患者列表改为服务端分页/筛选：支持 page、pageSize、keyword、doctorId 参数

患者详情页支持“编辑手术”流程：单手术直接编辑，多手术先进入手术列表选择
手术弹窗新增编辑模式：禁用设备结构增删，仅允许修改既有手术及设备字段
新增更新手术 API：PATCH /b/patients/:patientId/surgeries/:surgeryId
生命周期查询改为 B 端接口：GET /b/patients/:id/lifecycle
手术提交后支持回到详情并保持手术标签页，提升连续操作效率

package.json

@@ -24,6 +24,7 @@
     "@nestjs/mapped-types": "*",
     "@nestjs/platform-express": "^11.0.1",
     "@nestjs/swagger": "^11.2.6",
+    "@nestjs/throttler": "^6.5.0",
     "@prisma/adapter-pg": "^7.5.0",
     "@prisma/client": "^7.5.0",
     "bcrypt": "^6.0.0",
@@ -31,6 +32,7 @@
     "class-validator": "^0.15.1",
     "dotenv": "^17.3.1",
     "ffmpeg-static": "^5.3.0",
+    "helmet": "^8.1.0",
     "jsonwebtoken": "^9.0.3",
     "multer": "^2.1.1",
     "pg": "^8.20.0",

pnpm-lock.yaml

@@ -26,6 +26,9 @@ importers:
       '@nestjs/swagger':
         specifier: ^11.2.6
         version: 11.2.6(@nestjs/common@11.1.16(class-transformer@0.5.1)(class-validator@0.15.1)(reflect-metadata@0.2.2)(rxjs@7.8.2))(@nestjs/core@11.1.16)(class-transformer@0.5.1)(class-validator@0.15.1)(reflect-metadata@0.2.2)
+      '@nestjs/throttler':
+        specifier: ^6.5.0
+        version: 6.5.0(@nestjs/common@11.1.16(class-transformer@0.5.1)(class-validator@0.15.1)(reflect-metadata@0.2.2)(rxjs@7.8.2))(@nestjs/core@11.1.16)(reflect-metadata@0.2.2)
       '@prisma/adapter-pg':
         specifier: ^7.5.0
         version: 7.5.0
@@ -47,6 +50,9 @@ importers:
       ffmpeg-static:
         specifier: ^5.3.0
         version: 5.3.0
+      helmet:
+        specifier: ^8.1.0
+        version: 8.1.0
       jsonwebtoken:
         specifier: ^9.0.3
         version: 9.0.3
@@ -917,6 +923,13 @@ packages:
       '@nestjs/platform-express':
         optional: true
 
+  '@nestjs/throttler@6.5.0':
+    resolution: {integrity: sha512-9j0ZRfH0QE1qyrj9JjIRDz5gQLPqq9yVC2nHsrosDVAfI5HHw08/aUAWx9DZLSdQf4HDkmhTTEGLrRFHENvchQ==}
+    peerDependencies:
+      '@nestjs/common': ^7.0.0 || ^8.0.0 || ^9.0.0 || ^10.0.0 || ^11.0.0
+      '@nestjs/core': ^7.0.0 || ^8.0.0 || ^9.0.0 || ^10.0.0 || ^11.0.0
+      reflect-metadata: ^0.1.13 || ^0.2.0
+
   '@noble/hashes@1.8.0':
     resolution: {integrity: sha512-jCs9ldd7NwzpgXDIf6P3+NrHh9/sD6CQdxHyjQI+h/6rDNo88ypBxxz45UDuZHz9r3tNz7N/VInSVoVdtXEI4A==}
     engines: {node: ^14.21.3 || >=16}
@@ -2079,6 +2092,10 @@ packages:
     resolution: {integrity: sha512-0hJU9SCPvmMzIBdZFqNPXWa6dqh7WdH0cII9y+CyS8rG3nL48Bclra9HmKhVVUHyPWNH5Y7xDwAB7bfgSjkUMQ==}
     engines: {node: '>= 0.4'}
 
+  helmet@8.1.0:
+    resolution: {integrity: sha512-jOiHyAZsmnr8LqoPGmCjYAaiuWwjAPLgY8ZX2XrmHawt99/u1y6RgrZMTeoPfpUbV96HOalYgz1qzkRbw54Pmg==}
+    engines: {node: '>=18.0.0'}
+
   hono@4.11.4:
     resolution: {integrity: sha512-U7tt8JsyrxSRKspfhtLET79pU8K+tInj5QZXs1jSugO1Vq5dFj3kmZsRldo29mTBfcjDRVRXrEZ6LS63Cog9ZA==}
     engines: {node: '>=16.9.0'}
@@ -4332,6 +4349,12 @@ snapshots:
     optionalDependencies:
       '@nestjs/platform-express': 11.1.16(@nestjs/common@11.1.16(class-transformer@0.5.1)(class-validator@0.15.1)(reflect-metadata@0.2.2)(rxjs@7.8.2))(@nestjs/core@11.1.16)
 
+  '@nestjs/throttler@6.5.0(@nestjs/common@11.1.16(class-transformer@0.5.1)(class-validator@0.15.1)(reflect-metadata@0.2.2)(rxjs@7.8.2))(@nestjs/core@11.1.16)(reflect-metadata@0.2.2)':
+    dependencies:
+      '@nestjs/common': 11.1.16(class-transformer@0.5.1)(class-validator@0.15.1)(reflect-metadata@0.2.2)(rxjs@7.8.2)
+      '@nestjs/core': 11.1.16(@nestjs/common@11.1.16(class-transformer@0.5.1)(class-validator@0.15.1)(reflect-metadata@0.2.2)(rxjs@7.8.2))(@nestjs/platform-express@11.1.16)(reflect-metadata@0.2.2)(rxjs@7.8.2)
+      reflect-metadata: 0.2.2
+
   '@noble/hashes@1.8.0': {}
 
   '@nuxt/opencollective@0.4.1':
@@ -5559,6 +5582,8 @@ snapshots:
     dependencies:
       function-bind: 1.1.2
 
+  helmet@8.1.0: {}
+
   hono@4.11.4: {}
 
   html-escaper@2.0.2: {}

pnpm-workspace.yaml

@@ -1,3 +1,9 @@
 onlyBuiltDependencies:
+  - '@nestjs/core'
+  - '@prisma/engines'
+  - '@scarf/scarf'
+  - bcrypt
   - ffmpeg-static
+  - prisma
   - sharp
+  - unrs-resolver

src/app.module.ts

@@ -1,5 +1,7 @@
 import { Module } from '@nestjs/common';
+import { APP_GUARD } from '@nestjs/core';
 import { EventEmitterModule } from '@nestjs/event-emitter';
+import { ThrottlerGuard, ThrottlerModule } from '@nestjs/throttler';
 import { PrismaModule } from './prisma.module.js';
 import { UsersModule } from './users/users.module.js';
 import { TasksModule } from './tasks/tasks.module.js';
@@ -15,6 +17,16 @@ import { UploadsModule } from './uploads/uploads.module.js';
   imports: [
     PrismaModule,
     EventEmitterModule.forRoot(),
+    ThrottlerModule.forRoot({
+      errorMessage: '操作过于频繁，请稍后再试',
+      throttlers: [
+        {
+          name: 'default',
+          ttl: 60_000,
+          limit: 120,
+        },
+      ],
+    }),
     UsersModule,
     TasksModule,
     PatientsModule,
@@ -25,5 +37,11 @@ import { UploadsModule } from './uploads/uploads.module.js';
     DictionariesModule,
     UploadsModule,
   ],
+  providers: [
+    {
+      provide: APP_GUARD,
+      useClass: ThrottlerGuard,
+    },
+  ],
 })
 export class AppModule {}

src/auth/auth.controller.ts

@@ -1,5 +1,6 @@
 import { Body, Controller, Get, Post, UseGuards } from '@nestjs/common';
 import { ApiBearerAuth, ApiOperation, ApiTags } from '@nestjs/swagger';
+import { Throttle } from '@nestjs/throttler';
 import { AuthService } from './auth.service.js';
 import { AccessTokenGuard } from './access-token.guard.js';
 import { CurrentActor } from './current-actor.decorator.js';
@@ -22,6 +23,7 @@ export class AuthController {
    * 创建系统管理员（需引导密钥）。
    */
   @Post('system-admin')
+  @Throttle({ default: { limit: 3, ttl: 60_000 } })
   @ApiOperation({ summary: '创建系统管理员' })
   createSystemAdmin(@Body() dto: CreateSystemAdminDto) {
     return this.authService.createSystemAdmin(dto);
@@ -31,30 +33,35 @@ export class AuthController {
    * 院内账号密码登录：后台与小程序均可复用。
    */
   @Post('login')
+  @Throttle({ default: { limit: 5, ttl: 60_000 } })
   @ApiOperation({ summary: '院内账号密码登录' })
   login(@Body() dto: LoginDto) {
     return this.authService.login(dto);
   }
 
   @Post('login/confirm')
+  @Throttle({ default: { limit: 10, ttl: 60_000 } })
   @ApiOperation({ summary: '院内账号密码多账号确认登录' })
   confirmLogin(@Body() dto: PasswordLoginConfirmDto) {
     return this.authService.confirmLogin(dto);
   }
 
   @Post('miniapp/b/phone-login')
+  @Throttle({ default: { limit: 5, ttl: 60_000 } })
   @ApiOperation({ summary: 'B 端小程序手机号登录' })
   miniAppBLogin(@Body() dto: MiniappPhoneLoginDto) {
     return this.authService.miniAppBLogin(dto);
   }
 
   @Post('miniapp/b/phone-login/confirm')
+  @Throttle({ default: { limit: 10, ttl: 60_000 } })
   @ApiOperation({ summary: 'B 端小程序多账号确认登录' })
   miniAppBConfirmLogin(@Body() dto: MiniappPhoneLoginConfirmDto) {
     return this.authService.miniAppBConfirmLogin(dto);
   }
 
   @Post('miniapp/c/phone-login')
+  @Throttle({ default: { limit: 5, ttl: 60_000 } })
   @ApiOperation({ summary: 'C 端小程序手机号登录' })
   miniAppCLogin(@Body() dto: MiniappPhoneLoginDto) {
     return this.authService.miniAppCLogin(dto);

src/auth/wechat-miniapp/wechat-miniapp.service.ts

@@ -72,7 +72,12 @@ export class WechatMiniAppService {
       (await response.json().catch(() => null)) as WechatCode2SessionResponse | null;
 
     if (!response.ok || !payload?.openid || payload.errcode) {
-      throw new UnauthorizedException(MESSAGES.AUTH.WECHAT_MINIAPP_LOGIN_FAILED);
+      throw new UnauthorizedException(
+        this.buildWechatAuthErrorMessage(
+          MESSAGES.AUTH.WECHAT_MINIAPP_LOGIN_FAILED,
+          payload,
+        ),
+      );
     }
 
     return payload.openid;
@@ -100,7 +105,12 @@ export class WechatMiniAppService {
     const phone = payload?.phone_info?.phoneNumber;
 
     if (!response.ok || !phone || payload?.errcode) {
-      throw new UnauthorizedException(MESSAGES.AUTH.WECHAT_MINIAPP_PHONE_FAILED);
+      throw new UnauthorizedException(
+        this.buildWechatAuthErrorMessage(
+          MESSAGES.AUTH.WECHAT_MINIAPP_PHONE_FAILED,
+          payload,
+        ),
+      );
     }
 
     return phone;
@@ -128,7 +138,12 @@ export class WechatMiniAppService {
       (await response.json().catch(() => null)) as WechatAccessTokenResponse | null;
 
     if (!response.ok || !payload?.access_token || payload.errcode) {
-      throw new UnauthorizedException(MESSAGES.AUTH.WECHAT_MINIAPP_PHONE_FAILED);
+      throw new UnauthorizedException(
+        this.buildWechatAuthErrorMessage(
+          MESSAGES.AUTH.WECHAT_MINIAPP_PHONE_FAILED,
+          payload,
+        ),
+      );
     }
 
     this.accessTokenCache = {
@@ -173,4 +188,32 @@ export class WechatMiniAppService {
 
     return trimmed;
   }
+
+  /**
+   * 拼接微信开放平台原始错误，便于定位 appid/code/授权态问题。
+   */
+  private buildWechatAuthErrorMessage(
+    fallbackMessage: string,
+    payload:
+      | WechatAccessTokenResponse
+      | WechatCode2SessionResponse
+      | WechatPhoneResponse
+      | null,
+  ) {
+    const errcode =
+      payload && typeof payload.errcode === 'number' ? payload.errcode : null;
+    const errmsg =
+      payload && typeof payload.errmsg === 'string' ? payload.errmsg.trim() : '';
+
+    if (errcode == null && !errmsg) {
+      return fallbackMessage;
+    }
+
+    const details = [`errcode=${errcode ?? 'unknown'}`];
+    if (errmsg) {
+      details.push(`errmsg=${errmsg}`);
+    }
+
+    return `${fallbackMessage}（${details.join(', ')}）`;
+  }
 }

src/common/messages.ts

@@ -40,6 +40,7 @@ export const MESSAGES = {
     MINIAPP_OPEN_ID_BOUND_OTHER_FAMILY: '当前微信账号已绑定其他家属账号',
     FAMILY_PHONE_NOT_LINKED_PATIENT: '当前手机号未关联患者档案',
     FAMILY_ACCOUNT_NOT_FOUND: '家属登录账号不存在，请重新登录',
+    THROTTLED: '操作过于频繁，请稍后再试',
   },
 
   USER: {
@@ -108,6 +109,11 @@ export const MESSAGES = {
     IMPLANT_CATALOG_NOT_FOUND: '植入物型号不存在或不在当前医院可见范围内',
     SURGERY_UPDATE_NOT_SUPPORTED:
       '患者更新接口不支持直接修改手术，请使用新增手术接口',
+    SURGERY_DEVICE_SET_UPDATE_NOT_SUPPORTED:
+      '编辑手术暂不支持新增或删除植入设备，请逐项修改现有设备信息',
+    SURGERY_ABANDON_UPDATE_NOT_SUPPORTED:
+      '编辑手术暂不支持修改弃用旧设备，请通过追加手术处理',
+    SURGERY_DEVICE_TASK_CONFLICT: '存在调压任务记录的植入设备不支持修改型号',
     ABANDON_DEVICE_SCOPE_FORBIDDEN: '仅可弃用当前患者名下设备',
   },
 
@@ -144,6 +150,7 @@ export const MESSAGES = {
       '系统管理员上传文件时必须显式指定 hospitalId',
     INVALID_IMAGE_FILE: '上传的图片无法解析或压缩失败',
     INVALID_VIDEO_FILE: '上传的视频无法解析或压缩失败',
+    INVALID_FILE_SIGNATURE: '上传文件内容与声明类型不匹配',
     FFMPEG_NOT_AVAILABLE: '服务端缺少视频压缩能力',
   },
 

src/main.ts

@@ -1,24 +1,60 @@
 import 'dotenv/config';
 import { mkdirSync } from 'node:fs';
+import { basename, extname } from 'node:path';
 import { BadRequestException, ValidationPipe } from '@nestjs/common';
 import { NestFactory } from '@nestjs/core';
 import { NestExpressApplication } from '@nestjs/platform-express';
 import { DocumentBuilder, SwaggerModule } from '@nestjs/swagger';
+import helmet from 'helmet';
 import { AppModule } from './app.module.js';
 import { HttpExceptionFilter } from './common/http-exception.filter.js';
 import { MESSAGES } from './common/messages.js';
 import { ResponseEnvelopeInterceptor } from './common/response-envelope.interceptor.js';
 import { resolveUploadRootDir } from './uploads/upload-path.util.js';
 
+const INLINE_UPLOAD_EXTENSIONS = new Set([
+  '.png',
+  '.jpg',
+  '.jpeg',
+  '.gif',
+  '.bmp',
+  '.webp',
+  '.mp4',
+  '.mov',
+  '.avi',
+  '.mkv',
+  '.webm',
+]);
+
 async function bootstrap() {
-  // 创建应用实例并加载核心模块。
   const app = await NestFactory.create<NestExpressApplication>(AppModule);
-  app.enableCors();
+
+  app.use(
+    helmet({
+      contentSecurityPolicy: false,
+      crossOriginResourcePolicy: false,
+    }),
+  );
+  app.enableCors(buildCorsOptions());
+
   mkdirSync(resolveUploadRootDir(), { recursive: true });
   app.useStaticAssets(resolveUploadRootDir(), {
     prefix: '/uploads/',
+    setHeaders: (res, filePath) => {
+      const extension = extname(filePath).toLowerCase();
+      res.setHeader('X-Content-Type-Options', 'nosniff');
+
+      if (!INLINE_UPLOAD_EXTENSIONS.has(extension)) {
+        const fileName = basename(filePath);
+        res.setHeader(
+          'Content-Disposition',
+          `attachment; filename*=UTF-8''${encodeURIComponent(fileName)}`,
+        );
+        res.setHeader('Content-Type', 'application/octet-stream');
+      }
+    },
   });
-  // 全局校验：清理未知字段、自动类型转换，并将校验错误统一为中文信息。
+
   app.useGlobalPipes(
     new ValidationPipe({
       whitelist: true,
@@ -30,40 +66,98 @@ async function bootstrap() {
           .filter((item): item is string => Boolean(item));
         return new BadRequestException(
           messages.length > 0
-            ? messages.join('；')
+            ? messages.join('; ')
             : MESSAGES.DEFAULT_BAD_REQUEST,
         );
       },
     }),
   );
 
-  // 全局异常与成功响应统一格式化。
   app.useGlobalFilters(new HttpExceptionFilter());
   app.useGlobalInterceptors(new ResponseEnvelopeInterceptor());
 
-  // Swagger 文档：提供在线调试与 OpenAPI JSON 导出。
+  if (shouldEnableSwagger()) {
-  const swaggerConfig = new DocumentBuilder()
+    const swaggerBuilder = new DocumentBuilder()
-    .setTitle('TYT 多租户医疗调压系统 API')
+      .setTitle('调压通医疗平台接口文档')
-    .setDescription('后端接口文档（含认证、RBAC、任务流转与患者聚合）')
+      .setDescription('包含认证、权限、患者、手术、任务和上传等后端接口。')
       .setVersion('1.0.0')
-    .addServer('http://192.168.0.140:3000', 'localhost')
       .addBearerAuth(
         {
           type: 'http',
           scheme: 'bearer',
           bearerFormat: 'JWT',
-        description: '在此输入登录接口返回的 accessToken',
+          description: '请填写登录接口返回的访问令牌。',
         },
         'bearer',
-    )
+      );
-    .build();
 
-  const swaggerDocument = SwaggerModule.createDocument(app, swaggerConfig);
+    const publicBaseUrl = normalizeOrigin(process.env.PUBLIC_BASE_URL);
+    if (publicBaseUrl) {
+      swaggerBuilder.addServer(publicBaseUrl, '公开地址');
+    }
+
+    const swaggerDocument = SwaggerModule.createDocument(
+      app,
+      swaggerBuilder.build(),
+    );
     SwaggerModule.setup('api/docs', app, swaggerDocument, {
       jsonDocumentUrl: 'api/docs-json',
     });
+  }
 
-  // 启动 HTTP 服务。
   await app.listen(process.env.PORT ?? 3000);
 }
+
 bootstrap();
+
+function buildCorsOptions() {
+  const allowedOrigins = parseAllowedOrigins(process.env.CORS_ALLOWED_ORIGINS);
+
+  if (allowedOrigins.length === 0) {
+    return {
+      origin: process.env.NODE_ENV === 'production' ? false : true,
+      credentials: true,
+    };
+  }
+
+  return {
+    credentials: true,
+    origin: (
+      origin: string | undefined,
+      callback: (error: Error | null, allow?: boolean) => void,
+    ) => {
+      if (!origin) {
+        callback(null, true);
+        return;
+      }
+
+      callback(null, allowedOrigins.includes(normalizeOrigin(origin)));
+    },
+  };
+}
+
+function parseAllowedOrigins(value: string | undefined) {
+  if (!value) {
+    return [];
+  }
+
+  return Array.from(
+    new Set(
+      value
+        .split(',')
+        .map((origin) => normalizeOrigin(origin))
+        .filter(Boolean),
+    ),
+  );
+}
+
+function normalizeOrigin(origin: string | undefined) {
+  return String(origin ?? '').trim().replace(/\/+$/, '');
+}
+
+function shouldEnableSwagger() {
+  return (
+    process.env.ENABLE_SWAGGER === 'true' ||
+    process.env.NODE_ENV !== 'production'
+  );
+}

src/patients/b-patients/b-patients.controller.ts

@@ -17,20 +17,19 @@ import {
   ApiQuery,
   ApiTags,
 } from '@nestjs/swagger';
-import type { ActorContext } from '../../common/actor-context.js';
-import { CurrentActor } from '../../auth/current-actor.decorator.js';
 import { AccessTokenGuard } from '../../auth/access-token.guard.js';
-import { RolesGuard } from '../../auth/roles.guard.js';
+import { CurrentActor } from '../../auth/current-actor.decorator.js';
 import { Roles } from '../../auth/roles.decorator.js';
+import { RolesGuard } from '../../auth/roles.guard.js';
+import type { ActorContext } from '../../common/actor-context.js';
 import { Role } from '../../generated/prisma/enums.js';
-import { BPatientsService } from './b-patients.service.js';
 import { CreatePatientDto } from '../dto/create-patient.dto.js';
 import { CreatePatientSurgeryDto } from '../dto/create-patient-surgery.dto.js';
+import { PatientQueryDto } from '../dto/patient-query.dto.js';
+import { UpdatePatientSurgeryDto } from '../dto/update-patient-surgery.dto.js';
 import { UpdatePatientDto } from '../dto/update-patient.dto.js';
+import { BPatientsService } from './b-patients.service.js';
 
-/**
- * B 端患者控制器：院内可见性隔离查询。
- */
 @ApiTags('患者管理(B端)')
 @ApiBearerAuth('bearer')
 @Controller('b/patients')
@@ -38,9 +37,6 @@ import { UpdatePatientDto } from '../dto/update-patient.dto.js';
 export class BPatientsController {
   constructor(private readonly patientsService: BPatientsService) {}
 
-  /**
-   * 查询当前角色可选择的归属人员列表（医生/主任/组长）。
-   */
   @Get('doctors')
   @Roles(
     Role.SYSTEM_ADMIN,
@@ -49,11 +45,11 @@ export class BPatientsController {
     Role.LEADER,
     Role.DOCTOR,
   )
-  @ApiOperation({ summary: '查询当前角色可见归属人员列表' })
+  @ApiOperation({ summary: '查询当前登录人可见的医生列表' })
   @ApiQuery({
     name: 'hospitalId',
     required: false,
-    description: '系统管理员可显式指定医院',
+    description: '医院编号，仅系统管理员可选传',
   })
   findVisibleDoctors(
     @CurrentActor() actor: ActorContext,
@@ -64,9 +60,6 @@ export class BPatientsController {
     return this.patientsService.findVisibleDoctors(actor, requestedHospitalId);
   }
 
-  /**
-   * 按角色返回可见患者列表。
-   */
   @Get()
   @Roles(
     Role.SYSTEM_ADMIN,
@@ -75,25 +68,14 @@ export class BPatientsController {
     Role.LEADER,
     Role.DOCTOR,
   )
-  @ApiOperation({ summary: '按角色查询可见患者列表' })
+  @ApiOperation({ summary: '按服务端分页查询当前登录人可见的患者列表' })
-  @ApiQuery({
-    name: 'hospitalId',
-    required: false,
-    description: '系统管理员可显式指定医院',
-  })
   findVisiblePatients(
     @CurrentActor() actor: ActorContext,
-    @Query('hospitalId') hospitalId?: string,
+    @Query() query: PatientQueryDto,
   ) {
-    const requestedHospitalId =
+    return this.patientsService.findVisiblePatients(actor, query);
-      hospitalId == null || hospitalId === '' ? undefined : Number(hospitalId);
-
-    return this.patientsService.findVisiblePatients(actor, requestedHospitalId);
   }
 
-  /**
-   * 创建患者。
-   */
   @Post()
   @Roles(
     Role.SYSTEM_ADMIN,
@@ -102,7 +84,7 @@ export class BPatientsController {
     Role.LEADER,
     Role.DOCTOR,
   )
-  @ApiOperation({ summary: '创建患者' })
+  @ApiOperation({ summary: '创建患者档案' })
   createPatient(
     @CurrentActor() actor: ActorContext,
     @Body() dto: CreatePatientDto,
@@ -110,9 +92,6 @@ export class BPatientsController {
     return this.patientsService.createPatient(actor, dto);
   }
 
-  /**
-   * 为患者新增手术记录。
-   */
   @Post(':id/surgeries')
   @Roles(
     Role.SYSTEM_ADMIN,
@@ -122,7 +101,7 @@ export class BPatientsController {
     Role.DOCTOR,
   )
   @ApiOperation({ summary: '为患者新增手术记录' })
-  @ApiParam({ name: 'id', description: '患者 ID' })
+  @ApiParam({ name: 'id', description: '患者编号' })
   createPatientSurgery(
     @CurrentActor() actor: ActorContext,
     @Param('id', ParseIntPipe) id: number,
@@ -131,9 +110,43 @@ export class BPatientsController {
     return this.patientsService.createPatientSurgery(actor, id, dto);
   }
 
-  /**
+  @Patch(':id/surgeries/:surgeryId')
-   * 查询患者详情。
+  @Roles(
-   */
+    Role.SYSTEM_ADMIN,
+    Role.HOSPITAL_ADMIN,
+    Role.DIRECTOR,
+    Role.LEADER,
+    Role.DOCTOR,
+  )
+  @ApiOperation({ summary: '更新患者手术记录' })
+  @ApiParam({ name: 'id', description: '患者编号' })
+  @ApiParam({ name: 'surgeryId', description: '手术编号' })
+  updatePatientSurgery(
+    @CurrentActor() actor: ActorContext,
+    @Param('id', ParseIntPipe) id: number,
+    @Param('surgeryId', ParseIntPipe) surgeryId: number,
+    @Body() dto: UpdatePatientSurgeryDto,
+  ) {
+    return this.patientsService.updatePatientSurgery(actor, id, surgeryId, dto);
+  }
+
+  @Get(':id/lifecycle')
+  @Roles(
+    Role.SYSTEM_ADMIN,
+    Role.HOSPITAL_ADMIN,
+    Role.DIRECTOR,
+    Role.LEADER,
+    Role.DOCTOR,
+  )
+  @ApiOperation({ summary: '查询患者生命周期事件（B端详情页）' })
+  @ApiParam({ name: 'id', description: '患者编号' })
+  findPatientLifecycle(
+    @CurrentActor() actor: ActorContext,
+    @Param('id', ParseIntPipe) id: number,
+  ) {
+    return this.patientsService.findPatientLifecycle(actor, id);
+  }
+
   @Get(':id')
   @Roles(
     Role.SYSTEM_ADMIN,
@@ -143,7 +156,7 @@ export class BPatientsController {
     Role.DOCTOR,
   )
   @ApiOperation({ summary: '查询患者详情' })
-  @ApiParam({ name: 'id', description: '患者 ID' })
+  @ApiParam({ name: 'id', description: '患者编号' })
   findPatientById(
     @CurrentActor() actor: ActorContext,
     @Param('id', ParseIntPipe) id: number,
@@ -151,9 +164,6 @@ export class BPatientsController {
     return this.patientsService.findPatientById(actor, id);
   }
 
-  /**
-   * 更新患者信息。
-   */
   @Patch(':id')
   @Roles(
     Role.SYSTEM_ADMIN,
@@ -162,8 +172,8 @@ export class BPatientsController {
     Role.LEADER,
     Role.DOCTOR,
   )
-  @ApiOperation({ summary: '更新患者信息' })
+  @ApiOperation({ summary: '更新患者档案' })
-  @ApiParam({ name: 'id', description: '患者 ID' })
+  @ApiParam({ name: 'id', description: '患者编号' })
   updatePatient(
     @CurrentActor() actor: ActorContext,
     @Param('id', ParseIntPipe) id: number,
@@ -172,9 +182,6 @@ export class BPatientsController {
     return this.patientsService.updatePatient(actor, id, dto);
   }
 
-  /**
-   * 删除患者。
-   */
   @Delete(':id')
   @Roles(
     Role.SYSTEM_ADMIN,
@@ -183,8 +190,8 @@ export class BPatientsController {
     Role.LEADER,
     Role.DOCTOR,
   )
-  @ApiOperation({ summary: '删除患者' })
+  @ApiOperation({ summary: '删除患者档案' })
-  @ApiParam({ name: 'id', description: '患者 ID' })
+  @ApiParam({ name: 'id', description: '患者编号' })
   removePatient(
     @CurrentActor() actor: ActorContext,
     @Param('id', ParseIntPipe) id: number,

src/patients/b-patients/b-patients.service.ts

@@ -13,7 +13,13 @@ import { MESSAGES } from '../../common/messages.js';
 import { normalizePressureLabel } from '../../common/pressure-level.util.js';
 import { CreatePatientDto } from '../dto/create-patient.dto.js';
 import { CreatePatientSurgeryDto } from '../dto/create-patient-surgery.dto.js';
+import { PatientQueryDto } from '../dto/patient-query.dto.js';
+import { UpdatePatientSurgeryDto } from '../dto/update-patient-surgery.dto.js';
 import { UpdatePatientDto } from '../dto/update-patient.dto.js';
+import {
+  buildPatientLifecycleRecords,
+  PATIENT_LIFECYCLE_INCLUDE,
+} from '../patient-lifecycle.util.js';
 import { normalizePatientIdCard } from '../patient-id-card.util.js';
 
 type PrismaExecutor = Prisma.TransactionClient | PrismaService;
@@ -147,46 +153,32 @@ export class BPatientsService {
   /**
    * 查询当前角色可见患者列表。
    */
-  async findVisiblePatients(actor: ActorContext, requestedHospitalId?: number) {
+  async findVisiblePatients(actor: ActorContext, query: PatientQueryDto = {}) {
-    const hospitalId = this.resolveHospitalId(actor, requestedHospitalId);
+    const hospitalId = this.resolveHospitalId(actor, query.hospitalId);
-    const where = this.buildVisiblePatientWhere(actor, hospitalId);
+    const where = this.buildVisiblePatientWhere(actor, hospitalId, query);
+    const page = query.page && query.page > 0 ? query.page : 1;
+    const pageSize =
+      query.pageSize && query.pageSize > 0 && query.pageSize <= 100
+        ? query.pageSize
+        : 20;
 
-    const patients = await this.prisma.patient.findMany({
+    const [total, patients] = await this.prisma.$transaction([
+      this.prisma.patient.count({ where }),
+      this.prisma.patient.findMany({
         where,
         include: PATIENT_LIST_INCLUDE,
         orderBy: { id: 'desc' },
-    });
+        skip: (page - 1) * pageSize,
-
+        take: pageSize,
-    return patients.map((patient) => {
+      }),
-      const { _count, surgeries, ...rest } = patient;
+    ]);
-      const latestSurgery = surgeries[0] ?? null;
-      const currentDevice =
-        patient.devices.find(
-          (device) =>
-            device.status === DeviceStatus.ACTIVE && !device.isAbandoned,
-        ) ??
-        patient.devices.find((device) => !device.isAbandoned) ??
-        patient.devices[0] ??
-        null;
 
     return {
-        ...rest,
+      total,
-        primaryDisease: latestSurgery?.primaryDisease ?? null,
+      page,
-        hydrocephalusTypes: latestSurgery?.hydrocephalusTypes ?? [],
+      pageSize,
-        surgeryDate: latestSurgery?.surgeryDate ?? null,
+      list: patients.map((patient) => this.decoratePatientListItem(patient)),
-        currentPressure: currentDevice?.currentPressure ?? null,
-        initialPressure: currentDevice?.initialPressure ?? null,
-        shuntSurgeryCount: _count.surgeries,
-        latestSurgery,
-        activeDeviceCount: patient.devices.filter(
-          (device) =>
-            device.status === DeviceStatus.ACTIVE && !device.isAbandoned,
-        ).length,
-        abandonedDeviceCount: patient.devices.filter(
-          (device) => device.isAbandoned,
-        ).length,
     };
-    });
   }
 
   /**
@@ -313,6 +305,47 @@ export class BPatientsService {
     });
   }
 
+  /**
+   * 编辑患者既有手术记录，仅允许修改手术主信息与既有设备信息。
+   */
+  async updatePatientSurgery(
+    actor: ActorContext,
+    patientId: number,
+    surgeryId: number,
+    dto: UpdatePatientSurgeryDto,
+  ) {
+    const patient = await this.findPatientWithScope(patientId);
+    this.assertPatientScope(actor, patient);
+
+    return this.prisma.$transaction(async (tx) => {
+      const currentSurgery = await this.findPatientSurgeryForUpdate(
+        tx,
+        patient.id,
+        surgeryId,
+      );
+      const updatedSurgery = await this.updatePatientSurgeryRecord(
+        tx,
+        actor,
+        patient.id,
+        patient.doctorId,
+        currentSurgery,
+        dto,
+      );
+
+      const detail = await this.loadPatientDetail(tx, patient.id);
+      const decoratedPatient = this.decoratePatientDetail(detail);
+      const updated = decoratedPatient.surgeries.find(
+        (surgery) => surgery.id === updatedSurgery.id,
+      );
+
+      if (!updated) {
+        throw new NotFoundException(MESSAGES.PATIENT.SURGERY_NOT_FOUND);
+      }
+
+      return updated;
+    });
+  }
+
   /**
    * 查询患者详情。
    */
@@ -322,6 +355,25 @@ export class BPatientsService {
     return this.decoratePatientDetail(patient);
   }
 
+  async findPatientLifecycle(actor: ActorContext, id: number) {
+    const patient = await this.prisma.patient.findUnique({
+      where: { id },
+      include: PATIENT_LIFECYCLE_INCLUDE,
+    });
+
+    if (!patient) {
+      throw new NotFoundException(MESSAGES.PATIENT.NOT_FOUND);
+    }
+
+    this.assertPatientScope(actor, patient);
+
+    return {
+      patientId: patient.id,
+      patientCount: 1,
+      lifecycle: buildPatientLifecycleRecords([patient]),
+    };
+  }
+
   /**
    * 更新患者基础信息。
    */
@@ -425,6 +477,44 @@ export class BPatientsService {
     return patient;
   }
 
+  private async findPatientSurgeryForUpdate(
+    prisma: PrismaExecutor,
+    patientId: number,
+    surgeryId: number,
+  ) {
+    const normalizedSurgeryId = Number(surgeryId);
+    if (!Number.isInteger(normalizedSurgeryId)) {
+      throw new BadRequestException('surgeryId 必须为整数');
+    }
+
+    const surgery = await prisma.patientSurgery.findFirst({
+      where: {
+        id: normalizedSurgeryId,
+        patientId,
+      },
+      include: {
+        devices: {
+          select: {
+            id: true,
+            implantCatalogId: true,
+            currentPressure: true,
+            taskItems: {
+              select: { id: true },
+              take: 1,
+            },
+          },
+          orderBy: { id: 'desc' },
+        },
+      },
+    });
+
+    if (!surgery) {
+      throw new NotFoundException(MESSAGES.PATIENT.SURGERY_NOT_FOUND);
+    }
+
+    return surgery;
+  }
+
   /**
    * 校验当前角色是否可操作该患者。
    */
@@ -529,8 +619,12 @@ export class BPatientsService {
   /**
    * 按角色构造患者可见性查询条件。
    */
-  private buildVisiblePatientWhere(actor: ActorContext, hospitalId: number) {
+  private buildVisiblePatientWhere(
-    const where: Record<string, unknown> = { hospitalId };
+    actor: ActorContext,
+    hospitalId: number,
+    query: PatientQueryDto = {},
+  ) {
+    const where: Prisma.PatientWhereInput = { hospitalId };
     switch (actor.role) {
       case Role.DOCTOR:
         where.doctorId = actor.id;
@@ -559,6 +653,71 @@ export class BPatientsService {
       default:
         throw new ForbiddenException(MESSAGES.PATIENT.ROLE_FORBIDDEN);
     }
+
+    if (query.doctorId != null) {
+      const doctorId = this.toInt(query.doctorId, 'doctorId');
+      if (actor.role === Role.DOCTOR && doctorId !== actor.id) {
+        throw new ForbiddenException(MESSAGES.PATIENT.DOCTOR_SCOPE_FORBIDDEN);
+      }
+      where.doctorId = doctorId;
+    }
+
+    const keyword = query.keyword?.trim();
+    if (keyword) {
+      where.OR = [
+        {
+          name: {
+            contains: keyword,
+            mode: 'insensitive',
+          },
+        },
+        {
+          phone: {
+            contains: keyword,
+            mode: 'insensitive',
+          },
+        },
+        {
+          idCard: {
+            contains: keyword,
+            mode: 'insensitive',
+          },
+        },
+        {
+          inpatientNo: {
+            contains: keyword,
+            mode: 'insensitive',
+          },
+        },
+        {
+          doctor: {
+            name: {
+              contains: keyword,
+              mode: 'insensitive',
+            },
+          },
+        },
+        {
+          hospital: {
+            name: {
+              contains: keyword,
+              mode: 'insensitive',
+            },
+          },
+        },
+        {
+          surgeries: {
+            some: {
+              surgeryName: {
+                contains: keyword,
+                mode: 'insensitive',
+              },
+            },
+          },
+        },
+      ];
+    }
+
     return where;
   }
 
@@ -773,6 +932,204 @@ export class BPatientsService {
     return surgery;
   }
 
+  private async updatePatientSurgeryRecord(
+    prisma: PrismaExecutor,
+    actor: ActorContext,
+    patientId: number,
+    patientDoctorId: number,
+    currentSurgery: Awaited<
+      ReturnType<BPatientsService['findPatientSurgeryForUpdate']>
+    >,
+    dto: UpdatePatientSurgeryDto,
+  ) {
+    if (
+      Array.isArray(dto.abandonedDeviceIds) &&
+      dto.abandonedDeviceIds.length > 0
+    ) {
+      throw new BadRequestException(
+        MESSAGES.PATIENT.SURGERY_ABANDON_UPDATE_NOT_SUPPORTED,
+      );
+    }
+
+    const existingDeviceMap = new Map(
+      currentSurgery.devices.map((device) => [device.id, device]),
+    );
+    const requestedDeviceIds = dto.devices.map((device, index) =>
+      this.toInt(device.id, `devices[${index}].id`),
+    );
+    const uniqueRequestedIds = Array.from(new Set(requestedDeviceIds));
+
+    if (
+      requestedDeviceIds.length !== currentSurgery.devices.length ||
+      uniqueRequestedIds.length !== currentSurgery.devices.length ||
+      uniqueRequestedIds.some((deviceId) => !existingDeviceMap.has(deviceId))
+    ) {
+      throw new BadRequestException(
+        MESSAGES.PATIENT.SURGERY_DEVICE_SET_UPDATE_NOT_SUPPORTED,
+      );
+    }
+
+    const catalogIds = Array.from(
+      new Set(
+        dto.devices.map((device) =>
+          this.toInt(device.implantCatalogId, 'implantCatalogId'),
+        ),
+      ),
+    );
+
+    const [catalogMap, surgeon] = await Promise.all([
+      this.resolveImplantCatalogMap(prisma, catalogIds),
+      this.resolveWritableDoctor(actor, patientDoctorId),
+    ]);
+
+    await prisma.patientSurgery.update({
+      where: { id: currentSurgery.id },
+      data: {
+        surgeryDate: this.normalizeIsoDate(dto.surgeryDate, 'surgeryDate'),
+        surgeryName: this.normalizeRequiredString(
+          dto.surgeryName,
+          'surgeryName',
+        ),
+        surgeonId: surgeon.id,
+        surgeonName: surgeon.name,
+        preOpPressure:
+          dto.preOpPressure == null
+            ? null
+            : this.normalizeNonNegativeInteger(
+                dto.preOpPressure,
+                'preOpPressure',
+              ),
+        primaryDisease: this.normalizeRequiredString(
+          dto.primaryDisease,
+          'primaryDisease',
+        ),
+        hydrocephalusTypes: this.normalizeStringArray(
+          dto.hydrocephalusTypes,
+          'hydrocephalusTypes',
+        ),
+        previousShuntSurgeryDate: dto.previousShuntSurgeryDate
+          ? this.normalizeIsoDate(
+              dto.previousShuntSurgeryDate,
+              'previousShuntSurgeryDate',
+            )
+          : null,
+        preOpMaterials:
+          dto.preOpMaterials == null
+            ? Prisma.DbNull
+            : this.normalizePreOpMaterials(dto.preOpMaterials),
+        notes:
+          dto.notes === undefined
+            ? null
+            : this.normalizeNullableString(dto.notes, 'notes'),
+      },
+    });
+
+    for (const device of dto.devices) {
+      const deviceId = this.toInt(device.id, 'devices.id');
+      const currentDevice = existingDeviceMap.get(deviceId);
+      if (!currentDevice) {
+        throw new BadRequestException(
+          MESSAGES.PATIENT.SURGERY_DEVICE_SET_UPDATE_NOT_SUPPORTED,
+        );
+      }
+
+      const catalogId = this.toInt(device.implantCatalogId, 'implantCatalogId');
+      const catalog = catalogMap.get(catalogId);
+      if (!catalog) {
+        throw new NotFoundException(MESSAGES.PATIENT.IMPLANT_CATALOG_NOT_FOUND);
+      }
+
+      const catalogChanged = currentDevice.implantCatalogId !== catalog.id;
+      if (catalogChanged && currentDevice.taskItems.length > 0) {
+        throw new ConflictException(
+          MESSAGES.PATIENT.SURGERY_DEVICE_TASK_CONFLICT,
+        );
+      }
+
+      const initialPressure =
+        !catalog.isValve || device.initialPressure == null
+          ? null
+          : this.assertPressureLevelAllowed(
+              catalog,
+              this.normalizePressureLevel(
+                device.initialPressure,
+                'initialPressure',
+              ),
+            );
+      const currentPressure = catalogChanged
+        ? this.resolveUpdatedSurgeryDeviceCurrentPressure(
+            currentDevice.currentPressure,
+            catalog,
+            initialPressure,
+          )
+        : currentDevice.currentPressure;
+
+      await prisma.device.update({
+        where: {
+          id: currentDevice.id,
+        },
+        data: {
+          patient: { connect: { id: patientId } },
+          surgery: { connect: { id: currentSurgery.id } },
+          implantCatalog: { connect: { id: catalog.id } },
+          currentPressure,
+          implantModel: catalog.modelCode,
+          implantManufacturer: catalog.manufacturer,
+          implantName: catalog.name,
+          isValve: catalog.isValve,
+          isPressureAdjustable: catalog.isPressureAdjustable,
+          shuntMode: this.normalizeRequiredString(
+            device.shuntMode,
+            'shuntMode',
+          ),
+          proximalPunctureAreas: this.normalizeStringArray(
+            device.proximalPunctureAreas,
+            'proximalPunctureAreas',
+          ),
+          valvePlacementSites: catalog.isValve
+            ? this.normalizeStringArray(
+                device.valvePlacementSites,
+                'valvePlacementSites',
+              )
+            : this.normalizeOptionalStringArray(
+                device.valvePlacementSites,
+                'valvePlacementSites',
+              ),
+          distalShuntDirection: this.normalizeRequiredString(
+            device.distalShuntDirection,
+            'distalShuntDirection',
+          ),
+          initialPressure,
+          implantNotes:
+            device.implantNotes === undefined
+              ? null
+              : this.normalizeNullableString(
+                  device.implantNotes,
+                  'implantNotes',
+                ),
+          labelImageUrl:
+            device.labelImageUrl === undefined
+              ? null
+              : this.normalizeNullableString(
+                  device.labelImageUrl,
+                  'labelImageUrl',
+                ),
+        },
+      });
+    }
+
+    const updatedSurgery = await prisma.patientSurgery.findUnique({
+      where: { id: currentSurgery.id },
+      include: PATIENT_SURGERY_DETAIL_INCLUDE,
+    });
+
+    if (!updatedSurgery) {
+      throw new NotFoundException(MESSAGES.PATIENT.SURGERY_NOT_FOUND);
+    }
+
+    return updatedSurgery;
+  }
+
   /**
    * 解析并校验植入物型号字典。
    */
@@ -825,9 +1182,90 @@ export class BPatientsService {
     return pressure;
   }
 
+  private resolveUpdatedSurgeryDeviceCurrentPressure(
+    currentPressure: string,
+    catalog: {
+      isValve: boolean;
+      isPressureAdjustable: boolean;
+      pressureLevels: string[];
+    },
+    initialPressure: string | null,
+  ) {
+    if (!catalog.isValve) {
+      return '0';
+    }
+
+    const fallbackPressureLevel =
+      catalog.pressureLevels.length > 0 ? catalog.pressureLevels[0] : '0';
+    const normalizedCurrentPressure = this.normalizePressureLevel(
+      currentPressure,
+      'currentPressure',
+    );
+
+    if (
+      catalog.isPressureAdjustable &&
+      catalog.pressureLevels.length > 0 &&
+      catalog.pressureLevels.includes(normalizedCurrentPressure)
+    ) {
+      return normalizedCurrentPressure;
+    }
+
+    if (!catalog.isPressureAdjustable) {
+      return (
+        normalizedCurrentPressure || initialPressure || fallbackPressureLevel
+      );
+    }
+
+    return this.assertPressureLevelAllowed(
+      catalog,
+      initialPressure ?? fallbackPressureLevel,
+    );
+  }
+
   /**
    * 将患者详情补全为前端可直接消费的结构。
    */
+  private decoratePatientListItem(
+    patient: Prisma.PatientGetPayload<{ include: typeof PATIENT_LIST_INCLUDE }>,
+  ) {
+    const latestSurgery = patient.surgeries[0] ?? null;
+    const currentDevice =
+      patient.devices.find(
+        (device) =>
+          device.status === DeviceStatus.ACTIVE && !device.isAbandoned,
+      ) ??
+      patient.devices.find((device) => !device.isAbandoned) ??
+      patient.devices[0] ??
+      null;
+
+    return {
+      id: patient.id,
+      name: patient.name,
+      inpatientNo: patient.inpatientNo,
+      phone: patient.phone,
+      idCard: patient.idCard,
+      hospitalId: patient.hospitalId,
+      doctorId: patient.doctorId,
+      hospital: patient.hospital,
+      doctor: patient.doctor,
+      devices: patient.devices,
+      primaryDisease: latestSurgery?.primaryDisease ?? null,
+      hydrocephalusTypes: latestSurgery?.hydrocephalusTypes ?? [],
+      surgeryDate: latestSurgery?.surgeryDate ?? null,
+      currentPressure: currentDevice?.currentPressure ?? null,
+      initialPressure: currentDevice?.initialPressure ?? null,
+      shuntSurgeryCount: patient._count.surgeries,
+      latestSurgery,
+      activeDeviceCount: patient.devices.filter(
+        (device) =>
+          device.status === DeviceStatus.ACTIVE && !device.isAbandoned,
+      ).length,
+      abandonedDeviceCount: patient.devices.filter(
+        (device) => device.isAbandoned,
+      ).length,
+    };
+  }
+
   private decoratePatientDetail(
     patient: Awaited<ReturnType<BPatientsService['findPatientWithScope']>>,
   ) {

src/patients/c-patients/c-patients.service.ts

@@ -1,20 +1,15 @@
-import {
+import { Injectable, NotFoundException } from '@nestjs/common';
-  Injectable,
-  NotFoundException,
-} from '@nestjs/common';
-import { PrismaService } from '../../prisma.service.js';
 import { MESSAGES } from '../../common/messages.js';
+import { PrismaService } from '../../prisma.service.js';
+import {
+  buildPatientLifecycleRecords,
+  PATIENT_LIFECYCLE_INCLUDE,
+} from '../patient-lifecycle.util.js';
 
-/**
- * C 端患者服务：承载家属跨院生命周期聚合查询。
- */
 @Injectable()
 export class CPatientsService {
   constructor(private readonly prisma: PrismaService) {}
 
-  /**
-   * C 端查询：按当前家属账号绑定手机号跨院聚合患者生命周期记录。
-   */
   async getFamilyLifecycleByAccount(accountId: number) {
     const account = await this.prisma.familyMiniAppAccount.findUnique({
       where: { id: accountId },
@@ -31,180 +26,16 @@ export class CPatientsService {
       where: {
         phone: account.phone,
       },
-      include: {
+      include: PATIENT_LIFECYCLE_INCLUDE,
-        hospital: { select: { id: true, name: true } },
-        surgeries: {
-          include: {
-            devices: {
-              include: {
-                implantCatalog: {
-                  select: {
-                    id: true,
-                    modelCode: true,
-                    manufacturer: true,
-                    name: true,
-                    isValve: true,
-                    pressureLevels: true,
-                    isPressureAdjustable: true,
-                    notes: true,
-                  },
-                },
-              },
-            },
-          },
-          orderBy: { surgeryDate: 'desc' },
-        },
-        devices: {
-          include: {
-            surgery: {
-              select: {
-                id: true,
-                surgeryDate: true,
-                surgeryName: true,
-              },
-            },
-            implantCatalog: {
-              select: {
-                id: true,
-                modelCode: true,
-                manufacturer: true,
-                name: true,
-                isValve: true,
-                pressureLevels: true,
-                isPressureAdjustable: true,
-                notes: true,
-              },
-            },
-            taskItems: {
-              include: {
-                task: true,
-              },
-            },
-          },
-        },
-      },
     });
     if (patients.length === 0) {
       throw new NotFoundException(MESSAGES.PATIENT.LIFE_CYCLE_NOT_FOUND);
     }
 
-    const lifecycle = patients
-      .flatMap((patient) => {
-        const surgeryEvents = patient.surgeries.map(
-          (surgery, index, surgeries) => ({
-            eventType: 'SURGERY',
-            occurredAt: surgery.surgeryDate,
-            hospital: patient.hospital,
-            patient: {
-              id: this.toJsonNumber(patient.id),
-              name: patient.name,
-              inpatientNo: patient.inpatientNo,
-              projectName: patient.projectName,
-            },
-            surgery: {
-              id: this.toJsonNumber(surgery.id),
-              surgeryDate: surgery.surgeryDate,
-              surgeryName: surgery.surgeryName,
-              surgeonName: surgery.surgeonName,
-              primaryDisease: surgery.primaryDisease,
-              hydrocephalusTypes: surgery.hydrocephalusTypes,
-              previousShuntSurgeryDate: surgery.previousShuntSurgeryDate,
-              shuntSurgeryCount: surgeries.length - index,
-            },
-            devices: surgery.devices.map((device) => ({
-              id: this.toJsonNumber(device.id),
-              status: device.status,
-              isAbandoned: device.isAbandoned,
-              currentPressure: device.currentPressure,
-              initialPressure: device.initialPressure,
-              implantModel: device.implantModel,
-              implantManufacturer: device.implantManufacturer,
-              implantName: device.implantName,
-              isValve: device.isValve,
-              isPressureAdjustable: device.isPressureAdjustable,
-              shuntMode: device.shuntMode,
-              distalShuntDirection: device.distalShuntDirection,
-              proximalPunctureAreas: device.proximalPunctureAreas,
-              valvePlacementSites: device.valvePlacementSites,
-              implantCatalog: device.implantCatalog,
-            })),
-          }),
-        );
-
-        const taskEvents = patient.devices.flatMap((device) =>
-          device.taskItems.flatMap((taskItem) => {
-            // 容错：若存在脏数据导致 task 为空，直接跳过该条明细，避免接口 500。
-            if (!taskItem.task) {
-              return [];
-            }
-
-            const task = taskItem.task;
-            return [
-              {
-                eventType: 'TASK_PRESSURE_ADJUSTMENT',
-                occurredAt: task.createdAt,
-                hospital: patient.hospital,
-                patient: {
-                  id: this.toJsonNumber(patient.id),
-                  name: patient.name,
-                  inpatientNo: patient.inpatientNo,
-                  projectName: patient.projectName,
-                },
-                device: {
-                  id: this.toJsonNumber(device.id),
-                  status: device.status,
-                  isAbandoned: device.isAbandoned,
-                  currentPressure: device.currentPressure,
-                  implantModel: device.implantModel,
-                  implantManufacturer: device.implantManufacturer,
-                  implantName: device.implantName,
-                  isValve: device.isValve,
-                  isPressureAdjustable: device.isPressureAdjustable,
-                },
-                surgery: device.surgery
-                  ? {
-                      id: this.toJsonNumber(device.surgery.id),
-                      surgeryDate: device.surgery.surgeryDate,
-                      surgeryName: device.surgery.surgeryName,
-                    }
-                  : null,
-                task: {
-                  id: this.toJsonNumber(task.id),
-                  status: task.status,
-                  createdAt: task.createdAt,
-                },
-                taskItem: {
-                  id: this.toJsonNumber(taskItem.id),
-                  oldPressure: taskItem.oldPressure,
-                  targetPressure: taskItem.targetPressure,
-                },
-              },
-            ];
-          }),
-        );
-
-        return [...surgeryEvents, ...taskEvents];
-      })
-      .sort(
-        (a, b) =>
-          new Date(b.occurredAt).getTime() - new Date(a.occurredAt).getTime(),
-      );
-
     return {
-      // 前端详情弹窗和现有 E2E 都依赖这两个回显字段。
       phone: account.phone,
       patientCount: patients.length,
-      lifecycle,
+      lifecycle: buildPatientLifecycleRecords(patients),
     };
   }
-
-  /**
-   * 统一将 number/bigint 转为可 JSON 序列化的 number，避免 BigInt 序列化异常。
-   */
-  private toJsonNumber(value: number | bigint | null | undefined) {
-    if (value == null) {
-      return null;
-    }
-    return typeof value === 'bigint' ? Number(value) : value;
-  }
 }

src/patients/dto/create-patient-surgery.dto.ts

@@ -95,7 +95,7 @@ export class CreatePatientSurgeryDto {
   devices!: CreateSurgeryDeviceDto[];
 
   @ApiPropertyOptional({
-    description: '本次手术后需弃用的历史设备 ID 列表',
+    description: '本次手术后需弃用的历史设备编号列表',
     type: [Number],
     example: [1],
   })

src/patients/dto/create-patient.dto.ts

@@ -40,7 +40,7 @@ export class CreatePatientDto {
   @IsString({ message: 'idCard 必须是字符串' })
   idCard!: string;
 
-  @ApiProperty({ description: '归属人员 ID（医生/主任/组长）', example: 10001 })
+  @ApiProperty({ description: '归属人员编号（医生/主任/组长）', example: 10001 })
   @Type(() => Number)
   @IsInt({ message: 'doctorId 必须是整数' })
   @Min(1, { message: 'doctorId 必须大于 0' })

src/patients/dto/create-surgery-device.dto.ts

@@ -15,7 +15,7 @@ import {
  */
 export class CreateSurgeryDeviceDto {
   @ApiProperty({
-    description: '植入物型号 ID，选中后自动回填厂家与名称',
+    description: '植入物型号编号，选中后自动回填厂家与名称',
     example: 1,
   })
   @Type(() => Number)

src/patients/dto/patient-query.dto.ts

@@ -0,0 +1,51 @@
+import { ApiPropertyOptional } from '@nestjs/swagger';
+import { Type } from 'class-transformer';
+import { EmptyStringToUndefined } from '../../common/transforms/empty-string-to-undefined.transform.js';
+import { IsInt, IsOptional, IsString, Max, Min } from 'class-validator';
+
+export class PatientQueryDto {
+  @ApiPropertyOptional({
+    description: '患者名称、手机号、住院号、医生、医院或手术名称关键字',
+    example: 'VPS',
+  })
+  @IsOptional()
+  @IsString({ message: 'keyword 必须为字符串' })
+  keyword?: string;
+
+  @ApiPropertyOptional({ description: '医院编号', example: 1 })
+  @IsOptional()
+  @EmptyStringToUndefined()
+  @Type(() => Number)
+  @IsInt({ message: 'hospitalId 必须为整数' })
+  @Min(1, { message: 'hospitalId 必须大于 0' })
+  hospitalId?: number;
+
+  @ApiPropertyOptional({ description: '医生编号', example: 1 })
+  @IsOptional()
+  @EmptyStringToUndefined()
+  @Type(() => Number)
+  @IsInt({ message: 'doctorId 必须为整数' })
+  @Min(1, { message: 'doctorId 必须大于 0' })
+  doctorId?: number;
+
+  @ApiPropertyOptional({ description: '页码', example: 1, default: 1 })
+  @IsOptional()
+  @EmptyStringToUndefined()
+  @Type(() => Number)
+  @IsInt({ message: 'page 必须为整数' })
+  @Min(1, { message: 'page 最小值为 1' })
+  page?: number = 1;
+
+  @ApiPropertyOptional({
+    description: '每页条数',
+    example: 20,
+    default: 20,
+  })
+  @IsOptional()
+  @EmptyStringToUndefined()
+  @Type(() => Number)
+  @IsInt({ message: 'pageSize 必须为整数' })
+  @Min(1, { message: 'pageSize 最小值为 1' })
+  @Max(100, { message: 'pageSize 最大值为 100' })
+  pageSize?: number = 20;
+}

src/patients/dto/update-patient-surgery.dto.ts

@@ -0,0 +1,17 @@
+import { ApiProperty } from '@nestjs/swagger';
+import { Type } from 'class-transformer';
+import { ArrayMinSize, IsArray, ValidateNested } from 'class-validator';
+import { CreatePatientSurgeryDto } from './create-patient-surgery.dto.js';
+import { UpdateSurgeryDeviceDto } from './update-surgery-device.dto.js';
+
+export class UpdatePatientSurgeryDto extends CreatePatientSurgeryDto {
+  @ApiProperty({
+    description: '本次手术植入设备列表，编辑时需回传已有设备编号',
+    type: [UpdateSurgeryDeviceDto],
+  })
+  @IsArray({ message: 'devices 必须是数组' })
+  @ArrayMinSize(1, { message: 'devices 至少录入 1 个设备' })
+  @ValidateNested({ each: true })
+  @Type(() => UpdateSurgeryDeviceDto)
+  declare devices: UpdateSurgeryDeviceDto[];
+}

src/patients/dto/update-surgery-device.dto.ts

@@ -0,0 +1,16 @@
+import { ApiPropertyOptional } from '@nestjs/swagger';
+import { Type } from 'class-transformer';
+import { IsInt, IsOptional, Min } from 'class-validator';
+import { CreateSurgeryDeviceDto } from './create-surgery-device.dto.js';
+
+export class UpdateSurgeryDeviceDto extends CreateSurgeryDeviceDto {
+  @ApiPropertyOptional({
+    description: '已存在的手术设备编号，编辑手术时必传',
+    example: 12,
+  })
+  @IsOptional()
+  @Type(() => Number)
+  @IsInt({ message: 'devices.id 必须为整数' })
+  @Min(1, { message: 'devices.id 必须大于 0' })
+  id?: number;
+}

src/patients/patient-lifecycle.util.ts

@@ -0,0 +1,164 @@
+import { Prisma } from '../generated/prisma/client.js';
+
+const IMPLANT_CATALOG_SELECT = {
+  id: true,
+  modelCode: true,
+  manufacturer: true,
+  name: true,
+  isValve: true,
+  pressureLevels: true,
+  isPressureAdjustable: true,
+  notes: true,
+} as const;
+
+export const PATIENT_LIFECYCLE_INCLUDE = {
+  hospital: { select: { id: true, name: true } },
+  doctor: { select: { departmentId: true, groupId: true } },
+  surgeries: {
+    include: {
+      devices: {
+        include: {
+          implantCatalog: {
+            select: IMPLANT_CATALOG_SELECT,
+          },
+        },
+      },
+    },
+    orderBy: { surgeryDate: 'desc' },
+  },
+  devices: {
+    include: {
+      surgery: {
+        select: {
+          id: true,
+          surgeryDate: true,
+          surgeryName: true,
+        },
+      },
+      implantCatalog: {
+        select: IMPLANT_CATALOG_SELECT,
+      },
+      taskItems: {
+        include: {
+          task: true,
+        },
+      },
+    },
+  },
+} as const satisfies Prisma.PatientInclude;
+
+export type PatientLifecycleSource = Prisma.PatientGetPayload<{
+  include: typeof PATIENT_LIFECYCLE_INCLUDE;
+}>;
+
+export function buildPatientLifecycleRecords(
+  patients: PatientLifecycleSource[],
+) {
+  return patients
+    .flatMap((patient) => {
+      const surgeryEvents = patient.surgeries.map((surgery, index, surgeries) => ({
+        eventType: 'SURGERY',
+        occurredAt: surgery.surgeryDate,
+        hospital: patient.hospital,
+        patient: {
+          id: toJsonNumber(patient.id),
+          name: patient.name,
+          inpatientNo: patient.inpatientNo,
+          projectName: patient.projectName,
+        },
+        surgery: {
+          id: toJsonNumber(surgery.id),
+          surgeryDate: surgery.surgeryDate,
+          surgeryName: surgery.surgeryName,
+          surgeonName: surgery.surgeonName,
+          primaryDisease: surgery.primaryDisease,
+          hydrocephalusTypes: surgery.hydrocephalusTypes,
+          previousShuntSurgeryDate: surgery.previousShuntSurgeryDate,
+          shuntSurgeryCount: surgeries.length - index,
+        },
+        devices: surgery.devices.map((device) => ({
+          id: toJsonNumber(device.id),
+          status: device.status,
+          isAbandoned: device.isAbandoned,
+          currentPressure: device.currentPressure,
+          initialPressure: device.initialPressure,
+          implantModel: device.implantModel,
+          implantManufacturer: device.implantManufacturer,
+          implantName: device.implantName,
+          isValve: device.isValve,
+          isPressureAdjustable: device.isPressureAdjustable,
+          shuntMode: device.shuntMode,
+          distalShuntDirection: device.distalShuntDirection,
+          proximalPunctureAreas: device.proximalPunctureAreas,
+          valvePlacementSites: device.valvePlacementSites,
+          implantCatalog: device.implantCatalog,
+        })),
+      }));
+
+      const taskEvents = patient.devices.flatMap((device) =>
+        device.taskItems.flatMap((taskItem) => {
+          if (!taskItem.task) {
+            return [];
+          }
+
+          const task = taskItem.task;
+          return [
+            {
+              eventType: 'TASK_PRESSURE_ADJUSTMENT',
+              occurredAt: task.createdAt,
+              hospital: patient.hospital,
+              patient: {
+                id: toJsonNumber(patient.id),
+                name: patient.name,
+                inpatientNo: patient.inpatientNo,
+                projectName: patient.projectName,
+              },
+              device: {
+                id: toJsonNumber(device.id),
+                status: device.status,
+                isAbandoned: device.isAbandoned,
+                currentPressure: device.currentPressure,
+                implantModel: device.implantModel,
+                implantManufacturer: device.implantManufacturer,
+                implantName: device.implantName,
+                isValve: device.isValve,
+                isPressureAdjustable: device.isPressureAdjustable,
+              },
+              surgery: device.surgery
+                ? {
+                    id: toJsonNumber(device.surgery.id),
+                    surgeryDate: device.surgery.surgeryDate,
+                    surgeryName: device.surgery.surgeryName,
+                  }
+                : null,
+              task: {
+                id: toJsonNumber(task.id),
+                status: task.status,
+                createdAt: task.createdAt,
+              },
+              taskItem: {
+                id: toJsonNumber(taskItem.id),
+                oldPressure: taskItem.oldPressure,
+                targetPressure: taskItem.targetPressure,
+              },
+            },
+          ];
+        }),
+      );
+
+      return [...surgeryEvents, ...taskEvents];
+    })
+    .sort(
+      (left, right) =>
+        new Date(right.occurredAt).getTime() -
+        new Date(left.occurredAt).getTime(),
+    );
+}
+
+function toJsonNumber(value: number | bigint | null | undefined) {
+  if (value == null) {
+    return null;
+  }
+
+  return typeof value === 'bigint' ? Number(value) : value;
+}

src/uploads/b-uploads/b-uploads.controller.ts

@@ -36,6 +36,19 @@ import { extname } from 'node:path';
 import { randomUUID } from 'node:crypto';
 
 const MAX_UPLOAD_SIZE = 1024 * 1024 * 200;
+const ALLOWED_FILE_EXTENSIONS_BY_MIME = new Map<string, string[]>([
+  ['application/pdf', ['.pdf']],
+  ['application/msword', ['.doc']],
+  [
+    'application/vnd.openxmlformats-officedocument.wordprocessingml.document',
+    ['.docx'],
+  ],
+  ['application/vnd.ms-excel', ['.xls']],
+  [
+    'application/vnd.openxmlformats-officedocument.spreadsheetml.sheet',
+    ['.xlsx'],
+  ],
+]);
 
 function isAllowedMimeType(mimeType: string) {
   return (
@@ -51,6 +64,22 @@ function isAllowedMimeType(mimeType: string) {
   );
 }
 
+function isAllowedOriginalExtension(
+  originalName: string,
+  mimeType: string,
+) {
+  if (mimeType.startsWith('image/') || mimeType.startsWith('video/')) {
+    return true;
+  }
+
+  const allowedExtensions = ALLOWED_FILE_EXTENSIONS_BY_MIME.get(mimeType);
+  if (!allowedExtensions) {
+    return false;
+  }
+
+  return allowedExtensions.includes(extname(originalName).toLowerCase());
+}
+
 @ApiTags('上传资产(B端)')
 @ApiBearerAuth('bearer')
 @Controller('b/uploads')
@@ -83,7 +112,10 @@ export class BUploadsController {
       }),
       limits: { fileSize: MAX_UPLOAD_SIZE },
       fileFilter: (_req, file, cb) => {
-        if (!isAllowedMimeType(file.mimetype)) {
+        if (
+          !isAllowedMimeType(file.mimetype) ||
+          !isAllowedOriginalExtension(file.originalname, file.mimetype)
+        ) {
           cb(
             new BadRequestException(MESSAGES.UPLOAD.UNSUPPORTED_FILE_TYPE),
             false,

src/uploads/uploads.service.ts

@@ -5,7 +5,7 @@ import {
   NotFoundException,
 } from '@nestjs/common';
 import { spawn } from 'node:child_process';
-import { access, mkdir, rename, stat, unlink } from 'node:fs/promises';
+import { access, mkdir, open, rename, stat, unlink } from 'node:fs/promises';
 import { extname, join } from 'node:path';
 import { randomUUID } from 'node:crypto';
 import ffmpegPath from 'ffmpeg-static';
@@ -22,6 +22,20 @@ import {
   resolveUploadTempDir,
 } from './upload-path.util.js';
 
+const SAFE_FILE_MIME_TYPES: Record<string, string> = {
+  '.pdf': 'application/pdf',
+  '.doc': 'application/msword',
+  '.docx':
+    'application/vnd.openxmlformats-officedocument.wordprocessingml.document',
+  '.xls': 'application/vnd.ms-excel',
+  '.xlsx':
+    'application/vnd.openxmlformats-officedocument.spreadsheetml.sheet',
+};
+
+const OLE_SIGNATURE = Buffer.from([
+  0xd0, 0xcf, 0x11, 0xe0, 0xa1, 0xb1, 0x1a, 0xe1,
+]);
+
 @Injectable()
 export class UploadsService {
   constructor(private readonly prisma: PrismaService) {}
@@ -237,12 +251,7 @@ export class UploadsService {
       };
     }
 
-    return {
+    return this.prepareGenericFile(file);
-      tempPath: file.path,
-      outputExtension: extname(file.originalname),
-      mimeType: file.mimetype,
-      fileSize: file.size,
-    };
   }
 
   private async buildFinalFileName(
@@ -299,6 +308,65 @@ export class UploadsService {
     }
   }
 
+  private async prepareGenericFile(file: Express.Multer.File) {
+    const outputExtension = this.normalizeSafeFileExtension(file.originalname);
+    const signature = await this.readFileSignature(file.path, 8);
+
+    if (!this.isSafeFileSignature(outputExtension, signature)) {
+      throw new BadRequestException(MESSAGES.UPLOAD.INVALID_FILE_SIGNATURE);
+    }
+
+    const fileInfo = await stat(file.path);
+    return {
+      tempPath: file.path,
+      outputExtension,
+      mimeType: SAFE_FILE_MIME_TYPES[outputExtension],
+      fileSize: fileInfo.size,
+    };
+  }
+
+  private normalizeSafeFileExtension(originalName: string) {
+    const extension = extname(originalName).toLowerCase();
+    if (!SAFE_FILE_MIME_TYPES[extension]) {
+      throw new BadRequestException(MESSAGES.UPLOAD.UNSUPPORTED_FILE_TYPE);
+    }
+    return extension;
+  }
+
+  private async readFileSignature(path: string, byteLength: number) {
+    const handle = await open(path, 'r');
+
+    try {
+      const buffer = Buffer.alloc(byteLength);
+      const { bytesRead } = await handle.read(buffer, 0, byteLength, 0);
+      return buffer.subarray(0, bytesRead);
+    } finally {
+      await handle.close();
+    }
+  }
+
+  private isSafeFileSignature(extension: string, signature: Buffer) {
+    switch (extension) {
+      case '.pdf':
+        return signature.subarray(0, 5).toString('ascii') === '%PDF-';
+      case '.doc':
+      case '.xls':
+        return signature.length >= OLE_SIGNATURE.length &&
+          signature.subarray(0, OLE_SIGNATURE.length).equals(OLE_SIGNATURE);
+      case '.docx':
+      case '.xlsx':
+        return (
+          signature.length >= 4 &&
+          signature[0] === 0x50 &&
+          signature[1] === 0x4b &&
+          [0x03, 0x05, 0x07].includes(signature[2]) &&
+          [0x04, 0x06, 0x08].includes(signature[3])
+        );
+      default:
+        return false;
+    }
+  }
+
   private async compressVideo(inputPath: string, outputPath: string) {
     const command = ffmpegPath as unknown as string | null;
     if (!command) {

tyt-admin/src/api/patients.js

@@ -24,10 +24,14 @@ export const createPatientSurgery = (id, data) => {
   return request.post(`/b/patients/${id}/surgeries`, data);
 };
 
+export const updatePatientSurgery = (patientId, surgeryId, data) => {
+  return request.patch(`/b/patients/${patientId}/surgeries/${surgeryId}`, data);
+};
+
 export const deletePatient = (id) => {
   return request.delete(`/b/patients/${id}`);
 };
 
-export const getPatientLifecycle = (params) => {
+export const getPatientLifecycle = (id) => {
-  return request.get('/c/patients/lifecycle', { params });
+  return request.get(`/b/patients/${id}/lifecycle`);
 };

tyt-admin/src/constants/role-labels.js

@@ -0,0 +1,16 @@
+export const ROLE_LABELS = Object.freeze({
+  SYSTEM_ADMIN: '系统管理员',
+  HOSPITAL_ADMIN: '医院管理员',
+  DIRECTOR: '科室主任',
+  LEADER: '小组组长',
+  DOCTOR: '医生',
+  ENGINEER: '工程师',
+});
+
+export function getRoleLabel(role) {
+  if (!role) {
+    return '';
+  }
+
+  return ROLE_LABELS[role] || role;
+}

tyt-admin/src/layouts/AdminLayout.vue

@@ -84,12 +84,14 @@
     <el-container>
       <el-header class="header">
         <div class="header-left">
-          <!-- Breadcrumbs can go here -->
+          <!-- 这里预留面包屑区域 -->
         </div>
         <div class="header-right">
           <el-dropdown @command="handleCommand">
             <span class="el-dropdown-link user-info">
-              {{ userStore.userInfo?.name || '用户' }} ({{ userStore.role }})
+              {{ userStore.userInfo?.name || '用户' }}（{{
+                getRoleLabel(userStore.role) || '未分配角色'
+              }}）
               <el-icon class="el-icon--right">
                 <arrow-down />
               </el-icon>
@@ -117,6 +119,7 @@
 <script setup>
 import { computed } from 'vue';
 import { useRoute, useRouter } from 'vue-router';
+import { getRoleLabel } from '../constants/role-labels';
 import { useUserStore } from '../store/user';
 import {
   ROLE_PERMISSIONS,

tyt-admin/src/views/Dashboard.vue

@@ -2,7 +2,7 @@
   <div class="dashboard">
     <el-card shadow="never" class="welcome-card">
       <h2>欢迎使用调压通管理后台</h2>
-      <p>当前角色：{{ userStore.role || '未登录' }}</p>
+      <p>当前角色：{{ getRoleLabel(userStore.role) || '未登录' }}</p>
     </el-card>
 
     <el-card v-if="isSystemAdmin" shadow="never" class="filter-card">
@@ -59,6 +59,7 @@ import { useUserStore } from '../store/user';
 import { getHospitals, getDepartments, getGroups } from '../api/organization';
 import { getUsers } from '../api/users';
 import { getPatients } from '../api/patients';
+import { getRoleLabel } from '../constants/role-labels';
 
 const userStore = useUserStore();
 const loading = ref(false);
@@ -158,10 +159,17 @@ const fetchDashboardData = async () => {
       if (isSystemAdmin.value && !selectedHospitalId.value) {
         stats.value.patients = 0;
       } else {
-        const patientRes = await getPatients(params);
+        const patientRes = await getPatients({
-        stats.value.patients = Array.isArray(patientRes)
+          page: 1,
+          pageSize: 1,
+          ...params,
+        });
+        stats.value.patients = Number(
+          patientRes?.total ??
+            (Array.isArray(patientRes)
               ? patientRes.length
-          : 0;
+              : patientRes?.list?.length ?? 0),
+        );
       }
     }
   } finally {

tyt-admin/src/views/Login.vue

@@ -86,6 +86,7 @@ import { useRouter, useRoute } from 'vue-router';
 import { useUserStore } from '../store/user';
 import { User, Lock } from '@element-plus/icons-vue';
 import { ElMessage } from 'element-plus';
+import { getRoleLabel } from '../constants/role-labels';
 
 const router = useRouter();
 const route = useRoute();
@@ -116,7 +117,7 @@ const rules = {
 };
 
 const formatAccountMeta = (account) => {
-  const parts = [account.role];
+  const parts = [getRoleLabel(account.role)];
   if (account.hospitalName) {
     parts.push(account.hospitalName);
   }
@@ -157,7 +158,7 @@ const handleLogin = async () => {
           ElMessage.error('登录失败，未获取到登录信息');
         }
       } catch (error) {
-        console.error('Login failed', error);
+        console.error('登录请求失败', error);
       } finally {
         loading.value = false;
       }
@@ -185,7 +186,7 @@ const handleConfirmLogin = async () => {
 
     ElMessage.error('登录失败，未获取到登录信息');
   } catch (error) {
-    console.error('Confirm login failed', error);
+    console.error('确认登录失败', error);
   } finally {
     confirmLoading.value = false;
   }

tyt-admin/src/views/patients/Patients.vue

@@ -78,7 +78,11 @@
         </el-table-column>
         <el-table-column prop="phone" label="联系电话" min-width="140" />
         <el-table-column prop="idCard" label="身份证号" min-width="200" />
-        <el-table-column v-if="canViewHospitalInfo" label="归属医院" min-width="150">
+        <el-table-column
+          v-if="canViewHospitalInfo"
+          label="归属医院"
+          min-width="150"
+        >
           <template #default="{ row }">
             {{ row.hospital?.name || '-' }}
           </template>
@@ -88,7 +92,7 @@
             {{ row.doctor?.name || '-' }}
           </template>
         </el-table-column>
-        <el-table-column label="操作" width="360" fixed="right" align="center">
+        <el-table-column label="操作" width="440" fixed="right" align="center">
           <template #default="{ row }">
             <el-button
               v-if="canPublishAdjustTask"
@@ -106,6 +110,17 @@
             >
               详情
             </el-button>
+            <el-button
+              v-if="row.latestSurgery?.id"
+              size="small"
+              @click="
+                row.shuntSurgeryCount > 1
+                  ? openSurgeriesTab(row)
+                  : openSurgeryDialog(row, row.latestSurgery.id)
+              "
+            >
+              {{ row.shuntSurgeryCount > 1 ? '选择手术' : '编辑手术' }}
+            </el-button>
             <el-button
               size="small"
               type="success"
@@ -131,8 +146,8 @@
           :total="total"
           background
           layout="total, sizes, prev, pager, next, jumper"
-          @size-change="applyFiltersAndPagination"
+          @size-change="fetchData"
-          @current-change="applyFiltersAndPagination"
+          @current-change="fetchData"
         />
       </div>
     </el-card>
@@ -257,7 +272,7 @@
     </el-dialog>
 
     <el-dialog
-      title="追加手术"
+      :title="isSurgeryEditMode ? '编辑手术' : '追加手术'"
       v-model="surgeryDialogVisible"
       width="1120px"
       top="3vh"
@@ -272,15 +287,29 @@
           class="context-alert"
         >
           <template #title>
+            <template v-if="isSurgeryEditMode">
+              正在编辑患者「{{ surgeryPatientContext.name }}」的手术记录
+              <span v-if="surgeryPatientContext.editingSurgery">
+                ：{{ surgeryPatientContext.editingSurgery.surgeryName }} （{{
+                  formatDateTime(
+                    surgeryPatientContext.editingSurgery.surgeryDate,
+                  )
+                }}）
+              </span>
+            </template>
+            <template v-else>
               为患者「{{ surgeryPatientContext.name }}」追加手术
               <span v-if="surgeryPatientContext.latestSurgery">
                 ，上次手术：
                 {{ surgeryPatientContext.latestSurgery.surgeryName }}
                 （{{
-                formatDateTime(surgeryPatientContext.latestSurgery.surgeryDate)
+                  formatDateTime(
+                    surgeryPatientContext.latestSurgery.surgeryDate,
+                  )
                 }}）
               </span>
             </template>
+          </template>
         </el-alert>
 
         <SurgeryFormSection
@@ -291,9 +320,14 @@
           :dictionary-options="medicalDictionaryOptions"
           :upload-hospital-id="surgeryPatientContext.hospitalId"
           :abandonable-devices="surgeryPatientContext.activeDevices"
-          :show-abandon-selector="true"
+          :show-abandon-selector="!isSurgeryEditMode"
-          title="手术录入"
+          :allow-device-structure-edit="!isSurgeryEditMode"
-          description="若本次手术后需要停用旧设备，可在上方直接勾选弃用。"
+          :title="isSurgeryEditMode ? '编辑手术内容' : '手术录入'"
+          :description="
+            isSurgeryEditMode
+              ? '可修改本次手术及已有植入设备信息；如需调整历史弃用设备，请通过追加手术处理。'
+              : '若本次手术后需要停用旧设备，可在上方直接勾选弃用。'
+          "
         />
       </div>
 
@@ -305,7 +339,7 @@
             :loading="surgerySubmitLoading"
             @click="handleSubmitSurgery"
           >
-            保存手术
+            {{ isSurgeryEditMode ? '保存修改' : '保存手术' }}
           </el-button>
         </div>
       </template>
@@ -421,7 +455,10 @@
                   <el-descriptions-item label="创建人">
                     {{ detailPatient.creator?.name || '-' }}
                   </el-descriptions-item>
-                  <el-descriptions-item v-if="canViewHospitalInfo" label="归属医院">
+                  <el-descriptions-item
+                    v-if="canViewHospitalInfo"
+                    label="归属医院"
+                  >
                     {{ detailPatient.hospital?.name || '-' }}
                   </el-descriptions-item>
                   <el-descriptions-item label="建档时间">
@@ -460,6 +497,14 @@
                         </div>
                       </div>
                       <div class="surgery-card-tags">
+                        <el-button
+                          size="small"
+                          type="primary"
+                          plain
+                          @click="openSurgeryEditFromDetail(surgery)"
+                        >
+                          编辑手术
+                        </el-button>
                         <el-tag type="primary">
                           第 {{ surgery.shuntSurgeryCount || '-' }} 次分流手术
                         </el-tag>
@@ -716,7 +761,11 @@
                       {{ row.surgery?.surgeryName || '-' }}
                     </template>
                   </el-table-column>
-                  <el-table-column v-if="canViewHospitalInfo" label="医院" min-width="150">
+                  <el-table-column
+                    v-if="canViewHospitalInfo"
+                    label="医院"
+                    min-width="150"
+                  >
                     <template #default="{ row }">
                       {{ row.hospital?.name || '-' }}
                     </template>
@@ -757,6 +806,7 @@ import {
   getPatientLifecycle,
   getPatients,
   updatePatient,
+  updatePatientSurgery,
 } from '../../api/patients';
 import { getImplantCatalogs } from '../../api/devices';
 import { getDictionaries } from '../../api/dictionaries';
@@ -805,7 +855,6 @@ const submitLoading = ref(false);
 const surgerySubmitLoading = ref(false);
 const detailLoading = ref(false);
 
-const allPatients = ref([]);
 const tableData = ref([]);
 const total = ref(0);
 const page = ref(1);
@@ -832,6 +881,9 @@ const currentEditId = ref(null);
 
 const surgeryDialogVisible = ref(false);
 const surgeryPatientContext = ref(null);
+const surgeryDialogMode = ref('create');
+const currentEditSurgeryId = ref(null);
+const reopenDetailAfterSurgerySubmit = ref(false);
 const adjustDialogVisible = ref(false);
 const adjustSubmitLoading = ref(false);
 const currentAdjustPatient = ref(null);
@@ -867,6 +919,7 @@ const currentAdjustDevices = computed(() => {
     isAdjustableDeviceAvailable(device),
   );
 });
+const isSurgeryEditMode = computed(() => surgeryDialogMode.value === 'edit');
 
 const currentAdjustDevice = computed(() => {
   return (
@@ -939,8 +992,18 @@ function createSurgeryForm() {
   };
 }
 
-function createDeviceFormItem() {
+function createMaterialFormItem(overrides = {}) {
   return {
+    type: 'IMAGE',
+    name: '',
+    url: '',
+    ...overrides,
+  };
+}
+
+function createDeviceFormItem(overrides = {}) {
+  return {
+    id: null,
     implantCatalogId: null,
     shuntMode: '',
     proximalPunctureAreas: [],
@@ -949,6 +1012,7 @@ function createDeviceFormItem() {
     initialPressure: '',
     implantNotes: '',
     labelImageUrl: '',
+    ...overrides,
   };
 }
 
@@ -1102,8 +1166,10 @@ function validateSurgeryForm(form) {
   return '';
 }
 
-function buildSurgeryPayload(form) {
+function buildSurgeryPayload(form, options = {}) {
-  return {
+  const includeAbandonedDeviceIds = options.includeAbandonedDeviceIds !== false;
+
+  const payload = {
     surgeryDate: new Date(form.surgeryDate).toISOString(),
     surgeryName: String(form.surgeryName || '').trim(),
     preOpPressure:
@@ -1122,7 +1188,7 @@ function buildSurgeryPayload(form) {
       }))
       .filter((material) => material.url),
     devices: (form.devices || []).map((device) => {
-      return {
+      const payloadDevice = {
         implantCatalogId: device.implantCatalogId,
         shuntMode: String(device.shuntMode || '').trim(),
         proximalPunctureAreas: normalizeStringArray(
@@ -1141,10 +1207,68 @@ function buildSurgeryPayload(form) {
         implantNotes: normalizeOptionalString(device.implantNotes),
         labelImageUrl: normalizeOptionalString(device.labelImageUrl),
       };
+
+      if (Number.isInteger(Number(device.id)) && Number(device.id) > 0) {
+        payloadDevice.id = Number(device.id);
+      }
+
+      return payloadDevice;
     }),
-    abandonedDeviceIds: normalizeStringArray(form.abandonedDeviceIds).map(
+  };
-      Number,
+
+  if (includeAbandonedDeviceIds) {
+    payload.abandonedDeviceIds = normalizeStringArray(
+      form.abandonedDeviceIds,
+    ).map(Number);
+  }
+
+  return payload;
+}
+
+function mapSurgeryToForm(surgery) {
+  return {
+    surgeryDate: toDateTimeFormValue(surgery?.surgeryDate),
+    surgeryName: surgery?.surgeryName || '',
+    preOpPressure:
+      typeof surgery?.preOpPressure === 'number' ? surgery.preOpPressure : null,
+    primaryDisease: surgery?.primaryDisease || '',
+    hydrocephalusTypes: Array.isArray(surgery?.hydrocephalusTypes)
+      ? [...surgery.hydrocephalusTypes]
+      : [],
+    previousShuntSurgeryDate: toDateTimeFormValue(
+      surgery?.previousShuntSurgeryDate,
     ),
+    notes: surgery?.notes || '',
+    preOpMaterials: Array.isArray(surgery?.preOpMaterials)
+      ? surgery.preOpMaterials.map((material) =>
+          createMaterialFormItem({
+            type: material?.type || 'IMAGE',
+            name: material?.name || '',
+            url: material?.url || '',
+          }),
+        )
+      : [],
+    devices:
+      Array.isArray(surgery?.devices) && surgery.devices.length > 0
+        ? surgery.devices.map((device) =>
+            createDeviceFormItem({
+              id: device.id,
+              implantCatalogId: device.implantCatalogId ?? null,
+              shuntMode: device.shuntMode || '',
+              proximalPunctureAreas: Array.isArray(device.proximalPunctureAreas)
+                ? [...device.proximalPunctureAreas]
+                : [],
+              valvePlacementSites: Array.isArray(device.valvePlacementSites)
+                ? [...device.valvePlacementSites]
+                : [],
+              distalShuntDirection: device.distalShuntDirection || '',
+              initialPressure: device.initialPressure || '',
+              implantNotes: device.implantNotes || '',
+              labelImageUrl: device.labelImageUrl || '',
+            }),
+          )
+        : [createDeviceFormItem()],
+    abandonedDeviceIds: [],
   };
 }
 
@@ -1293,34 +1417,7 @@ function formatAdjustRecordPressureChange(event) {
 }
 
 function applyFiltersAndPagination() {
-  const keyword = String(searchForm.keyword || '').trim();
+  page.value = Math.max(1, Number(page.value) || 1);
-  const doctorId = searchForm.doctorId ? Number(searchForm.doctorId) : null;
-
-  const filtered = allPatients.value.filter((patient) => {
-    if (doctorId && patient.doctorId !== doctorId) {
-      return false;
-    }
-
-    if (!keyword) {
-      return true;
-    }
-
-    return [
-      patient.name,
-      patient.phone,
-      patient.idCard,
-      patient.inpatientNo,
-      patient.doctor?.name,
-      patient.hospital?.name,
-      patient.latestSurgery?.surgeryName,
-    ]
-      .filter(Boolean)
-      .some((field) => String(field).includes(keyword));
-  });
-
-  total.value = filtered.length;
-  const start = (page.value - 1) * pageSize.value;
-  tableData.value = filtered.slice(start, start + pageSize.value);
 }
 
 function syncDoctorFilterFromRoute() {
@@ -1388,7 +1485,6 @@ async function fetchMedicalDictionaryOptions() {
 
 async function fetchData() {
   if (isSystemAdmin.value && !searchForm.hospitalId) {
-    allPatients.value = [];
     tableData.value = [];
     total.value = 0;
     return;
@@ -1396,14 +1492,23 @@ async function fetchData() {
 
   loading.value = true;
   try {
-    const params = {};
+    const params = {
+      page: page.value,
+      pageSize: pageSize.value,
+    };
     if (isSystemAdmin.value) {
       params.hospitalId = searchForm.hospitalId;
     }
+    if (searchForm.keyword) {
+      params.keyword = searchForm.keyword;
+    }
+    if (searchForm.doctorId) {
+      params.doctorId = searchForm.doctorId;
+    }
 
     const res = await getPatients(params);
-    allPatients.value = Array.isArray(res) ? res : [];
+    tableData.value = Array.isArray(res?.list) ? res.list : [];
-    applyFiltersAndPagination();
+    total.value = Number(res?.total || 0);
   } finally {
     loading.value = false;
   }
@@ -1411,6 +1516,8 @@ async function fetchData() {
 
 async function handleSearchHospitalChange() {
   page.value = 1;
+  searchForm.doctorId = null;
+  searchForm.doctorName = '';
   await Promise.all([
     fetchOrgNodesForDoctorTree(searchForm.hospitalId),
     fetchDoctorOptions(searchForm.hospitalId),
@@ -1452,6 +1559,9 @@ function resetPatientForm() {
 function resetSurgeryDialog() {
   appendSurgeryForm.value = createSurgeryForm();
   surgeryPatientContext.value = null;
+  surgeryDialogMode.value = 'create';
+  currentEditSurgeryId.value = null;
+  reopenDetailAfterSurgerySubmit.value = false;
 }
 
 async function ensureCreateContext() {
@@ -1553,7 +1663,7 @@ async function handleSubmitPatient() {
   }
 }
 
-async function openSurgeryDialog(row) {
+async function openSurgeryDialog(row, surgeryId = null) {
   const detail = await getPatientById(row.id);
   const hospitalId = detail.hospital?.id || detail.hospitalId;
 
@@ -1562,16 +1672,37 @@ async function openSurgeryDialog(row) {
     fetchDoctorOptions(hospitalId),
   ]);
 
-  appendSurgeryForm.value = createSurgeryForm();
+  const normalizedSurgeryId = Number(surgeryId);
+  const editingSurgery =
+    Number.isInteger(normalizedSurgeryId) && normalizedSurgeryId > 0
+      ? (detail.surgeries || []).find(
+          (item) => item.id === normalizedSurgeryId,
+        ) || null
+      : null;
+
+  if (surgeryId != null && !editingSurgery) {
+    ElMessage.warning('未找到要编辑的手术记录');
+    return;
+  }
+
+  surgeryDialogMode.value = editingSurgery ? 'edit' : 'create';
+  currentEditSurgeryId.value = editingSurgery?.id || null;
+  appendSurgeryForm.value = editingSurgery
+    ? mapSurgeryToForm(editingSurgery)
+    : createSurgeryForm();
+
+  if (!editingSurgery) {
     appendSurgeryForm.value.previousShuntSurgeryDate = toDateTimeFormValue(
       detail.latestSurgery?.surgeryDate || detail.surgeries?.[0]?.surgeryDate,
     );
+  }
 
   surgeryPatientContext.value = {
     id: detail.id,
     name: detail.name,
     hospitalId,
     latestSurgery: detail.latestSurgery || detail.surgeries?.[0] || null,
+    editingSurgery,
     surgeonLabel:
       formatDoctorOptionLabel(detail.doctor) ||
       resolveSurgerySurgeonLabel(detail.doctorId),
@@ -1597,17 +1728,34 @@ async function handleSubmitSurgery() {
   surgerySubmitLoading.value = true;
   try {
     const patientId = surgeryPatientContext.value.id;
-    await createPatientSurgery(
+    const payload = buildSurgeryPayload(appendSurgeryForm.value, {
+      includeAbandonedDeviceIds: !isSurgeryEditMode.value,
+    });
+
+    if (isSurgeryEditMode.value) {
+      await updatePatientSurgery(
         patientId,
-      buildSurgeryPayload(appendSurgeryForm.value),
+        currentEditSurgeryId.value,
+        payload,
       );
+      ElMessage.success('手术记录已更新');
+    } else {
+      await createPatientSurgery(patientId, payload);
       ElMessage.success('手术记录已保存');
+    }
+
     surgeryDialogVisible.value = false;
     await fetchData();
 
-    if (detailDialogVisible.value && detailPatient.value?.id === patientId) {
+    if (
+      (detailDialogVisible.value || reopenDetailAfterSurgerySubmit.value) &&
+      detailPatient.value?.id === patientId
+    ) {
       await openDetailDialog({ ...detailPatient.value });
+      detailTab.value = 'surgeries';
     }
+
+    reopenDetailAfterSurgerySubmit.value = false;
   } finally {
     surgerySubmitLoading.value = false;
   }
@@ -1617,10 +1765,26 @@ function openSurgeryFromDetail() {
   if (!detailPatient.value) {
     return;
   }
+  reopenDetailAfterSurgerySubmit.value = true;
   detailDialogVisible.value = false;
   openSurgeryDialog(detailPatient.value);
 }
 
+async function openSurgeriesTab(row) {
+  await openDetailDialog(row);
+  detailTab.value = 'surgeries';
+}
+
+function openSurgeryEditFromDetail(surgery) {
+  if (!detailPatient.value || !surgery?.id) {
+    return;
+  }
+
+  reopenDetailAfterSurgerySubmit.value = true;
+  detailDialogVisible.value = false;
+  openSurgeryDialog(detailPatient.value, surgery.id);
+}
+
 function resolveDevicePressureLevels(device) {
   const pressureLevels = device?.implantCatalog?.pressureLevels;
   return Array.isArray(pressureLevels) ? pressureLevels : [];
@@ -1800,17 +1964,14 @@ async function openDetailDialog(row) {
 
   try {
     const detailPromise = getPatientById(row.id);
-    const lifecyclePromise =
+    const lifecyclePromise = getPatientLifecycle(row.id);
-      row.phone && row.idCard
-        ? getPatientLifecycle({
-            phone: row.phone,
-            idCard: row.idCard,
-          }).catch(() => ({ lifecycle: [] }))
-        : Promise.resolve({ lifecycle: [] });
 
     const [detail, lifecycle] = await Promise.all([
       detailPromise,
-      lifecyclePromise,
+      lifecyclePromise.catch((error) => {
+        ElMessage.error(error?.response?.data?.msg || '患者生命周期加载失败');
+        return { lifecycle: [] };
+      }),
     ]);
 
     detailPatient.value = detail;

tyt-admin/src/views/patients/components/SurgeryFormSection.vue

@@ -212,7 +212,12 @@
               选型号后自动联动厂家和名称；支持一次手术录入多台设备
             </div>
           </div>
-          <el-button type="primary" @click="addDevice">新增设备</el-button>
+          <el-button
+            v-if="allowDeviceStructureEdit"
+            type="primary"
+            @click="addDevice"
+            >新增设备</el-button
+          >
         </div>
       </template>
 
@@ -224,6 +229,7 @@
         <div class="device-card-head">
           <div class="device-card-title">设备 {{ index + 1 }}</div>
           <el-button
+            v-if="allowDeviceStructureEdit"
             type="danger"
             plain
             @click="removeDevice(index)"
@@ -477,6 +483,10 @@ const props = defineProps({
     type: Boolean,
     default: false,
   },
+  allowDeviceStructureEdit: {
+    type: Boolean,
+    default: true,
+  },
   title: {
     type: String,
     default: '',