fix(recall): 正畸/牙周误召 — 治疗分类 + 时间方向两处修复

根因(陈施羽 998421 复现):
1. 分类 bug:keyword "二期" 太宽,把"二期隐形矫正"(正畸)误判成 implant 种植
   → treatment_actual.yaml: 二期 → 种植二期;ortho 加"隐形矫"兜底
2. 时间方向:正畸/牙周全口慢性病,复诊反复重记诊断,"治疗须晚于诊断"失效 → 误召"未启动"
   → canonical-codes K05/K07 加 excludeIfEverTreated;scenario ⑤a 对其忽略时间方向(曾做过即排除)
   按牙位的码(K02/K04/K08 等)规则不变

定向重处理工具(线上只重摄受影响的 ~1493 人,不全量):
- cold-import: PAC_COHORT_ONLY_PATIENT 支持逗号列表(IN 过滤)
- recompute-persona / recompute-plans: 加 --pids=<逗号externalId> 定向重算

Co-Authored-By: Claude Opus 4.8 (1M context) <noreply@anthropic.com>

apps/pac-service/data/jvs-dw/assemblers/treatment_actual.yaml

@@ -442,9 +442,11 @@ enum_mapping:
 # ⚠️ 安全:只接管精确未命中的长尾,精确命中零影响;错配最坏退化=_default(现状),无回归。
 keyword_mapping:
   category:
-    - { value: implant,       any: [种植, 即拔即种, 植体, 二期] }
+    # ⚠️ "二期" 必须限定到「种植二期」:裸"二期"会误吞"二期隐形矫正"(正畸)等 → 误判 implant。
+    #    种植语境的二期都带"种植"(种植二期);ortho 的"二期隐形矫正/二期矫正"靠下面 orthodontic 兜住。
+    - { value: implant,       any: [种植, 即拔即种, 植体, 种植二期] }
     - { value: endodontic,    any: [根管, RCT, 牙髓, 开髓, 根备, 根充, 盖髓, 摘髓] }
-    - { value: orthodontic,   any: [正畸, 矫治, 矫正, 托槽, 保持器, 粘附件, 隐适美, 扩弓] }
+    - { value: orthodontic,   any: [正畸, 矫治, 矫正, 托槽, 保持器, 粘附件, 隐适美, 隐形矫, 扩弓] }
     - { value: cosmetic,      any: [贴面, 漂白, 美白] }
     - { value: prosthodontic, any: [冠, 桥, 义齿, 修复体, 桩核, 桩冠, 戴牙, 全瓷, 烤瓷, 重新粘接] }
     - { value: restorative,   any: [充填, 补牙, 树脂, 玻璃离子, 嵌体, 垫底] }

apps/pac-service/src/cli/recompute-persona.cli.ts

@@ -17,6 +17,7 @@ import { PrismaService } from '../prisma/prisma.service';
 interface Args {
   host: string;
   pid?: string;
+  pids?: string[]; // 多个 externalId(逗号分隔),定向重算受影响子集用
 }
 
 function parseArgs(argv: string[]): Args {
@@ -24,6 +25,9 @@ function parseArgs(argv: string[]): Args {
   for (const a of argv) {
     if (a.startsWith('--host=')) args.host = a.slice('--host='.length);
     else if (a.startsWith('--pid=')) args.pid = a.slice('--pid='.length);
+    else if (a.startsWith('--pids=')) {
+      args.pids = a.slice('--pids='.length).split(',').map((s) => s.trim()).filter(Boolean);
+    }
   }
   return args;
 }
@@ -46,7 +50,7 @@ async function bootstrap() {
       where: {
         hostId: host.id,
         active: true,
-        ...(args.pid ? { externalId: args.pid } : {}),
+        ...(args.pids?.length ? { externalId: { in: args.pids } } : args.pid ? { externalId: args.pid } : {}),
       },
       select: { id: true, externalId: true, name: true },
     });

apps/pac-service/src/cli/recompute-plans.cli.ts

@@ -2,8 +2,9 @@
  * Recompute Plans CLI — 批量跑 PlanEngine,产 FollowupPlan + PlanReason
  *
  * Usage:
- *   pnpm recompute-plans                   # 默认 host=demo
+ *   pnpm recompute-plans                   # 默认 host=demo,全量
  *   pnpm recompute-plans -- --host=friday
+ *   pnpm recompute-plans -- --host=jvs-dw --pids=998421,xxx   # 只重算指定 externalId(定向,O(子集))
  */
 import { NestFactory } from '@nestjs/core';
 import { Logger } from '@nestjs/common';
@@ -13,12 +14,16 @@ import { PrismaService } from '../prisma/prisma.service';
 
 interface Args {
   host: string;
+  pids?: string[]; // 指定 externalId(逗号分隔)→ 只重算这些患者(定向,recomputeForPatient)
 }
 
 function parseArgs(argv: string[]): Args {
   const args: Args = { host: 'demo' };
   for (const a of argv) {
     if (a.startsWith('--host=')) args.host = a.slice('--host='.length);
+    else if (a.startsWith('--pids=')) {
+      args.pids = a.slice('--pids='.length).split(',').map((s) => s.trim()).filter(Boolean);
+    }
   }
   return args;
 }
@@ -36,6 +41,28 @@ async function bootstrap() {
 
     const host = await prisma.host.findUnique({ where: { name: args.host } });
     if (!host) throw new Error(`Host '${args.host}' not found`);
+
+    // ── 定向模式:只重算指定 externalId 的患者(recomputeForPatient,O(子集))──
+    if (args.pids?.length) {
+      const patients = await prisma.patient.findMany({
+        where: { hostId: host.id, externalId: { in: args.pids } },
+        select: { id: true, tenantId: true, externalId: true },
+      });
+      logger.log(`▶ 定向重算 ${patients.length} patients(host=${args.host})...`);
+      let created = 0, failed = 0;
+      for (const p of patients) {
+        try {
+          const r = await engine.recomputeForPatient({ hostId: host.id, tenantId: p.tenantId, patientId: p.id });
+          created += r.plansCreated;
+        } catch (err) {
+          failed++;
+          logger.error(`  ${p.externalId} FAILED: ${err instanceof Error ? err.message : err}`);
+        }
+      }
+      logger.log(`Done(定向):patients=${patients.length} plansCreated=${created} failed=${failed}`);
+      return;
+    }
+
     // 取该 host 第一个 tenant(demo 场景固定一个)
     const tenants = await prisma.patient.findMany({
       where: { hostId: host.id },

apps/pac-service/src/modules/plan/engine/scenarios/treatment-initiation-recall.scenario.ts

@@ -239,6 +239,13 @@ export class TreatmentInitiationRecallScenario implements PlanScenarioPlugin {
       ? Prisma.sql`AND p.id = ${scope.patientId}::uuid`
       : Prisma.empty;
 
+    // ⑤a 时间方向开关:excludeIfEverTreated 的码(全口长疗程,正畸 K07 / 牙周 K05)忽略时间方向 —
+    //   "曾做过同类治疗"即排除(复诊反复重记诊断,不能要求治疗晚于诊断,否则误召"未启动")。
+    //   按牙位的码保留"治疗晚于诊断",靠牙位区分新旧病灶。
+    const afterDxFrag = rule.excludeIfEverTreated
+      ? Prisma.empty
+      : Prisma.sql`AND tx.occurred_at >= COALESCE(sig.occurred_at, sig.planned_for)`;
+
     // ╔═════════════════════════════════════════════════════════════════════╗
     // ║ 召回 SQL 完整解读(initiation = 潜在治疗新链召回)                  ║
     // ║                                                                      ║
@@ -337,7 +344,7 @@ export class TreatmentInitiationRecallScenario implements PlanScenarioPlugin {
             AND tx.kind = 'actual'
             AND tx.status IN ('active', 'fulfilled')       -- actual 完成 status=fulfilled
             AND tx.content->>'category' = ANY(${excludeCats}::text[])
-            AND tx.occurred_at >= COALESCE(sig.occurred_at, sig.planned_for)  -- ⭐ 时间方向:诊断之后
+            ${afterDxFrag}  -- ⭐ 时间方向:诊断之后(excludeIfEverTreated 码忽略,见 afterDxFrag)
             -- W4 末升级:牙位级 overlap(详见上面 ⑤a 注释 box)
             AND (
               -- 信号无牙位(全口诊断如 K05)→ patient/category 级排除,跟现状一致

apps/pac-service/src/modules/sync/cold-import/clickhouse-source.service.ts

@@ -323,6 +323,14 @@ export class ClickHouseSourceService {
       if (cursorCol && cursorCfg?.cursorValue) {
         whereParts.push(`${cursorCol} > '${cursorCfg.cursorValue.replace(/'/g, "''")}'`);
       }
+      // dev/ops:只摄入指定患者(PAC_COHORT_ONLY_PATIENT=<patient_id> 或逗号列表 id1,id2,...)
+      //   单患者复现 / 定向重摄受影响子集(分类修复后只重摄 reclassify 的患者)用。
+      const onlyPatient = process.env.PAC_COHORT_ONLY_PATIENT?.trim();
+      if (onlyPatient) {
+        const ids = onlyPatient.split(',').map((s) => s.trim()).filter(Boolean);
+        const quoted = ids.map((id) => `'${id.replace(/'/g, "''")}'`).join(', ');
+        whereParts.push(ids.length === 1 ? `${patient_key_column} = ${quoted}` : `${patient_key_column} IN (${quoted})`);
+      }
       const whereSql = whereParts.length > 0 ? ` WHERE ${whereParts.join(' AND ')}` : '';
       const selectCols = tenant_key_column
         ? `${patient_key_column}, ${tenant_key_column}`

packages/types/src/canonical-codes.ts

@@ -172,6 +172,11 @@ export interface DxTreatmentRule {
   urgencyDayThreshold: number;
   chainLabel: string;
   wholeMouth?: boolean;
+  /// 治疗"一次性发起、非按牙位"(全口长疗程/慢性,如正畸 K07、牙周 K05):
+  /// 召回排除闸 ⑤a **忽略时间方向** —— 只要曾做过同类治疗即排除(不要求治疗晚于诊断)。
+  /// 原因:这类病复诊会反复重记诊断,旧诊断之后没有"更晚的治疗"不代表没治 → 否则误召"未启动"。
+  /// 按牙位的码(K02 龋/K04 根管/K08 缺牙等)不设此项 — 时间方向+牙位匹配才正确(新牙长龋该召)。
+  excludeIfEverTreated?: boolean;
 }
 
 export const DiagnosisTreatmentMap = {
@@ -187,9 +192,9 @@ export const DiagnosisTreatmentMap = {
   // 之前曾加 'preventive' 想让做过洁牙的患者不被召回,但临床上洁牙(¥260-350 预防) ≠ 龈上洁治术(¥600+ SRP)
   // host 数据已正确区分两者:subtype/category 字段不同。王辉就是"医生让做 SRP 但只做洁牙"典型患者 —
   // 应该被召回去促进真 SRP,而不是被算"已启动"放过。chain-composer 显示 S3 未进行也支持这判定
-  K05: { categories: ['periodontic'],            cooldownDays: 30, windowDays: 120, urgencyDayThreshold: 90,  chainLabel: '牙周治疗', wholeMouth: true },
+  K05: { categories: ['periodontic'],            cooldownDays: 30, windowDays: 120, urgencyDayThreshold: 90,  chainLabel: '牙周治疗', wholeMouth: true, excludeIfEverTreated: true },
   K06: { categories: ['periodontic', 'surgical'], cooldownDays: 14, windowDays: 120, urgencyDayThreshold: 60,  chainLabel: '牙龈/牙槽嵴处置' },
-  K07: { categories: ['orthodontic'],            cooldownDays: 30, windowDays: 365, urgencyDayThreshold: 180, chainLabel: '正畸矫治' },
+  K07: { categories: ['orthodontic'],            cooldownDays: 30, windowDays: 365, urgencyDayThreshold: 180, chainLabel: '正畸矫治', excludeIfEverTreated: true },
   K08: { categories: ['implant', 'prosthodontic'], cooldownDays: 30, windowDays: 180, urgencyDayThreshold: 120, chainLabel: '种植修复' },
   K09: { categories: ['surgical'],               cooldownDays: 14, windowDays: 90,  urgencyDayThreshold: 60,  chainLabel: '颌骨囊肿摘除' },
   // 推荐码 — 同临床类目继承 K0x 配置