fix: 召回/治疗链口径对齐 + 诊断时间精度 + 展示修复(本地核验一轮)

诊断时间精度(摄入):
- diagnosis/treatment/recommendation/review 的 occurredAt 从 rq(纯日期→零点)改 created_date
  (精确就诊时刻,实测 100% 同 rq 日 + 就诊时段分布)→ 跟带时间的预约能正确比先后
  (修 Miyabe Juria 阻生牙被同次就诊预约误判"已进入"而误排召回)

召回/治疗链口径对齐(chain-composer 镜像 scenario,消除"召回有/链没有"分叉):
- 无牙位 perio/ortho actual = 全口覆盖(镜像 ⑤a b0b9705a)→ 曾松柏 K06@45;46 显示在管
- 桶有同牙位 category actual(笼统 subtype milestone 没匹配)→ ongoing 不再 discovered(Ammu 36 bare"种植")
- recommendation-only 链(只 planned_for)gapDays 用 effectiveTime → 不再被 cooldown 误滤(36 建议戴冠)
- 废用牙/无功能牙不立"种植修复·发现机会"潜在链,改中性标签 + 建议拔除/观察(常量收口到 canonical-codes)
- milestone 关键词补术式全称/缩写:根管治疗/RCT、种植修复/戴牙/即拔即种、正畸、牙周基础治疗 等
- implant 加 terminalSteps(戴冠=完成)+ 种植二/三期归 placement

展示:
- 召回理由"距今天数"实时化(signalOccurredAt 锚点,与治疗链断口同源,免随天数陈旧)
- 年龄缺失显示"?"岁(对齐列表页,不再"0岁")
- 再启 banner 用真实再诊断日/名 + emr 真实医嘱(替硬编码"医嘱建议X个月内")

96 测试通过;本地 100 患者已按此重摄(rq→created_date)+ 重算核验。

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

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

@@ -21,7 +21,7 @@ field_mapping:
   createdAt:         created_date
   patientExternalId:            patient_id
   clinicId:                     organization_id
-  occurredAt:                   rq
+  occurredAt:                   created_date   # 就诊精确时刻(rq 只到日→零点,无法跟带时间的预约比先后);created_date=初次录入=就诊点,100% 同 rq 日
   sourceEncounterExternalId:    emr_id
   code:                         diag_code_src    # K 码 或 归一中文名 → enum_mapping 翻译
   stdCodeRaw:                   std_code         # 溯源:判 code_source(std_code / name_map / null)

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

@@ -19,7 +19,7 @@ field_mapping:
   createdAt:         created_date
   patientExternalId: patient_id
   clinicId:          organization_id
-  occurredAt:        rq
+  occurredAt:        created_date          # 精确就诊时刻(rq 只到日);created_date=医生写建议的时点,100% 同 rq 日
   code:              treat_name             # "建议种植" 等 → enum_mapping 翻译到 PAC 推荐码
   toothPosition:     tooth_position
   doctorId:          user_id                # 建议医生(从 emr 父级继承)

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

@@ -30,7 +30,7 @@ field_mapping:
   createdAt:         created_date
   patientExternalId:           patient_id
   clinicId:                    organization_id
-  occurredAt:                  rq               # treat_plan 已发生,rq=就诊日,actual 时点
+  occurredAt:                  created_date     # 精确就诊时刻(rq 只到日);created_date=医生录治疗的时点,100% 同 rq 日,可跟预约/其它事件比先后
   sourceEncounterExternalId:   emr_id
   category:                    category_raw     # transforms 已带 treat_name 原文,这里 enum_mapping 翻译
   subtype:                     treat_name       # 原始 treatName 留作 subtype(给 chain milestone 字典 fallback 匹配)

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

@@ -29,7 +29,7 @@ field_mapping:
   createdAt:         created_date
   patientExternalId:           patient_id
   clinicId:                    organization_id
-  occurredAt:                  rq               # rq=就诊日(医生当天写的计划);plannedFor 由 parser 用此填
+  occurredAt:                  created_date     # 精确就诊时刻(医生当天写计划的时点;rq 只到日);plannedFor 由 parser 用此填,100% 同 rq 日
   sourceEncounterExternalId:   emr_id
   category:                    category_raw    # transforms 已带 treat_name 原文,这里 enum_mapping 翻译
   subtype:                     treat_name      # 原始 treatName 留作 subtype

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

@@ -21,7 +21,7 @@ field_mapping:
   createdAt:         created_date
   patientExternalId:           patient_id
   clinicId:                    organization_id
-  occurredAt:                  rq
+  occurredAt:                  created_date     # 精确就诊时刻(rq 只到日);created_date=就诊点,100% 同 rq 日
   sourceEncounterExternalId:   emr_id
   category:                    category_raw    # transforms 已固定填 _review_sentinel
   subtype:                     treat_name      # 原始动作名("常规复查"/"拆线"等)

apps/pac-service/src/modules/plan-aggregate/plan-aggregate.service.ts

 import { Injectable, NotFoundException } from '@nestjs/common';
 import type { Prisma } from '@prisma/client';
 import { maskName, maskPhone } from '@pac/utils';
+import { applyLiveDays } from '@pac/types';
 import { PrismaService } from '../../prisma/prisma.service';
 import { ChainComposerService } from '../plan/engine/chain-composer.service';
 import type { TenantScopeContext } from '../../common/decorators/tenant-scope.decorator';
@@ -335,7 +336,11 @@ function serializePlan(plan: {
       /// (不含 ruleIds — 算法版本追溯靠 git + plan.createdAt)
       breakdown: r.breakdown,
       /// W3 末:结构化召回信号(raw enum / canonical code,前端字典翻译富文本)
-      signals: r.signals,
+      /// daysSince 用锚点 signalOccurredAt 实时重算 → 跟治疗链断口(同请求 server 时刻)精确一致,
+      /// 不再随天数陈旧("388/389"漂移);旧 plan 无锚点 → 原样回落 baked。
+      signals: applyLiveDays(
+        r.signals as { daysSince?: number; signalOccurredAt?: string | null } | null,
+      ),
     })),
   };
 }

apps/pac-service/src/modules/plan/engine/chain-composer.service.ts

@@ -6,6 +6,7 @@ import {
   lookupDxTreatment,
   lookupTreatmentMilestone,
   lookupTreatmentLifecycle,
+  isRestorationIneligibleDxName,
   parseComplaintCategories,
   LegacyStepSubtypeKeywords,
   PACTreatmentStep,
@@ -15,6 +16,10 @@ import {
 } from '@pac/types';
 import { fmtYearMonthDay } from '@pac/utils';
 
+/// 无牙位 actual 视为"全口覆盖"的类目 —— 整牙弓治疗,无牙位是常态(牙周/正畸)。
+/// ⚠️ 必须跟召回 scenario ⑤a(b0b9705)口径一致:`tx.tooth='' AND category IN ('periodontic','orthodontic')`。
+const WHOLE_MOUTH_COVERAGE_CATS = new Set(['periodontic', 'orthodontic']);
+
 /**
  * ChainComposerService — 5 阶段治疗链分析(纯展示用,不参与召回算法)
  *
@@ -267,10 +272,15 @@ function inferChainStage(
   //   都算到 K03@12 桶里 → 误判 s3Reached=true → stage=4 ongoing
   //   实际上 12 一次治疗没做,SQL 召回是对的,chain 状态也该 stage=1 discovered
   //   wholeMouth 桶('*whole')+ actual-only 桶('')不过滤(全口治疗按牙位无意义)
+  //   ⭐ 镜像召回 ⑤a(b0b9705):**无牙位 actual 仅 periodontic/orthodontic 视为"全口覆盖"**
+  //     (整牙弓治疗无牙位是常态,牙周 134:1 / 正畸 19:1)→ 覆盖该桶具体牙位。
+  //     否则曾松柏 K06 牙周脓肿@45;46 全是无牙位"龈上洁治" → 链显示 discovered,但召回已按全口覆盖排除 → 分叉。
+  //     其它类目(restorative/surgical/implant 等)的无牙位 actual 不当覆盖(蒋卓易 K03@12 仍按牙位过滤)。
   const allActualsByCategory = getActualTreatments(category, byType);
   const allActuals = bucket.tooth && bucket.tooth !== '*whole'
     ? allActualsByCategory.filter((tx) => {
-        const txTooth = String((tx.content as Record<string, unknown>).tooth_position ?? '');
+        const txTooth = String((tx.content as Record<string, unknown>).tooth_position ?? '').trim();
+        if (!txTooth && WHOLE_MOUTH_COVERAGE_CATS.has(category)) return true; // 无牙位 perio/ortho = 全口覆盖
         return toothOverlap(bucket.tooth, txTooth);
       })
     : allActualsByCategory;
@@ -350,6 +360,12 @@ function inferChainStage(
   } else if (s3Reached) {
     currentStage = 3;
     status = 'ongoing';
+  } else if (actuals.length > 0) {
+    // ⭐ 桶里有同牙位同类 actual,但 milestone 没匹配上(host 笼统 subtype 如 bare "种植" / 牙位级残缺)。
+    //   治疗物理上已发生 —— 召回 ⑤a 正是据此(category 级)排除 → 链至少 ongoing(治疗中),不再 discovered。
+    //   例 Ammu 36:K08 缺牙 + actual"种植"(subtype 不含 milestone 关键词)→ 召回已排除,链却 discovered → 分叉。
+    currentStage = 3;
+    status = 'ongoing';
   } else if (s2Hits.length > 0) {
     currentStage = 2;
     status = 'entered';
@@ -363,7 +379,18 @@ function inferChainStage(
   const rawTooth = s1Earliest ? String((s1Earliest.content as Record<string, unknown>).tooth_position ?? '') : '';
   const dxRule = code ? lookupDxTreatment(code) : undefined;
   const fallback = dxRule?.wholeMouth ? '全口' : '未标注牙位';
-  const chainLabel = dxRule?.chainLabel ?? CATEGORY_LABEL[category] ?? category;
+  // ⭐ 废用牙/无功能牙(host 映射 K08,但牙还在无功能)— 桶内诊断全是这类 → "无修复必要"。
+  //   召回侧已剔除(scenario ④');展示侧 Option B:不当"种植修复·发现机会"潜在链,
+  //   改中性标签(诊断名)+ 建议拔除/观察 + 非召回目标(target=false),保留可见性。
+  const dxNameZh = s1Earliest ? String((s1Earliest.content as Record<string, unknown>).name_zh ?? '') : '';
+  const restorationIneligible =
+    s1Facts.length > 0 &&
+    s1Facts.every((f) =>
+      isRestorationIneligibleDxName(String((f.content as Record<string, unknown>).name_zh ?? '')),
+    );
+  const chainLabel = restorationIneligible
+    ? (dxNameZh || dxRule?.chainLabel || CATEGORY_LABEL[category] || category)
+    : (dxRule?.chainLabel ?? CATEGORY_LABEL[category] ?? category);
   // ⭐ tooth 显示用 bucket.tooth(union-find 合并后的并集 normalize 排序),不用 s1 第一条 rawTooth
   //   union-find 把同 (category, code) tooth 有交集的多个桶合并 → bucket.tooth 是完整并集
   //   显示并集让客服一眼看到"全部受影响牙位",不是只看到首诊那 1-3 颗
@@ -379,10 +406,23 @@ function inferChainStage(
         ? bucket.tooth
         : (rawTooth || actualToothUnion));
   const chainName = `${chainLabel} · ${tooth || fallback}`;
-  const diagnosedAt = s1Earliest?.occurredAt ? fmtYearMonthDay(s1Earliest.occurredAt) : '—';
-  const gapDays = s1Earliest?.occurredAt
-    ? Math.floor((Date.now() - s1Earliest.occurredAt.getTime()) / 86400_000)
+  // ⭐ 用 effectiveTime(occurred_at ?? planned_for),跟召回 SQL 的 COALESCE(occurred_at, planned_for) 同口径。
+  //   recommendation_record(医生建议,planned)只有 planned_for 没 occurred_at —— 旧版只看 occurredAt →
+  //   gapDays=undefined→0 < cooldown → 链被 cooldown 闸误滤掉(return null),但召回照样命中 → 召回有/链没有。
+  //   例 Miyabe Masashi:CROWN_RECOMMENDED@36 planned_for 2021-06-02 → 召回 1823 天,链却不显示。
+  const s1Time = s1Earliest ? effectiveTime(s1Earliest) : null;
+  const diagnosedAt = s1Time ? fmtYearMonthDay(s1Time) : '—';
+  const gapDays = s1Time
+    ? Math.floor((Date.now() - s1Time.getTime()) / 86400_000)
     : undefined;
+  // ⭐ 最近一次诊断(re-trigger 证据)— 多次诊断时即"在管又被诊断"那条;附带其医生真实医嘱
+  const s1Latest = latest(s1Facts);
+  const s1LatestC = s1Latest?.content as Record<string, unknown> | undefined;
+  const latestDxAt = s1Latest && effectiveTime(s1Latest) ? fmtYearMonthDay(effectiveTime(s1Latest)!) : undefined;
+  const latestDxName = s1LatestC
+    ? (String(s1LatestC.name_zh ?? s1LatestC.name ?? '') || undefined)
+    : undefined;
+  const latestDxAdvice = findDoctorAdvice(s1Latest, byType.emr) ?? undefined;
 
   // ★ 潜在新链 = 仅 discovered(纯诊断、零治疗规划 / 付费)。
   // entered(已有 planned 治疗 / 大额付款,但还没 actual)属于"已启动·待治疗",跟 scenario SQL 的
@@ -408,9 +448,13 @@ function inferChainStage(
     allCategories: dxRule?.categories,
     status,
     currentStage,
-    target: status === 'discovered',
+    // 废用牙/无功能牙不是召回目标(跟 scenario 剔除口径一致)
+    target: status === 'discovered' && !restorationIneligible,
     diagnosedAt,
     gapDays,
+    latestDxAt,
+    latestDxName,
+    latestDxAdvice,
     lifecycleNoteZh: lifecycle.noteZh,
     // 给 cross-chain alternative-closed pass 用;wholeMouth 桶 bucket.tooth='*whole'(内部 key),
     // 那种情况回填 s1Earliest 真实牙位串;其他用 bucket.tooth 并集(union-find 后)
@@ -436,6 +480,7 @@ function inferChainStage(
       doctorMap,
       crownOk,
       uncoveredTeeth,
+      restorationIneligible,
     }),
   };
 }
@@ -452,6 +497,7 @@ interface FactsByType {
   payment: ChainComposeInputFact[];
   encounter: ChainComposeInputFact[];
   refund: ChainComposeInputFact[];
+  emr: ChainComposeInputFact[];
 }
 
 function groupByType(facts: ChainComposeInputFact[]): FactsByType {
@@ -463,10 +509,39 @@ function groupByType(facts: ChainComposeInputFact[]): FactsByType {
     payment: facts.filter((f) => f.type === FactType.PAYMENT_RECORD),
     encounter: facts.filter((f) => f.type === FactType.ENCOUNTER_RECORD),
     refund: facts.filter((f) => f.type === FactType.REFUND_RECORD),
+    // emr_record 自由文本:**仅用于展示层证据**(把医生真实医嘱 doctor_advice 透给 UI),
+    //   不进任何 stage 判定 / 召回决策(遵守"算法不读自由文本"纪律)。
+    emr: facts.filter((f) => f.type === FactType.EMR_RECORD),
   };
 }
 
 /**
+ * 取某次诊断对应的医生真实医嘱(doctor_advice)— **展示层证据用,非算法决策**。
+ * 关联口径:同 source 文档(dx.source_encounter_external_id == emr.emr_external_id)优先,
+ *   退化到同日期(occurred_at 同天)。命中且 doctor_advice 非空才返回。
+ */
+function findDoctorAdvice(
+  dx: ChainComposeInputFact | null,
+  emrFacts: ChainComposeInputFact[],
+): string | null {
+  if (!dx) return null;
+  const dc = dx.content as Record<string, unknown> | null;
+  const srcId = dc?.source_encounter_external_id ? String(dc.source_encounter_external_id) : '';
+  const dxDay = effectiveTime(dx)?.toISOString().slice(0, 10) ?? '';
+  let dateFallback: string | null = null;
+  for (const e of emrFacts) {
+    const ec = e.content as Record<string, unknown> | null;
+    const advice = ec?.doctor_advice ? String(ec.doctor_advice).trim() : '';
+    if (!advice) continue;
+    // 精确:同 source 文档 id
+    if (srcId && String(ec?.emr_external_id ?? '') === srcId) return advice;
+    // 兜底:同日期(记下,循环结束没精确命中再用)
+    if (dxDay && effectiveTime(e)?.toISOString().slice(0, 10) === dxDay) dateFallback ??= advice;
+  }
+  return dateFallback;
+}
+
+/**
  * doctor_id → doctor_name 解析表(从所有 facts 学习一遍)。
  *
  * 缘由:host 部分 fact 给 doctor_id 但缺 doctor_name(典型:fact_settlement_out 只有 doctor_id;
@@ -1032,6 +1107,7 @@ function buildStageNodes(opts: {
   doctorMap: Map<string, string>;
   crownOk: boolean;   // W4 末:lifecycle.requiresCrownProtection 满足与否(inferChainStage 算过)
   uncoveredTeeth: string[];  // W4 末:多牙位桶里 actual 没覆盖到的牙位(用于 S5 hint)
+  restorationIneligible: boolean;  // 废用牙/无功能牙 — 建议拔除/观察而非修复(Option B)
 }): ChainNode[] {
   const {
     currentStage,
@@ -1051,11 +1127,15 @@ function buildStageNodes(opts: {
     doctorMap,
     crownOk,
     uncoveredTeeth,
+    restorationIneligible,
   } = opts;
   const reached = (s: number) => currentStage >= s;
   const cur = (s: number) => currentStage === s;
   const fmt = (d: Date | null | undefined) => (d ? fmtYearMonthDay(d) : '—');
-  const expectedHint = CATEGORY_RECOMMEND[category] ?? '相应治疗';
+  // 废用牙/无功能牙:不建议种植/桥/义齿,改建议拔除/观察(临床:无功能牙该拔或观察)
+  const expectedHint = restorationIneligible
+    ? '拔除 / 观察'
+    : (CATEGORY_RECOMMEND[category] ?? '相应治疗');
 
   // ─── S1 发现机会 ───────────────────────────────────
   const s1Node: ChainNode = (() => {
@@ -1102,8 +1182,10 @@ function buildStageNodes(opts: {
     matchedSteps.matched.length >= (milestone?.minSteps ?? 1) ||
     (!milestone && actuals.length > 0);
   const s2Node: ChainNode = (() => {
-    // S2 done:① 有 s2Earliest 强信号 OR ② S3 已到达(治疗都做了一定经过 S2)
-    const s2Done = !!s2Earliest || s3Reached;
+    // S2 done:① 有 s2Earliest 强信号 OR ② S3 已到达 OR ③ 桶里有 actual(治疗发生过必经 S2)
+    //   ③ 兜底 milestone 没匹配上的笼统 subtype(bare"种植"等)—— 跟 inferChainStage 的 actuals>0→ongoing 一致,
+    //   否则 S3 已治疗(✓)但 S2 还"尚未启动"(○)自相矛盾 + 误挂"建议种植"hint。
+    const s2Done = !!s2Earliest || s3Reached || actuals.length > 0;
     const n: ChainNode = { stage: 2, at: '—', done: s2Done, current: cur(2), missing: !s2Done };
 
     // 文案优先级 ① s2Earliest 强信号
@@ -1135,8 +1217,8 @@ function buildStageNodes(opts: {
       return n;
     }
 
-    // ③ 没强信号 也没 planned — 看 status
-    if (s3Reached) {
+    // ③ 没强信号 也没 planned — 看是否已有治疗(s3Reached 或 有 actual:笼统 subtype 也算治疗发生过)
+    if (s3Reached || actuals.length > 0) {
       n.title = '直接执行';
       n.detail = '未经预约';
     } else {
@@ -1169,7 +1251,9 @@ function buildStageNodes(opts: {
     //   - 单 step 类(periodontic/restorative minSteps=1)→ 一律走"次数"分支
     // 杨光宗 27 根管 3 次 actual:旧版"1/3 步骤"误导(像"差 2 步"),新版"已完成 3 次" 准确
     const totalCents = sumAmountCents(actuals);
-    const isMultiStep = !!milestone && milestone.minSteps > 1;
+    // matched>0 才显"X/Y 步骤"(真有部分步骤命中);matched=0 是笼统 subtype 没匹配上(bare"种植"等),
+    //   治疗确实发生了,显"N 次治疗"而非"0/Y 步骤(进行中)"(后者误导成"几乎没做")。
+    const isMultiStep = !!milestone && milestone.minSteps > 1 && matchedSteps.matched.length > 0;
     const progress = s3Reached
       ? `已完成 ${actuals.length} 次`
       : isMultiStep
@@ -1480,6 +1564,13 @@ export interface ComposedChain {
   diagnosedAt?: string;
   /// S1 至今天数 — gap 越大临床越紧迫(召回算法的紧迫度信号)
   gapDays?: number;
+  /// ⭐ 最近一次诊断日(re-trigger 证据)— 多次诊断时 = 再诊断日(如牙周在管又被诊断 2023-10-16)
+  latestDxAt?: string;
+  /// 最近一次诊断的中文名(如"慢性牙龈炎")— banner "又诊断「X」" 用
+  latestDxName?: string;
+  /// 该次诊断对应的医生真实医嘱(emr_record.doctor_advice,如"两个月复诊")— **展示层落地证据**,
+  ///   替代前端硬编码的"医嘱建议 X 个月内";无则前端不显示"医嘱"避免夸大。
+  latestDxAdvice?: string;
   /// 生命周期提示("终身维护(永不闭环)" 等)— UI tooltip
   lifecycleNoteZh?: string;
   /// 桶 tooth_position(用于 cross-chain "alternative-closed" 判定:同 patient 同 tooth overlap)

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

@@ -3,6 +3,7 @@ import {
   PlanScenario,
   DiagnosisTreatmentMap,
   APPT_COMPLAINT_TO_CATEGORY,
+  RESTORATION_INELIGIBLE_DX_NAMES,
   lookupDxTreatment,
   diagnosisCodeNameZh,
   treatmentCategoryNameZh,
@@ -69,7 +70,8 @@ import { toothSet } from '../../../sync/pipeline/parsers/tooth-position.util';
 /// → 不进 K08 种植召回。host 原文 name_zh 在 diagnosis_record.content 留底,据此精确剔除。
 /// 案例:韩雷 38;48 / 826790 18;28;38;48 都是"废用牙"被误当缺牙召回种植(91 分误召)。
 /// 注:这跟"真缺失"(缺失/牙列缺损 → 该修复)区分开;拔牙本身不做泛召回(详见 docs 讨论)。
-const RESTORATION_INELIGIBLE_NAMES = ['废用牙', '无功能牙'];
+/// ⭐ 单一真理源(canonical-codes):chain-composer 同表 → 不立"种植修复·发现机会"潜在链,口径一致。
+const RESTORATION_INELIGIBLE_NAMES = [...RESTORATION_INELIGIBLE_DX_NAMES];
 
 @Injectable()
 export class TreatmentInitiationRecallScenario implements PlanScenarioPlugin {
@@ -500,6 +502,8 @@ export class TreatmentInitiationRecallScenario implements PlanScenarioPlugin {
           triggers: r.cluster_triggers ?? [{ type: triggerType, code: r.signal_code }],
           toothPosition: r.tooth ?? null,
           daysSince: r.days_since,
+          // 不可变锚点:展示层据此实时算天数,跟治疗链断口同源(避免快照随天数陈旧 → "388/389"漂移)
+          signalOccurredAt: r.signal_occurred_at?.toISOString() ?? null,
           expectedCategories: [...excludeCats],
         },
         priorityBreakdown: breakdown,

apps/pac-service/src/modules/plan/plan.service.ts

@@ -9,6 +9,7 @@ import type { Prisma } from '@prisma/client';
 import {
   Permission,
   planScenarioLabel,
+  applyLiveDays,
   type ListPlansResponse,
   type PlanCountsResponse,
   type PlanDetailResponse,
@@ -377,7 +378,8 @@ function toPlanReasonBrief(
     id: r.id,
     scenario: r.scenario,
     subKey: r.subKey,
-    signals: (r.signals as PlanReasonBrief['signals']) ?? null,
+    // daysSince 用锚点 signalOccurredAt 实时重算(跟详情页/治疗链同源,不随天数陈旧);旧 plan 无锚点 → 回落 baked
+    signals: applyLiveDays((r.signals as PlanReasonBrief['signals']) ?? null),
     priorityScore: r.priorityScore,
     reason: r.reason,
     breakdown: r.breakdown ?? null,

apps/pac-service/tests/reason-live-days.spec.ts

+import { liveDaysSince, applyLiveDays } from '@pac/types';
+
+/**
+ * 召回理由"距今天数"实时化(修"召回 388 / 治疗链 389 差一天"漂移)。
+ *
+ * 根因:plan 生成那一刻把 daysSince 算好写死进 signals(快照),随天数推移陈旧;
+ *       治疗链断口(gapDays)是 read 时刻实时算的 → 两数差 = 中间过了几天。
+ * 修法:signals 存不可变锚点 signalOccurredAt,展示层用 chain 同款公式实时重算。
+ */
+describe('reason live daysSince', () => {
+  const NOW = new Date('2026-05-30T01:31:00Z');
+  const OCCURRED = '2025-05-06T00:00:00Z'; // 吴远 K07 诊断日
+
+  test('liveDaysSince 跟 chain gapDays 同款 floor 公式(2025-05-06 → 2026-05-30 = 389)', () => {
+    expect(liveDaysSince(OCCURRED, NOW)).toBe(389);
+  });
+
+  test('liveDaysSince 与 chain-composer 公式逐位等价(Math.floor((now-occurred)/一天))', () => {
+    const chainGap = Math.floor((NOW.getTime() - new Date(OCCURRED).getTime()) / 86_400_000);
+    expect(liveDaysSince(OCCURRED, NOW)).toBe(chainGap);
+  });
+
+  test('无锚点 → null(调用方回落 baked daysSince,不回归)', () => {
+    expect(liveDaysSince(null, NOW)).toBeNull();
+    expect(liveDaysSince(undefined, NOW)).toBeNull();
+    expect(liveDaysSince('not-a-date', NOW)).toBeNull();
+  });
+
+  test('未来锚点 clamp 到 0(防负数,满足 schema nonnegative)', () => {
+    expect(liveDaysSince('2099-01-01T00:00:00Z', NOW)).toBe(0);
+  });
+
+  test('applyLiveDays:有锚点覆盖 daysSince 为实时值(388 快照 → 389 实时)', () => {
+    const baked = {
+      subKey: 'ortho_no_consult',
+      triggers: [{ type: 'diagnosis', code: 'K07' }],
+      toothPosition: null,
+      daysSince: 388, // 昨天生成时的快照
+      signalOccurredAt: OCCURRED,
+      expectedCategories: ['orthodontic'],
+    };
+    const live = applyLiveDays(baked, NOW);
+    expect(live?.daysSince).toBe(389);
+    // 不可变:原对象不动
+    expect(baked.daysSince).toBe(388);
+  });
+
+  test('applyLiveDays:无锚点(旧 plan)→ 原样返回 baked', () => {
+    const oldPlan = {
+      subKey: 'ortho_no_consult',
+      triggers: [{ type: 'diagnosis', code: 'K07' }],
+      daysSince: 388,
+      expectedCategories: ['orthodontic'],
+    };
+    const out = applyLiveDays(oldPlan, NOW);
+    expect(out?.daysSince).toBe(388);
+    expect(out).toBe(oldPlan); // 引用不变(无锚点不拷贝)
+  });
+
+  test('applyLiveDays:null 透传', () => {
+    expect(applyLiveDays(null, NOW)).toBeNull();
+  });
+});

apps/pac-web/src/components/plan-detail/adapt-data.ts

@@ -28,7 +28,7 @@ export function adaptData(real: PlanDetailData, dict?: TokenDictionary) {
     name: real.patient.name ?? '(未知)',
     nameMasked: real.patient.nameMasked ?? '*',
     gender: real.patient.gender ?? '—',
-    age: real.patient.age ?? 0,
+    age: real.patient.age ?? null, // 生日缺失保留 null(渲染 "?" 岁),不要落成 0 岁
     birthDate: real.patient.birthDate ?? '',
     phone: real.patient.phone ?? '',
     phoneMasked: real.patient.phoneMasked ?? '',
@@ -61,6 +61,9 @@ export function adaptData(real: PlanDetailData, dict?: TokenDictionary) {
     target: c.target,
     diagnosedAt: c.diagnosedAt,
     gapDays: c.gapDays,
+    latestDxAt: c.latestDxAt,
+    latestDxName: c.latestDxName,
+    latestDxAdvice: c.latestDxAdvice,
     lifecycleNoteZh: c.lifecycleNoteZh,
     toothPosition: c.toothPosition,
     alternativeClosedBy: c.alternativeClosedBy,

apps/pac-web/src/components/plan-detail/chain-viz.tsx

@@ -253,13 +253,20 @@ function TargetTimelineRow({ chain }: { chain: Chain }) {
               <strong className="font-semibold tabular-nums"> · {formatDaysReadable(chain.gapDays)}未进入治疗链</strong>
             </>
           ) : (
-            // 再启新链:链已 ongoing/entered,gapDays 用最早诊断算误导(实际有 actual)
-            // 用相对说法,避免误用 diagnosedAt;后续后端给 latestDxAt + lastActualAt 再精化
+            // 再启新链:在管治疗链上又被诊断 → 用后端给的真实再诊断日 + 诊断名(落地证据,不再相对说法)
             <>
-              <strong className="font-semibold">再启信号</strong> · 在管治疗链上又被诊断 <strong className="font-semibold">建议再启一轮基础治疗</strong>
+              <strong className="font-semibold">再启信号</strong> ·{' '}
+              {chain.latestDxAt && chain.latestDxName
+                ? <>{chain.latestDxAt} 又诊断「{chain.latestDxName}」</>
+                : '在管治疗链上又被诊断'}
             </>
           )}
-          <span className="text-rose-600/80 ml-1">{chainTargetMeta(chain.category).window}</span>
+          {/* 落地证据:有真实医嘱(emr doctor_advice)→ 显示「医嘱:X」;没有则不再硬编码"医嘱建议 X 个月内"夸大 */}
+          {chain.latestDxAdvice ? (
+            <span className="ml-1">· 医嘱：<strong className="font-semibold">{chain.latestDxAdvice}</strong></span>
+          ) : chain.status !== 'discovered' ? (
+            <strong className="font-semibold ml-1">建议再启一轮基础治疗</strong>
+          ) : null}
         </div>
       </div>
     </div>

apps/pac-web/src/components/plan-detail/mock-data.ts

@@ -34,7 +34,7 @@ export const mockPatient = {
   name: '张志远',
   nameMasked: '张志*',
   gender: '男',
-  age: 42,
+  age: 42 as number | null, // null = 生日缺失,UI 显示 "?" 岁(跟列表页一致)
   birthDate: '1984-03-12',
   phone: '13855612937',
   phoneMasked: '138****2937',
@@ -99,6 +99,10 @@ export type Chain = {
   target?: boolean;
   diagnosedAt?: string;
   gapDays?: number;
+  /// 最近一次诊断(re-trigger 证据)+ 该次医生真实医嘱(doctor_advice)
+  latestDxAt?: string;
+  latestDxName?: string;
+  latestDxAdvice?: string;
   /// 生命周期提示("终身维护(永不闭环)" 等)— UI tooltip
   lifecycleNoteZh?: string;
   /// 桶牙位(cross-chain alternative-closed 判定用,UI 不直接展示)

apps/pac-web/src/components/plan-detail/plan-detail-app.tsx

@@ -744,7 +744,7 @@ function IdentityCard({
             <div className="flex items-center gap-1.5 flex-wrap min-w-0">
               <span className="text-[15px] font-semibold text-slate-900 leading-tight">{patient.name}</span>
               <span className="text-[10.5px] text-slate-500">
-                {formatGender(patient.gender)}·{patient.age}岁
+                {formatGender(patient.gender)}·{patient.age ?? '?'}岁
               </span>
             </div>
             <div className="flex items-center gap-2 flex-none">

apps/pac-web/src/components/plan-detail/plan-detail-types.ts

@@ -118,6 +118,10 @@ export type PlanDetailData = {
     estimatedValueCents?: number;
     diagnosedAt?: string;
     gapDays?: number;
+    /// 最近一次诊断(re-trigger 证据)+ 该次医生真实医嘱
+    latestDxAt?: string;
+    latestDxName?: string;
+    latestDxAdvice?: string;
     /// 生命周期提示("终身维护(永不闭环)" 等)
     lifecycleNoteZh?: string;
     /// 桶牙位(cross-chain alternative-closed 判定用,UI 不直接展示)

packages/types/src/canonical-codes.ts

@@ -209,6 +209,20 @@ export const DiagnosisTreatmentMap = {
 
 export type DiagnosisTreatmentCode = keyof typeof DiagnosisTreatmentMap;
 
+/**
+ * "算诊断但无修复必要"的诊断名(host 把它们映射到 K08 缺牙类,但牙还在、只是无功能)。
+ * 临床:该拔除 / 观察,**不是种植/桥/义齿修复对象**。
+ *
+ * **单一真理源**:召回 scenario(剔除出召回池)和 chain-composer(不立"种植修复·发现机会"潜在链,
+ *   改中性展示 + 建议拔除/观察)共用此表,避免两处口径分叉(canonical-fact-layer「单一收口」)。
+ */
+export const RESTORATION_INELIGIBLE_DX_NAMES = ['废用牙', '无功能牙'] as const;
+
+/// 判断诊断 name_zh 是否属"无修复必要"(废用牙/无功能牙)
+export function isRestorationIneligibleDxName(nameZh: string | null | undefined): boolean {
+  return !!nameZh && (RESTORATION_INELIGIBLE_DX_NAMES as readonly string[]).includes(nameZh);
+}
+
 /// 查表(找不到返回 undefined — 调用方决定如何降级)
 export function lookupDxTreatment(code: string): DxTreatmentRule | undefined {
   return (DiagnosisTreatmentMap as Record<string, DxTreatmentRule>)[code];
@@ -362,7 +376,11 @@ export interface TreatmentMilestone {
 }
 
 export const TreatmentMilestones = {
-  implant:       { steps: ['implant_placement', 'crown_placement'],                        minSteps: 2, lifecycle: 'linear' },
+  // terminalSteps: crown_placement(戴牙/上部修复)= 种植功能性完成 —— 临床上没有植体不可能戴冠,
+  //   所以即使"种植体植入"步因数据缺失(无牙位 / 早于诊断 / subtype 不命中)没匹配上,戴冠即视为收尾。
+  //   修复刘晓芳 47 案例:戴牙完成却因植入步丢失被误判 discovered ★(潜在新链)。
+  //   单做植入未戴冠 → 仍 matched=1<minSteps=2 且非 terminal → s3 不达成(保持"待戴冠"语义)。
+  implant:       { steps: ['implant_placement', 'crown_placement'],                        minSteps: 2, lifecycle: 'linear', terminalSteps: ['crown_placement'] },
   // endodontic 3 步 + minSteps=2(开髓 + 根充至少);patient 真做了开髓+根备+根充才算完整
   // lifecycle=linear_then_crown:闭环额外要求 prosthodontic 冠保护(临床:根管后不戴冠折裂率 ~30%)
   endodontic:    { steps: ['pulp_extirpation', 'canal_preparation', 'canal_filling', 'pulpotomy'], minSteps: 2, lifecycle: 'linear_then_crown', terminalSteps: ['canal_filling', 'pulpotomy'] },
@@ -382,21 +400,37 @@ export const TreatmentMilestones = {
 export const LegacyStepSubtypeKeywords: Partial<Record<PACTreatmentStepKey, readonly string[]>> = {
   pulp_extirpation: ['开髓', '拔髓'],
   canal_preparation: ['根备', '根管预备'],
-  canal_filling: ['根充', '根管充填'],
+  // canal_filling = RCT 终末步。除细分"根充/根管充填",再纳入**整根管术式全称/缩写**:
+  //   host 结算项常写笼统名(根管治疗 / 根管再治疗 / RCT / 根管治疗+冠修复…),不写细分步骤 →
+  //   旧版匹配 0/4 步骤,链误判"未做根管"(实际已做)。这些全称词即"根管已完成"的等价信号,归终末步。
+  //   ⚠️ 仍只匹配 subtype 不含细分 stages 的记录(matchMilestoneSteps:有 stages 则以 stages 为准),
+  //      子步骤(开髓/根备/根充)语义完整保留;"根管预备/根充"等仍各归其步,不受影响。
+  canal_filling: ['根充', '根管充填', '根管治疗', '根管再治疗', '根管二次治疗', 'RCT'],
   // pulpotomy 类:活髓切断 / 部分活髓切断 / 部分牙髓切断 / 冠髓切断 / 干髓 / 盖髓 / 牙髓血运重建
   // 这些都是"保留根髓"的终末术式(VPT — vital pulp therapy),临床等价
   pulpotomy: ['活髓切断', '部分活髓切断', '部分牙髓切断', '冠髓切断', '干髓', '盖髓', '牙髓血运重建', '活髓保存'],
-  implant_placement: ['种植体植入', '种植手术', '种植一期', '简单种植', '复杂种植', '即刻种植', '延期种植', '拔除后种植'],
-  crown_placement: ['种植上部修复', '种植冠修复', '种植戴牙', '种植二期', '种植三期'],
+  // 种植一/二/三期都是"外科植入阶段"(一期植入 → 二期暴露/愈合帽 → 三期),归 implant_placement;
+  //   不能进 crown_placement,否则"只做二期没戴冠"会被 terminalSteps 误判为种植完成。
+  implant_placement: ['种植体植入', '种植钉植入', '种植手术', '种植一期', '种植二期', '种植三期', '简单种植', '复杂种植', '即刻种植', '即拔即种', '延期种植', '拔除后种植'],
+  // crown_placement = 真正"戴上冠/上部修复完成"的终末信号(见 TreatmentMilestones.implant.terminalSteps)
+  //   除"种植上部修复/冠修复/戴牙",再纳入笼统全称 **种植修复**(host 结算项最常用,= 种植上部修复完成)、
+  //   种植冠加瓷(烤瓷冠)。同 endodontic 的"根管治疗"全称兜底:不写细分步骤的整术式记录也能认出"已修复"。
+  //   注:"种植上部修复"含"修复"但不含"种植修复"子串,两者各自独立匹配,不冲突。
+  crown_placement: ['种植上部修复', '种植冠修复', '种植戴牙', '种植修复', '种植冠加瓷'],
   supragingival_scaling: ['洁治', '洁牙', '洗牙'],
-  subgingival_scaling: ['刮治', '龈下'],
+  // 笼统全称"牙周基础治疗/牙周系统治疗"(host 结算项常用,= 已做 SRP 系统治疗)归 SRP 步,
+  //   否则牙周链误判"未做"。注:洁牙 vs SRP 的召回区分在 scenario 侧(SRP_RECOMMENDED),展示层不受影响。
+  subgingival_scaling: ['刮治', '龈下', '牙周基础治疗', '牙周系统治疗'],
   periodontal_maintenance: ['维护'],
   composite_filling: ['充填'],
   inlay: ['嵌体'],
-  crown_restoration: ['冠'],
+  // crown_restoration:除"冠",纳入"戴牙"(冠桥/义齿戴入完成 = 修复终末)。
+  crown_restoration: ['冠', '戴牙'],
   post_core: ['桩核'],
   tooth_extraction: ['拔除', '拔牙'],
-  bracket_placement: ['矫治器', '附件', '托槽'],
+  // bracket_placement:除具体器械(矫治器/托槽/附件),纳入笼统全称"正畸/正畸治疗/矫治"
+  //   (host 结算项最常写"正畸"——做正畸必然已戴矫治器,= 已进入正畸执行)。
+  bracket_placement: ['矫治器', '附件', '托槽', '正畸', '正畸治疗', '矫治'],
   retainer: ['保持器'],
   ortho_adjustment: ['加力', '调整'],
   fluoride_application: ['涂氟'],

packages/types/src/schemas/reason-signals.ts

@@ -34,8 +34,15 @@ export const ReasonSignalsSchema = z.object({
   toothPosition: z.string().nullable().optional(),
 
   /// 紧迫维度:触发信号距今多少天(跨场景通用)
+  /// ⚠️ 这是 plan 生成那一刻**固化的快照**,随天数推移会陈旧。
+  ///   展示层应优先用 signalOccurredAt 实时重算(见 applyLiveDays),此字段作 AI prompt / 旧数据兜底。
   daysSince: z.number().int().nonnegative(),
 
+  /// 触发信号发生时刻(诊断 occurred_at / 推荐 planned_for 的 ISO)— **不可变锚点**。
+  /// 展示层据此实时算天数,跟治疗链断口(chain.gapDays)同源同公式,避免"召回 388 / 治疗链 389"漂移。
+  /// optional/nullable:旧 plan 无此字段 → 回落 baked daysSince(无回归)。
+  signalOccurredAt: z.string().datetime().nullable().optional(),
+
   /// 期望待启动类别(raw PAC treatment category enum;前端用 treatmentCategoryNameZh 翻译)
   /// 不同场景含义:
   ///   - 召回类:期望启动哪类治疗(种植 / 充填 / 牙周基础 / 根管)
@@ -43,3 +50,35 @@ export const ReasonSignalsSchema = z.object({
   expectedCategories: z.array(z.string()),
 });
 export type ReasonSignals = z.infer<typeof ReasonSignalsSchema>;
+
+/**
+ * 据锚点 signalOccurredAt 实时算"距今天数"。
+ * **跟 chain-composer 的 gapDays 完全同款公式**(`Math.floor((now - occurred)/一天)`),
+ * 保证召回理由天数与治疗链断口永远精确一致(差异源自两者算的时刻不同 → 统一到 read 时刻)。
+ * @param iso 锚点 ISO 时间;为空返回 null(调用方回落 baked daysSince)
+ * @param now 参考时刻(默认当下)— 便于测试注入
+ */
+export function liveDaysSince(
+  iso: string | null | undefined,
+  now: Date = new Date(),
+): number | null {
+  if (!iso) return null;
+  const t = new Date(iso).getTime();
+  if (Number.isNaN(t)) return null;
+  return Math.max(0, Math.floor((now.getTime() - t) / 86_400_000));
+}
+
+/**
+ * 把 signals 的 daysSince 用锚点实时重算后返回(不可变拷贝)。
+ * 有锚点 → 覆盖为实时值;无锚点 → 原样返回(旧数据兜底)。
+ * 服务端两条序列化路径(列表 / 详情)共用,保证两处口径一致。
+ */
+export function applyLiveDays<T extends { daysSince?: number; signalOccurredAt?: string | null }>(
+  signals: T | null,
+  now: Date = new Date(),
+): T | null {
+  if (!signals) return signals;
+  const live = liveDaysSince(signals.signalOccurredAt, now);
+  if (live === null) return signals;
+  return { ...signals, daysSince: live };
+}