception()
+    {
+        return $this->only(['id']);
+    }
+
+    /**
+     * @notes 通知接诊医助场景
+     * @return AppointmentValidate
+     */
+    public function sceneNotifyAssistant()
+    {
+        return $this->only(['id']);
+    }
+
+    public function sceneAddDoctorNote()
+    {
+        return $this->only(['diagnosis_id']);
+    }
+
+    public function sceneDoctorNotes()
+    {
+        return $this->only(['diagnosis_id']);
+    }
+
+    public function sceneDeleteDoctorNoteImage()
+    {
+        return $this->only(['note_id', 'image_type', 'image_path']);
+    }
 }
@@ -64,7 +64,7 @@ class DiagnosisValidate extends BaseValidate

    public function sceneEdit()
    {
-        return $this->only(['id', 'patient_name', 'id_card', 'phone', 'gender', 'age', 'diagnosis_date', 'diagnosis_type', 'syndrome_type', 'marital_status', 'height', 'weight', 'region', 'systolic_pressure', 'diastolic_pressure', 'fasting_blood_sugar', 'diabetes_discovery_year', 'local_hospital_diagnosis', 'local_hospital_name', 'past_history', 'symptoms', 'tongue_coating', 'pulse', 'treatment_principle', 'prescription', 'doctor_advice', 'remark', 'current_medications', 'status', 'tongue_images', 'report_files']);
+        return $this->only(['id', 'patient_name', 'id_card', 'phone', 'gender', 'age', 'diagnosis_date', 'diagnosis_type', 'syndrome_type', 'marital_status', 'height', 'weight', 'region', 'systolic_pressure', 'diastolic_pressure', 'fasting_blood_sugar', 'diabetes_discovery_year', 'local_hospital_diagnosis', 'local_hospital_name', 'past_history', 'symptoms', 'tongue_coating', 'pulse', 'treatment_principle', 'prescription', 'doctor_advice', 'remark', 'current_medications', 'status']);
    }

    public function sceneId()