26-7-31-1

ai-service/.env.example

@@ -0,0 +1,17 @@
+# AI 服务端口
+AI_HOST=0.0.0.0
+AI_PORT=8001
+
+# demo | real | auto（auto：有权重用真实 YOLO，否则演示检测）
+DEMO_MODE=auto
+YOLO_WEIGHTS=
+
+# DeepSeek / Qwen 等 OpenAI 兼容接口
+LLM_BASE_URL=https://api.deepseek.com
+LLM_API_KEY=
+LLM_MODEL=deepseek-chat
+LLM_TEMPERATURE=0.3
+
+# 知识库与向量缓存目录
+KNOWLEDGE_DIR=./app/knowledge
+VECTOR_DIR=./data/vectorstore

ai-service/.gitignore

@@ -0,0 +1,11 @@
+.venv/
+__pycache__/
+*.py[cod]
+.env
+data/
+*.jpg
+*.jpeg
+*.png
+!samples/.gitkeep
+.idea/
+.vscode/

ai-service/README.md

@@ -0,0 +1,75 @@
+# Smart Hospital AI Service
+
+FastAPI 微服务：YOLO 影像检测（演示级）+ MONAI/OpenCV 预处理 + LangChain RAG + 报告/决策生成。
+
+兼容 **DeepSeek / Qwen** 等 OpenAI 协议大模型。
+
+## 快速启动
+
+```bash
+cd ai-service
+python -m venv .venv
+
+# Windows
+.venv\Scripts\activate
+# macOS/Linux
+# source .venv/bin/activate
+
+# CPU 版 torch（体积更小，实训推荐）
+pip install torch torchvision --index-url https://download.pytorch.org/whl/cpu
+pip install -r requirements.txt
+copy .env.example .env   # 按需填写 LLM_API_KEY
+
+uvicorn app.main:app --host 0.0.0.0 --port 8001
+```
+
+> `.venv` 可随时删除后按上面步骤重建；权重见 `data/weights/`（已精简保留医学检测模型）。
+
+- 文档：http://127.0.0.1:8001/docs  
+- 健康检查：http://127.0.0.1:8001/health  
+
+## 主要接口
+
+| 方法 | 路径 | 说明 |
+|------|------|------|
+| GET | `/health` | 服务与能力探测 |
+| POST | `/imaging/analyze` | 影像 YOLO 检测 + 初步诊断/报告 |
+| POST | `/report/decision` | EMR 辅助决策（护理/治疗/随访 + RAG） |
+| POST | `/report/imaging` | 单独生成影像报告 |
+| POST | `/rag/query` | 知识库问答 |
+| POST | `/rag/ingest` | 追加知识文档 |
+
+## 环境变量（`.env`）
+
+| 变量 | 说明 | 默认 |
+|------|------|------|
+| `DEMO_MODE` | `demo` / `real` / `auto` | `auto` |
+| `YOLO_WEIGHTS` | YOLO 权重路径 | 空则演示检测 |
+| `LLM_BASE_URL` | OpenAI 兼容地址 | `https://api.deepseek.com` |
+| `LLM_API_KEY` | API Key | 空则模板/RAG 摘要 |
+| `LLM_MODEL` | 模型名 | `deepseek-chat` |
+
+## 可选视觉栈
+
+```bash
+pip install torch torchvision ultralytics monai
+```
+
+安装后将 `YOLO_WEIGHTS` 指向权重文件，并设 `DEMO_MODE=auto` 或 `real`。
+
+## 与 Spring Boot 对接
+
+业务后端配置（`application.yml`）：
+
+```yaml
+ai:
+  service:
+    enabled: true
+    base-url: http://127.0.0.1:8001
+```
+
+前端仍只访问 Spring Boot `:8080`，由后端转发到本服务。
+
+## 声明
+
+输出仅供教学实训与辅助决策演示，**不能替代执业医师诊断**。

ai-service/app/__init__.py

@@ -0,0 +1 @@
+"""Smart Hospital AI Service."""

ai-service/app/api/__init__.py

@@ -0,0 +1 @@
+"""API routers."""

ai-service/app/api/health.py

@@ -0,0 +1,26 @@
+from fastapi import APIRouter
+
+from app.config import get_settings
+from app.schemas.models import HealthResponse
+from app.services.llm_client import get_llm
+from app.services.monai_preprocess import monai_available
+from app.services.rag_pipeline import get_rag, langchain_available
+from app.services.yolo_detector import yolo_available
+
+router = APIRouter(tags=["health"])
+
+
+@router.get("/health", response_model=HealthResponse)
+def health() -> HealthResponse:
+    settings = get_settings()
+    rag = get_rag()
+    llm = get_llm()
+    return HealthResponse(
+        status="ok",
+        yolo_available=yolo_available(),
+        monai_available=monai_available(),
+        langchain_available=langchain_available(),
+        llm_configured=llm.enabled,
+        demo_mode=settings.demo_mode,
+        knowledge_docs=rag.doc_count(),
+    )

ai-service/app/api/imaging.py

@@ -0,0 +1,89 @@
+from __future__ import annotations
+
+import logging
+from pathlib import Path
+
+from fastapi import APIRouter, File, Form, HTTPException, UploadFile
+
+from app.schemas.models import ImagingAnalyzeResponse
+from app.services.monai_preprocess import load_image_bgr, preprocess
+from app.services.report_generator import build_imaging_texts, generate_imaging_report, make_full_report
+from app.schemas.models import ImagingReportRequest
+from app.services.yolo_detector import get_detector
+from app.services.yolo_manager import get_yolo_manager
+
+logger = logging.getLogger(__name__)
+router = APIRouter(prefix="/imaging", tags=["imaging"])
+
+
+@router.post("/analyze", response_model=ImagingAnalyzeResponse)
+async def analyze_imaging(
+    file: UploadFile | None = File(default=None),
+    image_path: str | None = Form(default=None),
+    study_type: str = Form(default="CT"),
+    body_part: str = Form(default=""),
+    patient_summary: str = Form(default=""),
+) -> ImagingAnalyzeResponse:
+    raw = await _read_bytes(file, image_path)
+    try:
+        image_bgr = load_image_bgr(raw)
+        prep = preprocess(image_bgr)
+        detector = get_detector()
+        detections = detector.detect(image_bgr, study_type=study_type)
+        annotated = detector.annotate(image_bgr, detections)
+        findings, diagnosis, recommendations, confidence = build_imaging_texts(
+            study_type, body_part, detections, detector.mode
+        )
+        report = generate_imaging_report(
+            ImagingReportRequest(
+                study_type=study_type,
+                body_part=body_part,
+                patient_summary=patient_summary,
+                preliminary_diagnosis=diagnosis,
+                findings=findings,
+                detections=detections,
+                confidence=confidence,
+            )
+        )
+        backend = prep.get("backend", "opencv")
+        model_version = f"yolo-{detector.mode}+{backend}+{report.model_version}"
+        try:
+            get_yolo_manager().record_inference(
+                mode=detector.mode,
+                detections=detections,
+                study_type=study_type,
+                model_version=model_version,
+            )
+        except Exception as e:
+            logger.warning("记录 YOLO 统计失败: %s", e)
+        return ImagingAnalyzeResponse(
+            detections=detections,
+            annotated_image_base64=annotated,
+            preliminary_diagnosis=report.impression or diagnosis,
+            findings=report.findings or findings,
+            recommendations=report.recommendations or recommendations,
+            confidence=confidence,
+            model_version=model_version,
+            mode=detector.mode,  # type: ignore[arg-type]
+            full_report=report.full_report
+            or make_full_report(study_type, body_part, findings, diagnosis, recommendations, patient_summary),
+        )
+    except ValueError as e:
+        raise HTTPException(status_code=400, detail=str(e)) from e
+    except Exception as e:
+        logger.exception("影像分析失败")
+        raise HTTPException(status_code=500, detail=f"影像分析失败: {e}") from e
+
+
+async def _read_bytes(file: UploadFile | None, image_path: str | None) -> bytes:
+    if file is not None:
+        data = await file.read()
+        if not data:
+            raise HTTPException(status_code=400, detail="上传文件为空")
+        return data
+    if image_path:
+        path = Path(image_path)
+        if not path.is_file():
+            raise HTTPException(status_code=400, detail=f"影像路径不存在: {image_path}")
+        return path.read_bytes()
+    raise HTTPException(status_code=400, detail="请提供 file 或 image_path")

ai-service/app/api/llm_config.py

@@ -0,0 +1,70 @@
+"""管理端下发的 LLM 运行时配置。"""
+from __future__ import annotations
+
+import logging
+
+from fastapi import APIRouter
+from pydantic import BaseModel, Field
+
+from app.config import get_settings
+from app.services.llm_client import get_llm
+from app.services.llm_runtime import get_runtime_llm, update_runtime_llm
+
+logger = logging.getLogger(__name__)
+router = APIRouter(prefix="/llm", tags=["llm"])
+
+
+class LlmConfigUpdate(BaseModel):
+    enabled: bool | None = True
+    api_base_url: str | None = Field(default=None, alias="api_base_url")
+    api_key: str | None = None
+    model: str | None = None
+    temperature: float | None = None
+
+    # 兼容 camelCase（Spring 默认可能发 apiBaseUrl）
+    apiBaseUrl: str | None = None
+    apiKey: str | None = None
+
+    class Config:
+        populate_by_name = True
+
+
+@router.get("/config")
+def get_llm_config() -> dict:
+    return get_llm().info()
+
+
+@router.post("/config")
+def set_llm_config(body: LlmConfigUpdate) -> dict:
+    base = body.api_base_url or body.apiBaseUrl
+    key = body.api_key if body.api_key is not None else body.apiKey
+    # 注意：key 为 None 表示本次不改密钥；空字符串表示清空运行时密钥
+    rt = update_runtime_llm(
+        enabled=body.enabled,
+        api_base_url=base,
+        api_key=key,
+        model=body.model,
+        temperature=body.temperature,
+    )
+    info = get_llm().info()
+    logger.info(
+        "已更新运行时 LLM 配置 enabled=%s model=%s base=%s key=%s source=%s",
+        info.get("enabled"),
+        info.get("model"),
+        info.get("api_base_url"),
+        "yes" if info.get("api_key_configured") else "no",
+        rt.source,
+    )
+    return {"ok": True, **info}
+
+
+@router.get("/status")
+def llm_status() -> dict:
+    settings = get_settings()
+    info = get_llm().info()
+    rt = get_runtime_llm()
+    return {
+        **info,
+        "env_key_configured": bool(settings.llm_api_key and settings.llm_api_key.strip()),
+        "runtime_enabled_flag": rt.enabled,
+    }

ai-service/app/api/rag.py

@@ -0,0 +1,49 @@
+from fastapi import APIRouter
+from pydantic import BaseModel, Field
+
+from app.schemas.models import RagQueryRequest, RagQueryResponse, SourceRef
+from app.services.rag_pipeline import get_rag
+
+router = APIRouter(prefix="/rag", tags=["rag"])
+
+
+class IngestRequest(BaseModel):
+    title: str
+    content: str
+    category: str = "自定义"
+
+
+class IngestResponse(BaseModel):
+    ok: bool = True
+    chunks: int = 0
+
+
+@router.post("/query", response_model=RagQueryResponse)
+def rag_query(body: RagQueryRequest) -> RagQueryResponse:
+    rag = get_rag()
+    result = rag.query(body.query, top_k=body.top_k, extra_context=body.context or "")
+    raw_sources = result.get("sources") or []
+    sources: list[SourceRef] = []
+    for s in raw_sources:
+        if isinstance(s, SourceRef):
+            sources.append(s)
+        elif isinstance(s, dict):
+            sources.append(SourceRef(**s))
+    return RagQueryResponse(
+        answer=result.get("answer") or "",
+        sources=sources,
+        engine=result.get("engine") or "langchain-rag",
+    )
+
+
+@router.post("/ingest", response_model=IngestResponse)
+def rag_ingest(body: IngestRequest) -> IngestResponse:
+    rag = get_rag()
+    rag.ingest_text(body.title, body.content, body.category)
+    return IngestResponse(ok=True, chunks=rag.doc_count())
+
+
+@router.get("/stats")
+def rag_stats() -> dict:
+    rag = get_rag()
+    return {"chunks": rag.doc_count()}

ai-service/app/api/report.py

@@ -0,0 +1,21 @@
+from fastapi import APIRouter
+
+from app.schemas.models import (
+    DecisionRequest,
+    DecisionResponse,
+    ImagingReportRequest,
+    ImagingReportResponse,
+)
+from app.services.report_generator import generate_decision, generate_imaging_report
+
+router = APIRouter(prefix="/report", tags=["report"])
+
+
+@router.post("/imaging", response_model=ImagingReportResponse)
+def report_imaging(body: ImagingReportRequest) -> ImagingReportResponse:
+    return generate_imaging_report(body)
+
+
+@router.post("/decision", response_model=DecisionResponse)
+def report_decision(body: DecisionRequest) -> DecisionResponse:
+    return generate_decision(body)

ai-service/app/api/yolo.py

@@ -0,0 +1,135 @@
+from __future__ import annotations
+
+import logging
+
+from fastapi import APIRouter, File, HTTPException, UploadFile
+from pydantic import BaseModel, Field
+
+from app.services.yolo_detector import get_detector, reload_detector, yolo_available
+from app.services.yolo_manager import get_yolo_manager
+
+logger = logging.getLogger(__name__)
+router = APIRouter(prefix="/yolo", tags=["yolo"])
+
+
+class ActivateRequest(BaseModel):
+    name: str = Field(..., description="权重文件名")
+    demo_mode: str | None = Field(default=None, description="demo|real|auto")
+
+
+class DemoModeRequest(BaseModel):
+    demo_mode: str = Field(..., description="demo|real|auto")
+
+
+@router.get("/status")
+def yolo_status() -> dict:
+    mgr = get_yolo_manager()
+    det = get_detector()
+    return mgr.status(det.info())
+
+
+@router.get("/weights")
+def list_weights() -> dict:
+    mgr = get_yolo_manager()
+    return {"items": mgr.list_weights(), "count": len(mgr.list_weights())}
+
+
+@router.post("/weights/upload")
+async def upload_weight(file: UploadFile = File(...)) -> dict:
+    if not file.filename:
+        raise HTTPException(400, "缺少文件名")
+    raw = await file.read()
+    try:
+        item = get_yolo_manager().save_upload(file.filename, raw)
+        return {"ok": True, "weight": item}
+    except ValueError as e:
+        raise HTTPException(400, str(e)) from e
+    except Exception as e:
+        logger.exception("上传权重失败")
+        raise HTTPException(500, f"上传失败: {e}") from e
+
+
+@router.post("/weights/activate")
+def activate_weight(body: ActivateRequest) -> dict:
+    try:
+        status = get_yolo_manager().activate(body.name, body.demo_mode)
+        info = reload_detector()
+        status.update(info)
+        status["ok"] = True
+        return status
+    except FileNotFoundError as e:
+        raise HTTPException(404, str(e)) from e
+    except ValueError as e:
+        raise HTTPException(400, str(e)) from e
+
+
+@router.post("/weights/deactivate")
+def deactivate_weight() -> dict:
+    status = get_yolo_manager().deactivate()
+    info = reload_detector()
+    status.update(info)
+    status["ok"] = True
+    return status
+
+
+@router.delete("/weights/{name}")
+def delete_weight(name: str) -> dict:
+    """逻辑删除：隐藏权重，本地 .pt 文件仍保留在 data/weights。"""
+    try:
+        get_yolo_manager().delete_weight(name)
+        reload_detector()
+        return {
+            "ok": True,
+            "name": name,
+            "soft_delete": True,
+            "message": "已逻辑删除（本地文件保留，仅从列表隐藏）",
+        }
+    except FileNotFoundError as e:
+        raise HTTPException(404, str(e)) from e
+    except ValueError as e:
+        raise HTTPException(400, str(e)) from e
+
+
+@router.post("/weights/restore")
+def restore_weight(body: ActivateRequest) -> dict:
+    """恢复逻辑删除的权重。"""
+    try:
+        status = get_yolo_manager().restore_weight(body.name)
+        info = reload_detector()
+        status.update(info)
+        status["ok"] = True
+        return status
+    except FileNotFoundError as e:
+        raise HTTPException(404, str(e)) from e
+
+
+@router.post("/mode")
+def set_mode(body: DemoModeRequest) -> dict:
+    try:
+        status = get_yolo_manager().set_demo_mode(body.demo_mode)
+        info = reload_detector()
+        status.update(info)
+        status["ok"] = True
+        return status
+    except ValueError as e:
+        raise HTTPException(400, str(e)) from e
+
+
+@router.get("/visualization")
+def visualization() -> dict:
+    return get_yolo_manager().visualization()
+
+
+@router.post("/stats/reset")
+def reset_stats() -> dict:
+    get_yolo_manager().reset_stats()
+    return {"ok": True}
+
+
+@router.get("/capability")
+def capability() -> dict:
+    return {
+        "ultralytics": yolo_available(),
+        "detector": get_detector().info(),
+        "manager": get_yolo_manager().status(),
+    }

ai-service/app/config.py

@@ -0,0 +1,63 @@
+from __future__ import annotations
+
+from functools import lru_cache
+from pathlib import Path
+from typing import Literal
+
+from pydantic_settings import BaseSettings, SettingsConfigDict
+
+
+class Settings(BaseSettings):
+    model_config = SettingsConfigDict(
+        env_file=".env",
+        env_file_encoding="utf-8",
+        extra="ignore",
+    )
+
+    ai_host: str = "0.0.0.0"
+    ai_port: int = 8001
+
+    demo_mode: Literal["demo", "real", "auto"] = "auto"
+    yolo_weights: str = ""
+
+    llm_base_url: str = "https://api.deepseek.com"
+    llm_api_key: str = ""
+    llm_model: str = "deepseek-chat"
+    llm_temperature: float = 0.3
+
+    knowledge_dir: str = "./app/knowledge"
+    vector_dir: str = "./data/vectorstore"
+
+    @property
+    def root_dir(self) -> Path:
+        return Path(__file__).resolve().parent.parent
+
+    def resolve_path(self, value: str) -> Path:
+        p = Path(value)
+        if p.is_absolute():
+            return p
+        return (self.root_dir / p).resolve()
+
+    @property
+    def knowledge_path(self) -> Path:
+        return self.resolve_path(self.knowledge_dir)
+
+    @property
+    def vector_path(self) -> Path:
+        return self.resolve_path(self.vector_dir)
+
+    @property
+    def yolo_weights_path(self) -> Path | None:
+        if not self.yolo_weights or not self.yolo_weights.strip():
+            return None
+        path = self.resolve_path(self.yolo_weights.strip())
+        return path if path.is_file() else None
+
+    @property
+    def llm_enabled(self) -> bool:
+        return bool(self.llm_api_key and self.llm_api_key.strip())
+
+
+@lru_cache
+def get_settings() -> Settings:
+    return Settings()

ai-service/app/knowledge/cholecystolithiasis.md

@@ -0,0 +1,19 @@
+# 胆囊结石辅助管理要点
+
+category: 消化外科
+
+## 表现
+右上腹痛、油腻饮食后加重，可伴恶心；超声是首选检查。
+
+## 处理
+- 无症状结石可观察
+- 症状性结石评估腹腔镜胆囊切除指征
+- 合并胆管炎/胰腺炎需紧急处理
+
+## 护理与饮食
+- 低脂饮食
+- 观察腹痛、黄疸、发热
+- 术后早期活动
+
+## 注意
+实训演示用，非临床处方依据。

ai-service/app/knowledge/diabetes.md

@@ -0,0 +1,24 @@
+# 2 型糖尿病辅助管理要点
+
+category: 内分泌
+
+## 诊断要点
+空腹血糖、OGTT 或 HbA1c 达到诊断阈值；需排除 1 型及其他特殊类型。
+
+## 综合管理
+- 医学营养治疗与运动
+- 血糖自我监测
+- 个体化降糖药物（如二甲双胍等，注意禁忌）
+- 血压、血脂与抗血小板综合干预
+
+## 并发症筛查
+- 视网膜病变、肾病、神经病变、足病
+- 心血管风险评估
+
+## 护理与随访
+- 低血糖识别与处理
+- 足部护理
+- 定期复查血糖与 HbA1c
+
+## 注意
+本资料用于教学演示，临床决策需结合指南与患者情况。

ai-service/app/knowledge/fracture.md

@@ -0,0 +1,20 @@
+# 骨折影像与处置要点（示意）
+
+category: 骨科
+
+## 影像
+- X 线是基础检查；复杂部位可 CT/MRI。
+- 描述骨折部位、类型、移位、关节受累。
+
+## 处理原则
+- 复位、固定、功能锻炼
+- 开放伤注意清创抗感染
+- 评估血管神经损伤
+
+## 护理与随访
+- 患肢肿胀、血运、感觉观察
+- 疼痛管理与防深静脉血栓
+- 按医嘱复查 X 光评估愈合
+
+## 注意
+仅供实训演示，不作为临床操作依据。

ai-service/app/knowledge/general_emr.md

@@ -0,0 +1,17 @@
+# 电子病历与辅助决策书写规范（示意）
+
+category: 病历质控
+
+## 病历要素
+主诉、现病史、体格检查、辅助检查、诊断、治疗计划、用药、随访。
+
+## AI 辅助使用原则
+- AI 输出仅供参考，必须经医师审核修改后入档。
+- 引用知识库内容时注明来源类别。
+- 避免将模型幻觉内容写入正式病历。
+
+## 护理建议常见结构
+病情观察、用药护理、生活指导、心理支持、健康宣教。
+
+## 随访计划
+复诊时间、复查项目、危险症状返院指征。

ai-service/app/knowledge/hypertension.md

@@ -0,0 +1,24 @@
+# 原发性高血压辅助管理要点
+
+category: 心血管
+
+## 诊断
+非同日三次诊室血压 ≥140/90 mmHg 可诊断高血压；鼓励家庭血压与动态血压监测。
+
+## 非药物治疗
+- 限盐（<5 g/日）、DASH 饮食
+- 规律有氧运动、控制体重
+- 戒烟限酒、减少精神压力
+
+## 药物治疗（示意）
+- 常用类别：ACEI/ARB、CCB、利尿剂、β 受体阻滞剂等。
+- 合并糖尿病、慢性肾病等需个体化选药。
+- 注意体位性低血压与电解质紊乱。
+
+## 护理与随访
+- 规范测量并记录血压
+- 提高服药依从性宣教
+- 评估靶器官损害，定期复诊
+
+## 注意
+用药方案必须由执业医师开具，本文仅供实训演示。

ai-service/app/knowledge/mri_spine.md

@@ -0,0 +1,22 @@
+# 颈椎/腰椎间盘突出 MRI 辅助解读要点
+
+category: 骨科/影像
+
+## 常见表现
+- 椎间盘信号改变、突出压迫硬膜囊或神经根
+- 可伴椎管狭窄、黄韧带肥厚
+
+## 临床相关
+- 颈肩痛、上肢放射痛、腰痛、下肢放射痛、麻木
+- 需与脊髓病、肿瘤、感染鉴别
+
+## 治疗路径（示意）
+- 多数可先保守：休息、理疗、药物、功能锻炼
+- 神经功能障碍加重或马尾症状需紧急评估手术指征
+
+## 随访
+- 症状变化记录
+- 必要时复查 MRI
+
+## 注意
+教学演示资料，诊断以影像科与临床医师为准。

ai-service/app/knowledge/pneumonia.md

@@ -0,0 +1,23 @@
+# 社区获得性肺炎辅助诊疗要点
+
+category: 呼吸内科
+
+## 概述
+社区获得性肺炎（CAP）是指在医院外罹患的肺实质感染，常见症状包括发热、咳嗽、咳痰、胸痛与呼吸困难。
+
+## 影像表现
+- X 线/CT：片状、斑片状浸润影或实变，可伴空气支气管征。
+- 需与肺结核、肿瘤、肺水肿等鉴别。
+
+## 治疗原则
+- 评估 CURB-65 或 PSI 严重程度分层。
+- 经验性抗感染覆盖常见病原（肺炎链球菌等），并根据培养结果调整。
+- 支持治疗：氧疗、补液、退热、止咳化痰。
+
+## 护理与随访
+- 监测体温、呼吸频率、血氧饱和度。
+- 鼓励有效咳嗽与体位引流。
+- 治疗后 3–5 天评估疗效；必要时复查胸片。
+
+## 注意
+本资料仅供教学演示与辅助决策参考，不能替代临床指南与医师判断。

ai-service/app/knowledge/pulmonary_nodule.md

@@ -0,0 +1,23 @@
+# 肺结节随访与管理要点
+
+category: 呼吸/胸外
+
+## 定义
+肺结节通常指直径 ≤3 cm 的圆形或类圆形 dens 灶，需结合大小、形态、密度及随访变化综合判断。
+
+## 影像关注点
+- 大小与倍增时间
+- 边缘（毛刺、分叶）、钙化、空泡、胸膜牵拉
+- 实性 / 部分实性 / 磨玻璃
+
+## 管理建议（示意）
+- 微小结节：定期 CT 随访。
+- 可疑恶性特征：建议专科评估，必要时 PET、活检或多学科讨论。
+- 戒烟是重要干预措施。
+
+## 护理与宣教
+- 缓解患者焦虑，说明随访意义。
+- 出现咯血、胸痛、进行性气促及时就诊。
+
+## 注意
+本资料仅供教学演示，实际随访间隔需按最新指南与个体情况确定。

ai-service/app/main.py

@@ -0,0 +1,75 @@
+from __future__ import annotations
+
+import logging
+
+from fastapi import FastAPI
+from fastapi.middleware.cors import CORSMiddleware
+
+from app.api import health, imaging, llm_config, rag, report, yolo
+from app.config import get_settings
+from app.services.llm_client import get_llm
+from app.services.rag_pipeline import get_rag
+from app.services.yolo_detector import get_detector
+
+logging.basicConfig(
+    level=logging.INFO,
+    format="%(asctime)s [%(levelname)s] %(name)s - %(message)s",
+)
+logger = logging.getLogger("ai-service")
+
+settings = get_settings()
+
+app = FastAPI(
+    title="Smart Hospital AI Service",
+    description="YOLO/MONAI 影像识别 + LangChain RAG + 报告/决策生成（实训演示）",
+    version="1.0.0",
+)
+
+app.add_middleware(
+    CORSMiddleware,
+    allow_origins=["*"],
+    allow_credentials=True,
+    allow_methods=["*"],
+    allow_headers=["*"],
+)
+
+app.include_router(health.router)
+app.include_router(imaging.router)
+app.include_router(rag.router)
+app.include_router(report.router)
+app.include_router(yolo.router)
+app.include_router(llm_config.router)
+
+
+@app.on_event("startup")
+def on_startup() -> None:
+    rag_pipe = get_rag()
+    det_info = get_detector().info()
+    llm_info = get_llm().info()
+    logger.info(
+        "AI 服务启动 port=%s knowledge_chunks=%s llm=%s yolo_mode=%s",
+        settings.ai_port,
+        rag_pipe.doc_count(),
+        llm_info.get("enabled"),
+        det_info.get("runtime_mode"),
+    )
+
+
+@app.get("/")
+def root() -> dict:
+    return {
+        "service": "smart-hospital-ai",
+        "docs": "/docs",
+        "health": "/health",
+    }
+
+
+if __name__ == "__main__":
+    import uvicorn
+
+    uvicorn.run(
+        "app.main:app",
+        host=settings.ai_host,
+        port=settings.ai_port,
+        reload=False,
+    )

ai-service/app/schemas/__init__.py

@@ -0,0 +1,27 @@
+from .models import (
+    Detection,
+    ImagingAnalyzeResponse,
+    ImagingReportRequest,
+    ImagingReportResponse,
+    DecisionRequest,
+    DecisionResponse,
+    RiskItem,
+    SourceRef,
+    RagQueryRequest,
+    RagQueryResponse,
+    HealthResponse,
+)
+
+__all__ = [
+    "Detection",
+    "ImagingAnalyzeResponse",
+    "ImagingReportRequest",
+    "ImagingReportResponse",
+    "DecisionRequest",
+    "DecisionResponse",
+    "RiskItem",
+    "SourceRef",
+    "RagQueryRequest",
+    "RagQueryResponse",
+    "HealthResponse",
+]

ai-service/app/schemas/models.py

@@ -0,0 +1,108 @@
+from __future__ import annotations
+
+from typing import Any, Literal, Optional
+
+from pydantic import BaseModel, Field
+
+
+class Detection(BaseModel):
+    label: str
+    confidence: float
+    bbox: list[float] = Field(description="[x1, y1, x2, y2] 像素坐标")
+    label_zh: Optional[str] = None
+
+
+class ImagingAnalyzeResponse(BaseModel):
+    detections: list[Detection] = []
+    annotated_image_base64: Optional[str] = None
+    preliminary_diagnosis: str
+    findings: str
+    recommendations: str
+    confidence: float
+    model_version: str
+    mode: Literal["demo", "real"] = "demo"
+    full_report: Optional[str] = None
+    disclaimer: str = "本结果仅供辅助决策，不能替代执业医师诊断。"
+
+
+class ImagingReportRequest(BaseModel):
+    study_type: str = "CT"
+    body_part: str = ""
+    patient_summary: str = ""
+    preliminary_diagnosis: str = ""
+    findings: str = ""
+    detections: list[Detection] = []
+    confidence: float = 0.85
+
+
+class ImagingReportResponse(BaseModel):
+    findings: str
+    impression: str
+    recommendations: str
+    full_report: str
+    model_version: str = "report-v1"
+
+
+class PatientInfo(BaseModel):
+    age: Optional[int] = None
+    gender: Optional[str] = None
+    name: Optional[str] = None
+
+
+class DecisionRequest(BaseModel):
+    chief_complaint: str = ""
+    history: str = ""
+    exam_findings: str = ""
+    diagnosis: str = ""
+    medications: str = ""
+    imaging_summary: str = ""
+    patient: Optional[PatientInfo] = None
+
+
+class RiskItem(BaseModel):
+    type: str
+    description: str
+    level: str = "中"
+    confidence: float = 0.8
+
+
+class SourceRef(BaseModel):
+    title: str
+    snippet: str = ""
+    category: str = ""
+    score: float = 0.0
+
+
+class DecisionResponse(BaseModel):
+    treatment_suggestions: list[dict[str, Any]] = []
+    medication_suggestions: list[dict[str, Any]] = []
+    nursing_advice: list[str] = []
+    follow_up_plan: list[str] = []
+    risks: list[RiskItem] = []
+    conflicts: list[str] = []
+    sources: list[SourceRef] = []
+    full_text: str = ""
+    engine: str = "fastapi-rag"
+    disclaimer: str = "本结果仅供辅助决策，不能替代执业医师诊断。"
+
+
+class RagQueryRequest(BaseModel):
+    query: str
+    top_k: int = 4
+    context: str = ""
+
+
+class RagQueryResponse(BaseModel):
+    answer: str
+    sources: list[SourceRef] = []
+    engine: str = "langchain-rag"
+
+
+class HealthResponse(BaseModel):
+    status: str = "ok"
+    yolo_available: bool = False
+    monai_available: bool = False
+    langchain_available: bool = False
+    llm_configured: bool = False
+    demo_mode: str = "auto"
+    knowledge_docs: int = 0

ai-service/app/services/__init__.py

@@ -0,0 +1 @@
+"""AI service implementations."""

ai-service/app/services/llm_client.py

@@ -0,0 +1,142 @@
+"""OpenAI 兼容 LLM 客户端（DeepSeek / Qwen）。支持 .env + 管理端运行时覆盖。"""
+from __future__ import annotations
+
+import json
+import logging
+import re
+from typing import Any
+
+import httpx
+
+from app.config import Settings, get_settings
+from app.services.llm_runtime import get_runtime_llm
+
+logger = logging.getLogger(__name__)
+
+
+class LlmClient:
+    def __init__(self, settings: Settings | None = None):
+        self.settings = settings or get_settings()
+
+    def _effective_key(self) -> str:
+        rt = get_runtime_llm()
+        if rt.api_key is not None:
+            return rt.api_key.strip()
+        return (self.settings.llm_api_key or "").strip()
+
+    def _effective_base_url(self) -> str:
+        rt = get_runtime_llm()
+        if rt.api_base_url:
+            return rt.api_base_url.rstrip("/")
+        return (self.settings.llm_base_url or "https://api.deepseek.com").rstrip("/")
+
+    def _effective_model(self) -> str:
+        rt = get_runtime_llm()
+        if rt.model:
+            return rt.model
+        return self.settings.llm_model or "deepseek-chat"
+
+    def _effective_temperature(self, override: float | None = None) -> float:
+        if override is not None:
+            return override
+        rt = get_runtime_llm()
+        if rt.temperature is not None:
+            return float(rt.temperature)
+        return float(self.settings.llm_temperature)
+
+    @property
+    def enabled(self) -> bool:
+        """管理端 enabled=false 强制关闭；否则有可用 API Key 即启用。"""
+        key = self._effective_key()
+        if not key:
+            return False
+        rt = get_runtime_llm()
+        if rt.enabled is False:
+            return False
+        if rt.enabled is True:
+            return True
+        # 未下发 enabled 时：有 key（env 或 runtime）即视为可用
+        return True
+
+    def info(self) -> dict[str, Any]:
+        rt = get_runtime_llm()
+        return {
+            "enabled": self.enabled,
+            "api_key_configured": bool(self._effective_key()),
+            "api_base_url": self._effective_base_url(),
+            "model": self._effective_model(),
+            "temperature": self._effective_temperature(),
+            "source": rt.source if (rt.api_key or rt.enabled is not None) else "env",
+        }
+
+    def chat(self, messages: list[dict[str, str]], temperature: float | None = None) -> str:
+        if not self.enabled:
+            raise RuntimeError("未配置 LLM（请在管理端「AI 配置」启用并填写 API Key，或设置 ai-service/.env 的 LLM_API_KEY）")
+        base = self._effective_base_url()
+        if base.endswith("/v1"):
+            url = base + "/chat/completions"
+        else:
+            url = base + "/v1/chat/completions"
+        payload = {
+            "model": self._effective_model(),
+            "temperature": self._effective_temperature(temperature),
+            "messages": messages,
+        }
+        headers = {
+            "Authorization": f"Bearer {self._effective_key()}",
+            "Content-Type": "application/json",
+        }
+        with httpx.Client(timeout=90.0) as client:
+            resp = client.post(url, headers=headers, json=payload)
+            if resp.status_code >= 400:
+                raise RuntimeError(f"LLM HTTP {resp.status_code}: {resp.text[:300]}")
+            data = resp.json()
+            content = (
+                data.get("choices", [{}])[0]
+                .get("message", {})
+                .get("content", "")
+            )
+            if not content:
+                raise RuntimeError("LLM 返回空内容")
+            return content.strip()
+
+    def chat_json(self, messages: list[dict[str, str]]) -> dict[str, Any]:
+        text = self.chat(messages, temperature=0.2)
+        return extract_json(text)
+
+
+def extract_json(text: str) -> dict[str, Any]:
+    text = text.strip()
+    try:
+        return json.loads(text)
+    except json.JSONDecodeError:
+        pass
+    fence = re.search(r"```(?:json)?\s*([\s\S]*?)```", text)
+    if fence:
+        try:
+            return json.loads(fence.group(1).strip())
+        except json.JSONDecodeError:
+            pass
+    start, end = text.find("{"), text.rfind("}")
+    if start >= 0 and end > start:
+        try:
+            return json.loads(text[start : end + 1])
+        except json.JSONDecodeError:
+            pass
+    raise ValueError("无法从模型输出解析 JSON")
+
+
+_llm: LlmClient | None = None
+
+
+def get_llm() -> LlmClient:
+    global _llm
+    if _llm is None:
+        _llm = LlmClient()
+    return _llm
+
+
+def reset_llm_client() -> None:
+    """测试或热更新后可重置单例（配置本身已从 runtime 动态读取，一般无需调用）。"""
+    global _llm
+    _llm = None

ai-service/app/services/llm_runtime.py

@@ -0,0 +1,84 @@
+"""运行时 LLM 配置：可由业务后端（管理端 AI 配置）动态下发，覆盖 .env。"""
+from __future__ import annotations
+
+from dataclasses import dataclass, field
+from threading import RLock
+from typing import Any
+
+
+@dataclass
+class RuntimeLlmConfig:
+    """enabled=None 表示未由管理端覆盖，沿用 .env。"""
+
+    enabled: bool | None = None
+    api_base_url: str | None = None
+    api_key: str | None = None
+    model: str | None = None
+    temperature: float | None = None
+    source: str = "env"
+
+
+_lock = RLock()
+_runtime = RuntimeLlmConfig()
+
+
+def get_runtime_llm() -> RuntimeLlmConfig:
+    with _lock:
+        return RuntimeLlmConfig(
+            enabled=_runtime.enabled,
+            api_base_url=_runtime.api_base_url,
+            api_key=_runtime.api_key,
+            model=_runtime.model,
+            temperature=_runtime.temperature,
+            source=_runtime.source,
+        )
+
+
+def update_runtime_llm(
+    *,
+    enabled: bool | None = None,
+    api_base_url: str | None = None,
+    api_key: str | None = None,
+    model: str | None = None,
+    temperature: float | None = None,
+) -> RuntimeLlmConfig:
+    """
+    更新运行时配置。
+    - api_key 为 None：不改密钥
+    - api_key 为非空字符串：覆盖
+    - api_key 为 ""：清空运行时密钥（回退 .env）
+    """
+    with _lock:
+        if enabled is not None:
+            _runtime.enabled = bool(enabled)
+        if api_base_url is not None and api_base_url.strip():
+            _runtime.api_base_url = api_base_url.strip()
+        if api_key is not None:
+            _runtime.api_key = api_key.strip() if api_key.strip() else None
+        if model is not None and model.strip():
+            _runtime.model = model.strip()
+        if temperature is not None:
+            t = float(temperature)
+            _runtime.temperature = max(0.0, min(2.0, t))
+        _runtime.source = "runtime"
+        return get_runtime_llm()
+
+
+def runtime_status(env_key_configured: bool, env_base: str, env_model: str) -> dict[str, Any]:
+    rt = get_runtime_llm()
+    key_ok = bool(rt.api_key) or env_key_configured
+    enabled = False
+    if key_ok:
+        if rt.enabled is None:
+            enabled = env_key_configured or bool(rt.api_key)
+        else:
+            enabled = bool(rt.enabled)
+    return {
+        "enabled": enabled,
+        "configured": key_ok,
+        "api_key_configured": key_ok,
+        "api_base_url": rt.api_base_url or env_base,
+        "model": rt.model or env_model,
+        "temperature": rt.temperature,
+        "source": rt.source if (rt.api_key or rt.enabled is not None or rt.api_base_url) else "env",
+    }

ai-service/app/services/monai_preprocess.py

@@ -0,0 +1,78 @@
+"""医学影像预处理：优先 MONAI，失败则用 OpenCV/Pillow 降级。"""
+from __future__ import annotations
+
+import logging
+from typing import Any
+
+import cv2
+import numpy as np
+
+logger = logging.getLogger(__name__)
+
+_MONAI_OK = False
+try:
+    import monai  # noqa: F401
+    from monai.transforms import Compose, ScaleIntensity, Resize
+
+    _MONAI_OK = True
+except Exception:  # pragma: no cover
+    _MONAI_OK = False
+    logger.info("MONAI 未安装，使用 OpenCV 预处理管线")
+
+
+def monai_available() -> bool:
+    return _MONAI_OK
+
+
+def load_image_bgr(image_bytes: bytes) -> np.ndarray:
+    arr = np.frombuffer(image_bytes, dtype=np.uint8)
+    img = cv2.imdecode(arr, cv2.IMREAD_COLOR)
+    if img is None:
+        raise ValueError("无法解码影像文件，请上传常见图片格式（jpg/png 等）")
+    return img
+
+
+def preprocess(image_bgr: np.ndarray, target_size: int = 640) -> dict[str, Any]:
+    """
+    返回：
+      - image_bgr: 原始 BGR
+      - image_rgb: RGB
+      - tensor_like: 归一化后的 float32 CHW（MONAI 或 numpy 模拟）
+      - meta: 尺寸信息
+    """
+    h, w = image_bgr.shape[:2]
+    rgb = cv2.cvtColor(image_bgr, cv2.COLOR_BGR2RGB)
+
+    if _MONAI_OK:
+        try:
+            # 灰度/三通道统一为 CHW float，再经 MONAI ScaleIntensity + Resize
+            chw = np.transpose(rgb.astype(np.float32) / 255.0, (2, 0, 1))
+            transforms = Compose(
+                [
+                    ScaleIntensity(minv=0.0, maxv=1.0),
+                    Resize(spatial_size=(target_size, target_size), mode="bilinear"),
+                ]
+            )
+            tensor = transforms(chw)
+            if hasattr(tensor, "numpy"):
+                tensor = tensor.numpy()
+            return {
+                "image_bgr": image_bgr,
+                "image_rgb": rgb,
+                "tensor_like": np.asarray(tensor),
+                "backend": "monai",
+                "meta": {"orig_h": h, "orig_w": w, "target": target_size},
+            }
+        except Exception as e:  # pragma: no cover
+            logger.warning("MONAI 预处理失败，降级 OpenCV: %s", e)
+
+    # OpenCV 降级：resize + normalize
+    resized = cv2.resize(rgb, (target_size, target_size), interpolation=cv2.INTER_LINEAR)
+    tensor = np.transpose(resized.astype(np.float32) / 255.0, (2, 0, 1))
+    return {
+        "image_bgr": image_bgr,
+        "image_rgb": rgb,
+        "tensor_like": tensor,
+        "backend": "opencv",
+        "meta": {"orig_h": h, "orig_w": w, "target": target_size},
+    }

ai-service/app/services/rag_pipeline.py

@@ -0,0 +1,242 @@
+"""LangChain 风格 RAG：文档切分 + 关键词检索 + 可选 LLM 生成。"""
+from __future__ import annotations
+
+import logging
+import re
+from dataclasses import dataclass
+from typing import Any
+
+from app.config import Settings, get_settings
+from app.schemas.models import SourceRef
+from app.services.llm_client import get_llm
+
+logger = logging.getLogger(__name__)
+
+_LC_OK = False
+try:
+    from langchain_core.documents import Document
+    from langchain_text_splitters import RecursiveCharacterTextSplitter
+
+    _LC_OK = True
+except Exception:  # pragma: no cover
+    Document = None  # type: ignore
+    RecursiveCharacterTextSplitter = None  # type: ignore
+    logger.info("LangChain 未完全安装，将使用内置简易检索")
+
+
+def langchain_available() -> bool:
+    return _LC_OK
+
+
+@dataclass
+class Chunk:
+    title: str
+    category: str
+    content: str
+    source: str
+
+
+class RagPipeline:
+    def __init__(self, settings: Settings | None = None):
+        self.settings = settings or get_settings()
+        self.chunks: list[Chunk] = []
+        self._load_knowledge()
+
+    def _load_knowledge(self) -> None:
+        path = self.settings.knowledge_path
+        path.mkdir(parents=True, exist_ok=True)
+        files = sorted(list(path.glob("*.md")) + list(path.glob("*.txt")))
+        raw_docs: list[tuple[str, str, str]] = []
+        for f in files:
+            try:
+                text = f.read_text(encoding="utf-8")
+            except Exception:
+                continue
+            title, category, body = self._parse_doc(f.stem, text)
+            raw_docs.append((title, category, body))
+
+        if not raw_docs:
+            logger.warning("知识库目录为空: %s", path)
+            self.chunks = []
+            return
+
+        if _LC_OK:
+            splitter = RecursiveCharacterTextSplitter(chunk_size=500, chunk_overlap=80)
+            for title, category, body in raw_docs:
+                docs = splitter.split_documents(
+                    [Document(page_content=body, metadata={"title": title, "category": category})]
+                )
+                for d in docs:
+                    self.chunks.append(
+                        Chunk(
+                            title=title,
+                            category=category,
+                            content=d.page_content,
+                            source=title,
+                        )
+                    )
+        else:
+            for title, category, body in raw_docs:
+                for part in self._simple_split(body, 500):
+                    self.chunks.append(
+                        Chunk(title=title, category=category, content=part, source=title)
+                    )
+
+        logger.info("知识库已加载 %d 个文档片段", len(self.chunks))
+
+    @staticmethod
+    def _parse_doc(stem: str, text: str) -> tuple[str, str, str]:
+        title = stem
+        category = "临床指南"
+        body = text.strip()
+        lines = body.splitlines()
+        if lines and lines[0].startswith("#"):
+            title = lines[0].lstrip("#").strip() or stem
+            body = "\n".join(lines[1:]).strip()
+        m = re.search(r"category:\s*(.+)", body, re.I)
+        if m:
+            category = m.group(1).strip()
+        return title, category, body
+
+    @staticmethod
+    def _simple_split(text: str, size: int) -> list[str]:
+        if len(text) <= size:
+            return [text]
+        parts: list[str] = []
+        i = 0
+        while i < len(text):
+            parts.append(text[i : i + size])
+            i += max(1, size - 50)
+        return parts
+
+    def reload(self) -> int:
+        self.chunks = []
+        self._load_knowledge()
+        return len(self.chunks)
+
+    def doc_count(self) -> int:
+        return len(self.chunks)
+
+    def retrieve(self, query: str, top_k: int = 4) -> list[SourceRef]:
+        if not query or not self.chunks:
+            return []
+        tokens = self._tokenize(query)
+        scored: list[tuple[float, Chunk]] = []
+        q = query.lower()
+        for ch in self.chunks:
+            score = self._score(ch, tokens, q)
+            if score > 0:
+                scored.append((score, ch))
+        scored.sort(key=lambda x: x[0], reverse=True)
+        results: list[SourceRef] = []
+        seen: set[tuple[str, str]] = set()
+        for score, ch in scored:
+            key = (ch.title, ch.content[:80])
+            if key in seen:
+                continue
+            seen.add(key)
+            results.append(
+                SourceRef(
+                    title=ch.title,
+                    category=ch.category,
+                    snippet=ch.content[:220].replace("\n", " "),
+                    score=round(score, 2),
+                )
+            )
+            if len(results) >= top_k:
+                break
+        return results
+
+    def build_context(self, sources: list[SourceRef]) -> str:
+        if not sources:
+            return ""
+        parts = []
+        for i, s in enumerate(sources, 1):
+            parts.append(f"【资料{i}】{s.title}\n{s.snippet}")
+        return "\n\n".join(parts)
+
+    def query(self, query: str, top_k: int = 4, extra_context: str = "") -> dict[str, Any]:
+        sources = self.retrieve(query, top_k=top_k)
+        context = self.build_context(sources)
+        if extra_context:
+            context = (extra_context.strip() + "\n\n" + context).strip()
+
+        llm = get_llm()
+        if llm.enabled and (context or query):
+            try:
+                answer = llm.chat(
+                    [
+                        {
+                            "role": "system",
+                            "content": (
+                                "你是医院临床辅助决策助手。请仅依据给定资料与问题作答，"
+                                "语言专业简洁，并提醒需医师审核。不要编造未提供的检查数据。"
+                            ),
+                        },
+                        {
+                            "role": "user",
+                            "content": f"参考资料：\n{context or '（无）'}\n\n问题：{query}",
+                        },
+                    ]
+                )
+                return {"answer": answer, "sources": sources, "engine": "langchain-rag+llm"}
+            except Exception as e:
+                logger.warning("RAG LLM 失败: %s", e)
+
+        if sources:
+            answer = (
+                f"基于本地知识库检索（LangChain 文档切分 + 关键词排序），与「{query}」相关的要点：\n"
+                + "\n".join(f"- {s.title}：{s.snippet[:120]}" for s in sources)
+                + "\n\n（未配置大模型 API Key 或调用失败时展示检索摘要，仅供参考。）"
+            )
+            return {"answer": answer, "sources": sources, "engine": "langchain-rag-local"}
+
+        return {
+            "answer": f"知识库中未检索到与「{query}」高度相关的条目，建议补充临床指南或完善病历描述。",
+            "sources": [],
+            "engine": "langchain-rag-empty",
+        }
+
+    def ingest_text(self, title: str, content: str, category: str = "自定义") -> None:
+        path = self.settings.knowledge_path
+        path.mkdir(parents=True, exist_ok=True)
+        safe = re.sub(r"[^\w\u4e00-\u9fff\-]+", "_", title)[:40] or "doc"
+        file_path = path / f"{safe}.md"
+        file_path.write_text(
+            f"# {title}\n\ncategory: {category}\n\n{content}\n",
+            encoding="utf-8",
+        )
+        self.reload()
+
+    @staticmethod
+    def _tokenize(text: str) -> list[str]:
+        parts = re.split(r"[\s,，。.!！?？;；:：、/\\|_\-—（）()\[\]{}]+", text.lower())
+        return [p for p in parts if len(p) >= 2]
+
+    @staticmethod
+    def _score(ch: Chunk, tokens: list[str], q: str) -> float:
+        title = ch.title.lower()
+        content = ch.content.lower()
+        score = 0.0
+        if q and q in title:
+            score += 30
+        if q and q in content:
+            score += 15
+        for t in tokens:
+            if t in title:
+                score += 8
+            if t in content:
+                score += 3
+            if t in ch.category.lower():
+                score += 2
+        return score
+
+
+_rag: RagPipeline | None = None
+
+
+def get_rag() -> RagPipeline:
+    global _rag
+    if _rag is None:
+        _rag = RagPipeline()
+    return _rag

ai-service/app/services/report_generator.py

@@ -0,0 +1,417 @@
+"""影像报告与临床决策建议生成。"""
+from __future__ import annotations
+
+import logging
+import re
+from typing import Any
+
+from app.schemas.models import (
+    DecisionRequest,
+    DecisionResponse,
+    Detection,
+    ImagingReportRequest,
+    ImagingReportResponse,
+    RiskItem,
+    SourceRef,
+)
+from app.services.llm_client import get_llm
+from app.services.rag_pipeline import get_rag
+
+logger = logging.getLogger(__name__)
+
+STUDY_LABEL = {
+    "X_RAY": "X 光",
+    "CT": "CT",
+    "MRI": "MRI",
+    "ULTRASOUND": "超声",
+}
+
+
+def build_imaging_texts(
+    study_type: str,
+    body_part: str,
+    detections: list[Detection],
+    mode: str,
+) -> tuple[str, str, str, float]:
+    """返回 findings, diagnosis, recommendations, confidence。"""
+    st = STUDY_LABEL.get(study_type.upper(), study_type)
+    part = body_part or "相关部位"
+    if not detections:
+        findings = f"{st}检查（{part}）：影像质量可评估，未见明确异常密度/信号灶。"
+        diagnosis = f"{part}{st}未见明显异常"
+        rec = "建议结合临床，必要时复查或进一步检查。"
+        return findings, diagnosis, rec, 0.82
+
+    lines = []
+    for d in detections:
+        name = d.label_zh or d.label
+        lines.append(
+            f"- 可见{name}样改变，框选区域约 ({int(d.bbox[0])},{int(d.bbox[1])})-"
+            f"({int(d.bbox[2])},{int(d.bbox[3])})，模型置信度 {d.confidence:.0%}"
+        )
+    findings = f"{st}检查（{part}）AI 辅助读片所见：\n" + "\n".join(lines)
+    top = max(detections, key=lambda x: x.confidence)
+    diagnosis = f"{part}可疑{top.label_zh or top.label}，建议专科医师复核"
+    rec = _rec_for_label(top.label)
+    conf = sum(d.confidence for d in detections) / len(detections)
+    if mode == "demo":
+        findings += "\n（演示模式：检测框由 YOLO 演示引擎生成，非临床验证模型输出）"
+    return findings, diagnosis, rec, round(min(0.98, conf), 4)
+
+
+def _rec_for_label(label: str) -> str:
+    mapping = {
+        "opacity": "建议结合血常规/炎症指标，必要时抗感染治疗并短期复查胸片。",
+        "nodule": "建议按结节指南分层管理，3 个月后复查 CT，必要时多学科会诊。",
+        "fracture": "建议骨科评估，必要时制动/固定，复查局部 X 光。",
+        "effusion": "建议评估积液性质，必要时穿刺或超声随访。",
+        "lesion": "建议结合临床与实验室检查，必要时增强扫描或专科转诊。",
+        "mass": "建议进一步定性检查，排除占位性病变，及时专科就诊。",
+        "calcification": "多为良性钙化可能，建议定期随访观察。",
+    }
+    return mapping.get(label, "建议专科医师综合临床资料判读，制定个体化方案。")
+
+
+def _normalize_multiline(text: str) -> str:
+    """把挤成一段的长文尽量拆成可读多行（句号/分号后换行，编号建议分行）。"""
+    if not text:
+        return ""
+    s = str(text).strip()
+    # 已有明显换行则只做空白整理
+    if "\n" in s and s.count("\n") >= 2:
+        return "\n".join(line.strip() for line in s.splitlines() if line.strip())
+
+    # 编号建议：1. / 1、 / （1） 前换行
+    s = re.sub(r"(?<![.\d])\s*([（(]?\d+[）).、])\s*", r"\n\1", s)
+    # 中文段落分隔：句号/分号后跟新意时换行（保留较短从句）
+    s = re.sub(r"([。；])\s*", r"\1\n", s)
+    lines = [ln.strip() for ln in s.splitlines() if ln.strip()]
+    # 合并过碎的短行（如单独标点）
+    merged: list[str] = []
+    for ln in lines:
+        if merged and len(ln) <= 2 and not re.match(r"^[（(]?\d+", ln):
+            merged[-1] = merged[-1] + ln
+        else:
+            merged.append(ln)
+    return "\n".join(merged)
+
+
+def _normalize_recommendations(text: str) -> str:
+    """建议统一为多行编号列表。"""
+    if not text:
+        return ""
+    s = str(text).strip()
+    # 已是多行编号
+    if re.search(r"(?m)^\s*[（(]?\d+[\.、）)]", s):
+        return "\n".join(ln.strip() for ln in s.splitlines() if ln.strip())
+
+    # 行内编号：1. / 1、 / （1）
+    items = re.findall(
+        r"[（(]?([1-9]\d?)[\.、）)]\s*([^（(]*?)(?=(?:[（(]?[1-9]\d?[\.、）)])|$)",
+        s,
+    )
+    cleaned = [(idx, t.strip(" ；;。 \t")) for idx, t in items if t.strip(" ；;。 \t")]
+    if len(cleaned) >= 2:
+        return "\n".join(f"{i}. {t}" for i, (_, t) in enumerate(cleaned, 1))
+
+    # 按分号切成条目
+    chunks = [c.strip(" ；;。") for c in re.split(r"[；;]", s) if c.strip(" ；;。")]
+    if len(chunks) >= 2:
+        return "\n".join(f"{i}. {c}" for i, c in enumerate(chunks, 1))
+    return s
+
+
+def make_full_report(
+    study_type: str,
+    body_part: str,
+    findings: str,
+    impression: str,
+    recommendations: str,
+    patient_summary: str = "",
+) -> str:
+    """结构化完整报告：固定四段，便于前端分段渲染。"""
+    st = STUDY_LABEL.get(study_type.upper(), study_type)
+    findings_n = _normalize_multiline(findings)
+    impression_n = _normalize_multiline(impression) or impression
+    rec_n = _normalize_recommendations(recommendations) or recommendations
+
+    header = [
+        "【影像诊断报告（AI 辅助）】",
+        f"检查类型：{st}",
+        f"检查部位：{body_part or '—'}",
+    ]
+    if patient_summary:
+        header.append(f"临床摘要：{patient_summary}")
+
+    sections = [
+        "\n".join(header),
+        "一、影像所见\n" + (findings_n or "—"),
+        "二、诊断印象\n" + (impression_n or "—"),
+        "三、建议\n" + (rec_n or "—"),
+        "四、声明\n本报告由 AI 辅助生成，仅供临床参考，需执业医师审核，不能替代正式报告。",
+    ]
+    return "\n\n".join(sections)
+
+
+def generate_imaging_report(req: ImagingReportRequest) -> ImagingReportResponse:
+    llm = get_llm()
+    if llm.enabled:
+        try:
+            det_lines = []
+            for d in req.detections:
+                name = d.label_zh or d.label
+                box = ",".join(str(int(x)) for x in d.bbox[:4]) if d.bbox else "-"
+                det_lines.append(f"{name} conf={d.confidence:.0%} box=[{box}]")
+            data = llm.chat_json(
+                [
+                    {
+                        "role": "system",
+                        "content": (
+                            "你是三甲医院影像科辅助报告生成器。"
+                            "必须只输出一个 JSON 对象（不要 markdown 代码块），字段："
+                            "findings（影像所见：多段文字，用换行分隔；先写检查方法与部位，"
+                            "再写病灶描述，再写其余部位阴性所见，勿写成一整段）、"
+                            "impression（诊断印象：1～3 句，可换行）、"
+                            "recommendations（建议：必须用换行的编号列表，如 "
+                            "'1. ...\\n2. ...\\n3. ...'，含进一步检查/随访/会诊）、"
+                            "full_report 不要输出（由系统按分段模板拼接）。"
+                            "依据 YOLO 检测结果撰写，专业简洁；"
+                            "明确写明需执业医师审核，不能替代正式报告。"
+                            "禁止编造未提供的患者检验结果。"
+                        ),
+                    },
+                    {
+                        "role": "user",
+                        "content": (
+                            f"检查类型={req.study_type}\n"
+                            f"检查部位={req.body_part or '未注明'}\n"
+                            f"患者摘要={req.patient_summary or '无'}\n"
+                            f"规则初诊={req.preliminary_diagnosis}\n"
+                            f"规则所见={req.findings}\n"
+                            f"检测列表:\n" + ("\n".join(det_lines) if det_lines else "（无检出）")
+                        ),
+                    },
+                ]
+            )
+            findings = _normalize_multiline(str(data.get("findings") or req.findings).strip())
+            impression = _normalize_multiline(
+                str(
+                    data.get("impression")
+                    or data.get("preliminary_diagnosis")
+                    or req.preliminary_diagnosis
+                ).strip()
+            )
+            rec = _normalize_recommendations(
+                str(data.get("recommendations") or "建议专科医师复核。").strip()
+            )
+            # 始终用分段模板拼完整报告，避免 LLM 输出一整段墙文本
+            full = make_full_report(
+                req.study_type, req.body_part, findings, impression, rec, req.patient_summary
+            )
+            model_name = llm.info().get("model") or "llm"
+            logger.info("影像报告已由 LLM 生成 model=%s", model_name)
+            return ImagingReportResponse(
+                findings=findings,
+                impression=impression,
+                recommendations=rec,
+                full_report=full,
+                model_version=f"report-llm:{model_name}",
+            )
+        except Exception as e:
+            logger.warning("影像报告 LLM 失败，回退模板: %s", e)
+
+    logger.info("影像报告使用模板模式（LLM 未启用或调用失败） llm_enabled=%s", llm.enabled)
+    # recommendations 留空，由 imaging API 回退到 build_imaging_texts 的按病灶建议
+    full = make_full_report(
+        req.study_type,
+        req.body_part,
+        req.findings,
+        req.preliminary_diagnosis,
+        "建议结合临床，由影像科/临床医师最终签发。",
+        req.patient_summary,
+    )
+    return ImagingReportResponse(
+        findings=req.findings,
+        impression=req.preliminary_diagnosis,
+        recommendations="",
+        full_report=full,
+        model_version="report-template",
+    )
+
+
+def generate_decision(req: DecisionRequest) -> DecisionResponse:
+    rag = get_rag()
+    query = " ".join(
+        x for x in [req.diagnosis, req.chief_complaint, req.history, req.imaging_summary] if x
+    ).strip() or "常见病辅助决策"
+    sources = rag.retrieve(query, top_k=4)
+    context = rag.build_context(sources)
+    patient = req.patient
+    patient_desc = ""
+    if patient:
+        patient_desc = f"年龄={patient.age} 性别={patient.gender} 姓名={patient.name or ''}"
+
+    llm = get_llm()
+    if llm.enabled:
+        try:
+            data = llm.chat_json(
+                [
+                    {
+                        "role": "system",
+                        "content": (
+                            "你是临床辅助决策系统。输出严格 JSON，字段："
+                            "treatment_suggestions(数组，元素含 title,description,confidence),"
+                            "medication_suggestions(数组，元素含 name,dosage,category,confidence),"
+                            "nursing_advice(字符串数组),"
+                            "follow_up_plan(字符串数组),"
+                            "risks(数组，元素含 type,description,level,confidence),"
+                            "conflicts(字符串数组),"
+                            "full_text(字符串)。"
+                            "必须提醒需医师审核；勿编造不存在的检查结果。"
+                        ),
+                    },
+                    {
+                        "role": "user",
+                        "content": (
+                            f"患者：{patient_desc}\n"
+                            f"主诉：{req.chief_complaint}\n"
+                            f"病史：{req.history}\n"
+                            f"查体：{req.exam_findings}\n"
+                            f"诊断：{req.diagnosis}\n"
+                            f"用药：{req.medications}\n"
+                            f"影像摘要：{req.imaging_summary}\n"
+                            f"知识库：\n{context or '无'}"
+                        ),
+                    },
+                ]
+            )
+            return _map_decision(data, sources, engine="fastapi-rag+llm")
+        except Exception as e:
+            logger.warning("决策 LLM 失败: %s", e)
+
+    return _template_decision(req, sources)
+
+
+def _map_decision(data: dict[str, Any], sources: list[SourceRef], engine: str) -> DecisionResponse:
+    risks = []
+    for r in data.get("risks") or []:
+        if isinstance(r, dict):
+            risks.append(
+                RiskItem(
+                    type=str(r.get("type") or "风险"),
+                    description=str(r.get("description") or ""),
+                    level=str(r.get("level") or "中"),
+                    confidence=float(r.get("confidence") or 0.8),
+                )
+            )
+    return DecisionResponse(
+        treatment_suggestions=list(data.get("treatment_suggestions") or []),
+        medication_suggestions=list(data.get("medication_suggestions") or []),
+        nursing_advice=[str(x) for x in (data.get("nursing_advice") or [])],
+        follow_up_plan=[str(x) for x in (data.get("follow_up_plan") or [])],
+        risks=risks,
+        conflicts=[str(x) for x in (data.get("conflicts") or [])],
+        sources=sources,
+        full_text=str(data.get("full_text") or ""),
+        engine=engine,
+    )
+
+
+def _template_decision(req: DecisionRequest, sources: list[SourceRef]) -> DecisionResponse:
+    dx = req.diagnosis or ""
+    treatments: list[dict[str, Any]] = []
+    meds: list[dict[str, Any]] = []
+    nursing: list[str] = []
+    follow: list[str] = []
+    risks: list[RiskItem] = []
+
+    if "高血压" in dx:
+        treatments = [
+            {"title": "生活方式干预", "description": "低盐饮食，适量有氧运动，控制体重，戒烟限酒", "confidence": 0.95},
+            {"title": "药物治疗", "description": "可考虑 ACEI/ARB 或 CCB 作为一线方案（需医师确认）", "confidence": 0.9},
+        ]
+        meds = [
+            {"name": "氨氯地平", "dosage": "5mg qd", "category": "钙通道阻滞剂", "confidence": 0.9},
+            {"name": "缬沙坦", "dosage": "80mg qd", "category": "ARB", "confidence": 0.88},
+        ]
+        nursing = ["监测血压并记录", "宣教服药依从性", "观察头晕、乏力等低血压症状"]
+        follow = ["1–2 周门诊复查血压", "评估靶器官损害相关检查"]
+    elif "糖尿病" in dx:
+        treatments = [
+            {"title": "饮食运动", "description": "控制总热量与碳水，规律运动", "confidence": 0.95},
+            {"title": "降糖治疗", "description": "二甲双胍等一线方案需结合肾功能与禁忌", "confidence": 0.9},
+        ]
+        meds = [{"name": "二甲双胍", "dosage": "0.5g tid", "category": "双胍类", "confidence": 0.92}]
+        nursing = ["血糖监测指导", "足部护理宣教", "低血糖识别与处理"]
+        follow = ["2–4 周复诊评估血糖", "定期查 HbA1c"]
+    elif "肺炎" in dx or "阴影" in dx:
+        treatments = [
+            {"title": "抗感染", "description": "根据社区/医院获得性肺炎指南选择抗生素", "confidence": 0.88},
+            {"title": "支持治疗", "description": "休息、补液、必要时氧疗", "confidence": 0.92},
+        ]
+        meds = [{"name": "阿莫西林", "dosage": "0.5g tid", "category": "青霉素类", "confidence": 0.85}]
+        nursing = ["监测体温与呼吸", "叩背排痰指导", "隔离防护宣教（如需要）"]
+        follow = ["3–5 天评估疗效", "必要时复查胸片"]
+    elif "结节" in dx:
+        treatments = [
+            {"title": "分层随访", "description": "按结节大小与特征选择随访或进一步检查", "confidence": 0.9},
+        ]
+        nursing = ["戒烟宣教", "避免焦虑，说明随访意义"]
+        follow = ["3 个月复查 CT", "出现咯血/胸痛及时就诊"]
+    else:
+        treatments = [
+            {"title": "进一步评估", "description": "完善相关检查以明确诊断", "confidence": 0.85},
+            {"title": "对症处理", "description": "根据症状给予相应支持治疗", "confidence": 0.88},
+        ]
+        nursing = ["观察病情变化", "用药与生活方式宣教"]
+        follow = ["按病情 1–2 周复诊", "出现加重症状及时急诊"]
+
+    if req.patient and req.patient.age and req.patient.age >= 65:
+        risks.append(
+            RiskItem(
+                type="高龄风险",
+                description="高龄患者需注意剂量调整、跌倒与多药联用风险",
+                level="高",
+                confidence=0.85,
+            )
+        )
+    if "高血压" in dx and req.patient and req.patient.age and req.patient.age > 60:
+        risks.append(
+            RiskItem(
+                type="心血管风险",
+                description="高血压合并高龄，心血管事件风险增加",
+                level="中",
+                confidence=0.8,
+            )
+        )
+
+    conflicts: list[str] = []
+    meds_text = req.medications or ""
+    if "华法林" in meds_text and "阿司匹林" in meds_text:
+        conflicts.append("警告：华法林与阿司匹林联合使用可能增加出血风险")
+    if "ACEI" in meds_text and "保钾" in meds_text:
+        conflicts.append("注意：ACEI 与保钾利尿剂联用可能致高钾血症")
+
+    src_hint = ""
+    if sources:
+        src_hint = "\n知识库参考：" + "；".join(s.title for s in sources[:3])
+
+    full = (
+        f"诊断相关辅助建议（规则+RAG）：{dx or '未明确'}\n"
+        f"治疗：{'; '.join(t['title'] for t in treatments)}\n"
+        f"护理：{'；'.join(nursing)}\n"
+        f"随访：{'；'.join(follow)}"
+        f"{src_hint}\n"
+        "（模板模式，可配置 LLM_API_KEY 启用大模型增强）"
+    )
+    return DecisionResponse(
+        treatment_suggestions=treatments,
+        medication_suggestions=meds,
+        nursing_advice=nursing,
+        follow_up_plan=follow,
+        risks=risks,
+        conflicts=conflicts,
+        sources=sources,
+        full_text=full,
+        engine="fastapi-rag-template",
+    )

ai-service/app/services/yolo_detector.py

@@ -0,0 +1,246 @@
+"""YOLO 检测：管理员配置的权重优先；无权重或加载失败则演示模式。"""
+from __future__ import annotations
+
+import base64
+import logging
+import random
+from typing import Any
+
+import cv2
+import numpy as np
+
+from app.config import get_settings
+from app.schemas.models import Detection
+from app.services.yolo_manager import get_yolo_manager
+
+logger = logging.getLogger(__name__)
+
+_YOLO_OK = False
+try:
+    from ultralytics import YOLO  # type: ignore
+
+    _YOLO_OK = True
+except Exception:  # pragma: no cover
+    YOLO = None  # type: ignore
+    logger.info("ultralytics 未安装，影像检测将使用演示模式")
+
+
+LABEL_ZH = {
+    # 演示 / 规则降级
+    "opacity": "片状阴影/渗出",
+    "nodule": "结节",
+    "fracture": "骨折线",
+    "effusion": "积液",
+    "lesion": "异常 dens 区",
+    "calcification": "钙化",
+    "mass": "占位",
+    "object": "可疑区域",
+    # 肺炎单类权重
+    "Pneumonia": "肺炎",
+    "pneumonia": "肺炎",
+    # 胸部 X 光多病灶检测（VinBigData / 类似类别）
+    "Aortic enlargement": "主动脉增宽",
+    "Atelectasis": "肺不张",
+    "Calcification": "钙化",
+    "Cardiomegaly": "心脏增大",
+    "Consolidation": "实变",
+    "ILD": "间质性肺病",
+    "Infiltration": "浸润",
+    "Lung Opacity": "肺野透过度减低",
+    "Nodule/Mass": "结节/肿块",
+    "Other lesion": "其他病灶",
+    "Pleural effusion": "胸腔积液",
+    "Pleural thickening": "胸膜增厚",
+    "Pneumothorax": "气胸",
+    "Pulmonary fibrosis": "肺纤维化",
+}
+
+
+def yolo_available() -> bool:
+    return _YOLO_OK
+
+
+class YoloDetector:
+    def __init__(self) -> None:
+        self._model = None
+        self._mode: str = "demo"
+        self._loaded_path: str | None = None
+        self._class_names: dict[int, str] = {}
+        self._load_error: str | None = None
+        self.reload()
+
+    def reload(self) -> dict[str, Any]:
+        """按管理端配置重新加载权重。"""
+        mgr = get_yolo_manager()
+        mode_pref = mgr.effective_demo_mode()
+        weights = mgr.active_weight_path()
+        self._model = None
+        self._class_names = {}
+        self._load_error = None
+        self._loaded_path = None
+
+        if mode_pref == "demo":
+            self._mode = "demo"
+            logger.info("YOLO 强制演示模式")
+            return self.info()
+
+        if weights is None:
+            self._mode = "demo"
+            if mode_pref == "real":
+                self._load_error = "已选 real 模式但未配置有效权重文件"
+                logger.warning(self._load_error)
+            else:
+                logger.info("未配置权重，使用演示模式")
+            return self.info()
+
+        if not _YOLO_OK:
+            self._mode = "demo"
+            self._load_error = "未安装 ultralytics，无法加载真实权重"
+            logger.warning(self._load_error)
+            return self.info()
+
+        try:
+            self._model = YOLO(str(weights))
+            self._mode = "real"
+            self._loaded_path = str(weights)
+            names = getattr(self._model, "names", None) or {}
+            if isinstance(names, dict):
+                self._class_names = {int(k): str(v) for k, v in names.items()}
+            logger.info("已加载 YOLO 权重: %s", weights)
+        except Exception as e:
+            self._mode = "demo"
+            self._model = None
+            self._load_error = f"加载权重失败: {e}"
+            logger.warning(self._load_error)
+        return self.info()
+
+    @property
+    def mode(self) -> str:
+        return self._mode
+
+    def info(self) -> dict[str, Any]:
+        return {
+            "runtime_mode": self._mode,
+            "ultralytics_installed": _YOLO_OK,
+            "loaded_path": self._loaded_path,
+            "class_names": list(self._class_names.values()) if self._class_names else [],
+            "class_count": len(self._class_names),
+            "load_error": self._load_error,
+            "env_demo_mode": get_settings().demo_mode,
+        }
+
+    def detect(self, image_bgr: np.ndarray, study_type: str = "CT") -> list[Detection]:
+        if self._mode == "real" and self._model is not None:
+            return self._detect_real(image_bgr)
+        return self._detect_demo(image_bgr, study_type)
+
+    def _detect_real(self, image_bgr: np.ndarray) -> list[Detection]:
+        results = self._model.predict(source=image_bgr, verbose=False)
+        detections: list[Detection] = []
+        if not results:
+            return detections
+        r0 = results[0]
+        names = r0.names or self._class_names or {}
+        boxes = getattr(r0, "boxes", None)
+        if boxes is None:
+            return detections
+        for box in boxes:
+            xyxy = box.xyxy[0].tolist()
+            conf = float(box.conf[0]) if box.conf is not None else 0.0
+            cls_id = int(box.cls[0]) if box.cls is not None else 0
+            label = str(names.get(cls_id, f"class_{cls_id}"))
+            detections.append(
+                Detection(
+                    label=label,
+                    label_zh=LABEL_ZH.get(label, label),
+                    confidence=round(conf, 4),
+                    bbox=[round(float(x), 2) for x in xyxy],
+                )
+            )
+        return detections
+
+    def _detect_demo(self, image_bgr: np.ndarray, study_type: str) -> list[Detection]:
+        h, w = image_bgr.shape[:2]
+        rng = random.Random(h * 31 + w * 17 + hash(study_type) % 997)
+        catalog = {
+            "X_RAY": [("opacity", 0.86), ("fracture", 0.78)],
+            "CT": [("nodule", 0.88), ("lesion", 0.81), ("calcification", 0.74)],
+            "MRI": [("lesion", 0.84), ("mass", 0.79)],
+            "ULTRASOUND": [("mass", 0.80), ("lesion", 0.76)],
+        }
+        pairs = catalog.get(study_type.upper(), [("object", 0.75)])
+        n = 1 if rng.random() < 0.35 else 2
+        chosen = pairs[:n] if len(pairs) >= n else pairs
+        detections: list[Detection] = []
+        for i, (label, base_conf) in enumerate(chosen):
+            bw = int(w * rng.uniform(0.12, 0.28))
+            bh = int(h * rng.uniform(0.12, 0.28))
+            x1 = int(rng.uniform(0.1, 0.65) * w)
+            y1 = int(rng.uniform(0.1, 0.65) * h)
+            x2 = min(w - 1, x1 + bw)
+            y2 = min(h - 1, y1 + bh)
+            conf = min(0.98, base_conf + rng.uniform(-0.05, 0.08) - i * 0.03)
+            detections.append(
+                Detection(
+                    label=label,
+                    label_zh=LABEL_ZH.get(label, label),
+                    confidence=round(conf, 4),
+                    bbox=[float(x1), float(y1), float(x2), float(y2)],
+                )
+            )
+        return detections
+
+    def annotate(self, image_bgr: np.ndarray, detections: list[Detection]) -> str:
+        """返回 JPEG base64（无 data URL 前缀）。"""
+        canvas = image_bgr.copy()
+        for det in detections:
+            x1, y1, x2, y2 = [int(v) for v in det.bbox]
+            color = (40, 120, 255) if self._mode == "demo" else (46, 204, 113)
+            cv2.rectangle(canvas, (x1, y1), (x2, y2), color, 2)
+            text = f"{det.label_zh or det.label} {det.confidence:.0%}"
+            (tw, th), _ = cv2.getTextSize(text, cv2.FONT_HERSHEY_SIMPLEX, 0.55, 1)
+            cv2.rectangle(canvas, (x1, max(0, y1 - th - 8)), (x1 + tw + 6, y1), color, -1)
+            cv2.putText(
+                canvas,
+                text,
+                (x1 + 3, y1 - 5),
+                cv2.FONT_HERSHEY_SIMPLEX,
+                0.55,
+                (255, 255, 255),
+                1,
+                cv2.LINE_AA,
+            )
+        # 角标：模式 / 权重
+        badge = f"YOLO:{self._mode}"
+        if self._loaded_path:
+            badge += f" | {PathName(self._loaded_path)}"
+        cv2.putText(
+            canvas, badge, (10, 24), cv2.FONT_HERSHEY_SIMPLEX, 0.6, (20, 20, 20), 3, cv2.LINE_AA
+        )
+        cv2.putText(
+            canvas, badge, (10, 24), cv2.FONT_HERSHEY_SIMPLEX, 0.6, (255, 255, 255), 1, cv2.LINE_AA
+        )
+        ok, buf = cv2.imencode(".jpg", canvas, [int(cv2.IMWRITE_JPEG_QUALITY), 88])
+        if not ok:
+            raise RuntimeError("标注图编码失败")
+        return base64.b64encode(buf.tobytes()).decode("ascii")
+
+
+def PathName(p: str) -> str:
+    from pathlib import Path
+    return Path(p).name
+
+
+_detector: YoloDetector | None = None
+
+
+def get_detector() -> YoloDetector:
+    global _detector
+    if _detector is None:
+        _detector = YoloDetector()
+    return _detector
+
+
+def reload_detector() -> dict[str, Any]:
+    det = get_detector()
+    return det.reload()

ai-service/app/services/yolo_manager.py

@@ -0,0 +1,345 @@
+"""YOLO 权重文件管理：上传、激活、统计可视化数据。"""
+from __future__ import annotations
+
+import json
+import logging
+import re
+import shutil
+import time
+from datetime import datetime, timezone
+from pathlib import Path
+from typing import Any
+
+from app.config import get_settings
+
+logger = logging.getLogger(__name__)
+
+ALLOWED_EXT = {".pt", ".pth", ".onnx", ".engine"}
+
+
+class YoloManager:
+    def __init__(self) -> None:
+        settings = get_settings()
+        self.root = settings.root_dir
+        self.weights_dir = (self.root / "data" / "weights").resolve()
+        self.config_path = (self.root / "data" / "yolo_config.json").resolve()
+        self.stats_path = (self.root / "data" / "yolo_stats.json").resolve()
+        self.weights_dir.mkdir(parents=True, exist_ok=True)
+        self.config_path.parent.mkdir(parents=True, exist_ok=True)
+        self._config = self._load_json(self.config_path, default={
+            "active_weight": "",
+            "demo_mode": "auto",  # demo | real | auto
+            "deleted_weights": [],  # 逻辑删除的文件名列表（本地 .pt 仍保留）
+            "updated_at": None,
+        })
+        if not isinstance(self._config.get("deleted_weights"), list):
+            self._config["deleted_weights"] = []
+        self._stats = self._load_json(self.stats_path, default=self._empty_stats())
+
+    @staticmethod
+    def _empty_stats() -> dict[str, Any]:
+        return {
+            "total_inferences": 0,
+            "real_count": 0,
+            "demo_count": 0,
+            "class_counts": {},
+            "confidence_buckets": {"0-50": 0, "50-70": 0, "70-85": 0, "85-100": 0},
+            "recent": [],  # last 20 runs
+            "updated_at": None,
+        }
+
+    @staticmethod
+    def _load_json(path: Path, default: dict) -> dict:
+        if not path.is_file():
+            return dict(default)
+        try:
+            data = json.loads(path.read_text(encoding="utf-8"))
+            if isinstance(data, dict):
+                merged = dict(default)
+                merged.update(data)
+                return merged
+        except Exception as e:
+            logger.warning("读取 %s 失败: %s", path, e)
+        return dict(default)
+
+    def _save_config(self) -> None:
+        self._config["updated_at"] = datetime.now(timezone.utc).isoformat()
+        self.config_path.write_text(
+            json.dumps(self._config, ensure_ascii=False, indent=2),
+            encoding="utf-8",
+        )
+
+    def _save_stats(self) -> None:
+        self._stats["updated_at"] = datetime.now(timezone.utc).isoformat()
+        self.stats_path.write_text(
+            json.dumps(self._stats, ensure_ascii=False, indent=2),
+            encoding="utf-8",
+        )
+
+    def _deleted_set(self) -> set[str]:
+        return {str(x) for x in (self._config.get("deleted_weights") or []) if x}
+
+    def list_weights(self) -> list[dict[str, Any]]:
+        """仅列出未逻辑删除的权重。"""
+        active = (self._config.get("active_weight") or "").strip()
+        deleted = self._deleted_set()
+        items: list[dict[str, Any]] = []
+        for p in sorted(self.weights_dir.iterdir(), key=lambda x: x.stat().st_mtime, reverse=True):
+            if not p.is_file() or p.suffix.lower() not in ALLOWED_EXT:
+                continue
+            if p.name in deleted:
+                continue
+            # 回收目录 / 隐藏文件不展示
+            if p.name.startswith("."):
+                continue
+            st = p.stat()
+            items.append({
+                "name": p.name,
+                "path": str(p),
+                "size_bytes": st.st_size,
+                "size_mb": round(st.st_size / (1024 * 1024), 3),
+                "modified_at": datetime.fromtimestamp(st.st_mtime, tz=timezone.utc).isoformat(),
+                "active": p.name == active,
+                "ext": p.suffix.lower(),
+                "deleted": False,
+            })
+        return items
+
+    def save_upload(self, filename: str, content: bytes) -> dict[str, Any]:
+        if not content:
+            raise ValueError("文件为空")
+        safe = self._safe_name(filename)
+        ext = Path(safe).suffix.lower()
+        if ext not in ALLOWED_EXT:
+            raise ValueError(f"仅支持权重格式: {', '.join(sorted(ALLOWED_EXT))}")
+        # 限制 500MB
+        if len(content) > 500 * 1024 * 1024:
+            raise ValueError("权重文件不能超过 500MB")
+        target = self.weights_dir / safe
+        # 避免覆盖：同名追加时间戳
+        if target.exists():
+            stem = target.stem
+            target = self.weights_dir / f"{stem}_{int(time.time())}{ext}"
+            safe = target.name
+        target.write_bytes(content)
+        logger.info("已保存 YOLO 权重: %s (%d bytes)", target, len(content))
+        return {
+            "name": safe,
+            "path": str(target),
+            "size_bytes": len(content),
+            "size_mb": round(len(content) / (1024 * 1024), 3),
+            "active": False,
+        }
+
+    def activate(self, name: str, demo_mode: str | None = None) -> dict[str, Any]:
+        path = self.weights_dir / name
+        if not path.is_file():
+            raise FileNotFoundError(f"权重不存在: {name}")
+        if name in self._deleted_set():
+            raise FileNotFoundError(f"权重已逻辑删除，无法激活: {name}")
+        if path.suffix.lower() not in ALLOWED_EXT:
+            raise ValueError("非法权重文件")
+        self._config["active_weight"] = name
+        if demo_mode in ("demo", "real", "auto"):
+            self._config["demo_mode"] = demo_mode
+        elif not self._config.get("demo_mode"):
+            self._config["demo_mode"] = "auto"
+        self._save_config()
+        return self.status()
+
+    def set_demo_mode(self, mode: str) -> dict[str, Any]:
+        if mode not in ("demo", "real", "auto"):
+            raise ValueError("demo_mode 仅支持 demo / real / auto")
+        self._config["demo_mode"] = mode
+        self._save_config()
+        return self.status()
+
+    def deactivate(self) -> dict[str, Any]:
+        self._config["active_weight"] = ""
+        self._save_config()
+        return self.status()
+
+    def delete_weight(self, name: str) -> None:
+        """逻辑删除：不删除磁盘文件，仅从可用列表隐藏。"""
+        path = self.weights_dir / name
+        if not path.is_file() and name not in self._deleted_set():
+            raise FileNotFoundError(f"权重不存在: {name}")
+        if path.is_file() and path.suffix.lower() not in ALLOWED_EXT:
+            raise ValueError("非法权重文件")
+        deleted = list(self._config.get("deleted_weights") or [])
+        if name not in deleted:
+            deleted.append(name)
+        self._config["deleted_weights"] = deleted
+        if (self._config.get("active_weight") or "") == name:
+            self._config["active_weight"] = ""
+        self._save_config()
+        logger.info("YOLO 权重逻辑删除（文件保留）: %s path=%s", name, path)
+
+    def restore_weight(self, name: str) -> dict[str, Any]:
+        """从逻辑删除中恢复（若本地文件仍在）。"""
+        path = self.weights_dir / name
+        if not path.is_file():
+            raise FileNotFoundError(f"本地文件不存在，无法恢复: {name}")
+        deleted = [x for x in (self._config.get("deleted_weights") or []) if x != name]
+        self._config["deleted_weights"] = deleted
+        self._save_config()
+        logger.info("YOLO 权重已从逻辑删除恢复: %s", name)
+        return self.status()
+
+    def active_weight_path(self) -> Path | None:
+        name = (self._config.get("active_weight") or "").strip()
+        if not name:
+            # 兼容环境变量
+            settings = get_settings()
+            return settings.yolo_weights_path
+        if name in self._deleted_set():
+            return None
+        path = self.weights_dir / name
+        return path if path.is_file() else None
+
+    def effective_demo_mode(self) -> str:
+        mode = (self._config.get("demo_mode") or "auto").strip().lower()
+        if mode in ("demo", "real", "auto"):
+            return mode
+        return get_settings().demo_mode
+
+    def status(self, detector_info: dict[str, Any] | None = None) -> dict[str, Any]:
+        active_path = self.active_weight_path()
+        weights = self.list_weights()
+        body: dict[str, Any] = {
+            "weights_dir": str(self.weights_dir),
+            "active_weight": self._config.get("active_weight") or "",
+            "active_path": str(active_path) if active_path else None,
+            "active_exists": active_path is not None and active_path.is_file(),
+            "demo_mode": self.effective_demo_mode(),
+            "weights_count": len(weights),
+            "weights": weights,
+            "updated_at": self._config.get("updated_at"),
+        }
+        if detector_info:
+            body.update(detector_info)
+        return body
+
+    def record_inference(
+        self,
+        mode: str,
+        detections: list[Any],
+        study_type: str = "",
+        model_version: str = "",
+    ) -> None:
+        self._stats["total_inferences"] = int(self._stats.get("total_inferences") or 0) + 1
+        if mode == "real":
+            self._stats["real_count"] = int(self._stats.get("real_count") or 0) + 1
+        else:
+            self._stats["demo_count"] = int(self._stats.get("demo_count") or 0) + 1
+
+        class_counts: dict[str, int] = self._stats.setdefault("class_counts", {})
+        buckets: dict[str, int] = self._stats.setdefault(
+            "confidence_buckets",
+            {"0-50": 0, "50-70": 0, "70-85": 0, "85-100": 0},
+        )
+        labels: list[str] = []
+        confs: list[float] = []
+        for d in detections or []:
+            if hasattr(d, "label"):
+                label = getattr(d, "label_zh", None) or d.label
+                conf = float(d.confidence)
+            elif isinstance(d, dict):
+                label = d.get("label_zh") or d.get("label") or "unknown"
+                conf = float(d.get("confidence") or 0)
+            else:
+                continue
+            labels.append(str(label))
+            confs.append(conf)
+            class_counts[str(label)] = int(class_counts.get(str(label), 0)) + 1
+            pct = conf * 100
+            if pct < 50:
+                buckets["0-50"] = buckets.get("0-50", 0) + 1
+            elif pct < 70:
+                buckets["50-70"] = buckets.get("50-70", 0) + 1
+            elif pct < 85:
+                buckets["70-85"] = buckets.get("70-85", 0) + 1
+            else:
+                buckets["85-100"] = buckets.get("85-100", 0) + 1
+
+        recent = self._stats.setdefault("recent", [])
+        recent.insert(0, {
+            "time": datetime.now(timezone.utc).isoformat(),
+            "mode": mode,
+            "study_type": study_type,
+            "model_version": model_version,
+            "detection_count": len(labels),
+            "labels": labels[:10],
+            "avg_confidence": round(sum(confs) / len(confs), 4) if confs else 0,
+            "weight": self._config.get("active_weight") or "",
+        })
+        self._stats["recent"] = recent[:30]
+        self._save_stats()
+
+    def visualization(self) -> dict[str, Any]:
+        """供前端 ECharts 使用的聚合数据。"""
+        class_counts = self._stats.get("class_counts") or {}
+        buckets = self._stats.get("confidence_buckets") or {}
+        real = int(self._stats.get("real_count") or 0)
+        demo = int(self._stats.get("demo_count") or 0)
+        total = int(self._stats.get("total_inferences") or 0)
+        class_pie = [
+            {"name": k, "value": v}
+            for k, v in sorted(class_counts.items(), key=lambda x: -x[1])
+        ]
+        conf_bar = [
+            {"name": k, "value": int(buckets.get(k, 0))}
+            for k in ["0-50", "50-70", "70-85", "85-100"]
+        ]
+        mode_pie = [
+            {"name": "真实权重推理", "value": real},
+            {"name": "演示模式", "value": demo},
+        ]
+        # 近 10 次检测数折线
+        recent = list(reversed(self._stats.get("recent") or []))[-15:]
+        trend = {
+            "times": [ (r.get("time") or "")[11:19] for r in recent ],
+            "counts": [ int(r.get("detection_count") or 0) for r in recent ],
+            "modes": [ r.get("mode") or "" for r in recent ],
+        }
+        active = self.active_weight_path()
+        return {
+            "summary": {
+                "total_inferences": total,
+                "real_count": real,
+                "demo_count": demo,
+                "real_ratio": round(real / total, 4) if total else 0,
+                "active_weight": self._config.get("active_weight") or "",
+                "demo_mode": self.effective_demo_mode(),
+                "active_exists": bool(active and active.is_file()),
+                "weights_count": len(self.list_weights()),
+            },
+            "class_distribution": class_pie,
+            "confidence_distribution": conf_bar,
+            "mode_distribution": mode_pie,
+            "inference_trend": trend,
+            "recent": self._stats.get("recent") or [],
+            "updated_at": self._stats.get("updated_at"),
+        }
+
+    def reset_stats(self) -> None:
+        self._stats = self._empty_stats()
+        self._save_stats()
+
+    @staticmethod
+    def _safe_name(filename: str) -> str:
+        name = Path(filename or "weights.pt").name
+        name = re.sub(r"[^\w.\-()+]", "_", name)
+        if not name or name in (".", ".."):
+            name = f"weights_{int(time.time())}.pt"
+        return name
+
+
+_manager: YoloManager | None = None
+
+
+def get_yolo_manager() -> YoloManager:
+    global _manager
+    if _manager is None:
+        _manager = YoloManager()
+    return _manager

ai-service/requirements.txt

@@ -0,0 +1,23 @@
+# 智慧医院 AI 微服务（演示级）
+fastapi>=0.110.0
+uvicorn[standard]>=0.27.0
+pydantic>=2.6.0
+pydantic-settings>=2.2.0
+python-multipart>=0.0.9
+httpx>=0.27.0
+numpy>=1.26.0
+Pillow>=10.2.0
+# 无 GUI 的 OpenCV，比 opencv-python 更小
+opencv-python-headless>=4.9.0
+
+# LangChain RAG（兼容 OpenAI 协议：DeepSeek / Qwen）
+langchain>=0.2.0
+langchain-core>=0.2.0
+langchain-community>=0.2.0
+langchain-text-splitters>=0.2.0
+
+# 视觉推理：请先单独安装 CPU 版 torch，再装 ultralytics
+#   pip install torch torchvision --index-url https://download.pytorch.org/whl/cpu
+#   pip install ultralytics
+# monai 可选：pip install monai
+ultralytics

ai-service/samples/README.md

@@ -0,0 +1,142 @@
+# 测试素材说明（图片集 + YOLO 权重）
+
+本目录与 `data/weights` 已预置**可离线手动测试**的公开样例，供实训演示使用。
+
+> ⚠️ 仅供教学 / 系统联调，**不能用于真实临床诊断**。
+
+---
+
+## 一、YOLO 权重位置
+
+目录：
+
+```
+ai-service/data/weights/
+├── yolov8n.pt        # YOLOv8 Nano 检测（约 6.3 MB，推荐先用这个）
+└── yolov8n-seg.pt    # YOLOv8 Nano 分割（约 6.7 MB，可选）
+```
+
+| 文件 | 来源 | 适配说明 |
+|------|------|----------|
+| `yolov8n.pt` | Ultralytics 官方 COCO 预训练 | 与本系统 FastAPI `ultralytics.YOLO` 完全兼容；可在「YOLO 权重」页上传/激活 |
+| `yolov8n-seg.pt` | 官方分割权重 | 本系统当前检测管线以 **detect** 为主，分割权重可作扩展试验 |
+
+**说明：**  
+公开可直接下载、体积适中、协议清晰的医学专用 YOLO 权重较少；此处采用官方通用权重验证「上传 → 激活 → 真实推理」全链路。  
+医学影像上 COCO 类别不一定命中（可能 0 个框），属正常；此时系统仍可走报告逻辑，或回退演示检测。  
+若你有自己训练的胸片/结节 `.pt`，直接替换或上传覆盖即可。
+
+### 在管理端激活
+
+1. 登录 `admin / admin123`
+2. 打开 **YOLO 权重**
+3. 上传 `ai-service/data/weights/yolov8n.pt`（或直接在该目录已有文件时点刷新后激活）
+4. 策略选 `auto` 或 `real`
+5. **需安装** `ultralytics` 才能真实加载：
+
+```bash
+cd ai-service
+.\.venv\Scripts\activate
+pip install ultralytics torch torchvision
+# 重启 AI 服务
+uvicorn app.main:app --host 0.0.0.0 --port 8001
+```
+
+也可在 PowerShell 用接口激活（AI 服务已启动时）：
+
+```bash
+# 若权重已在 data/weights 下，FastAPI 可直接 activate
+curl -X POST http://127.0.0.1:8001/yolo/weights/activate -H "Content-Type: application/json" -d "{\"name\":\"yolov8n.pt\",\"demo_mode\":\"auto\"}"
+```
+
+---
+
+## 二、图片集位置
+
+### 1. 真实公开胸片（COVID 相关科研数据集子集）
+
+```
+ai-service/samples/medical/
+├── chest_sample_1.jpeg ~ chest_sample_4.jpeg
+├── covid_xray_1.jpg ~ covid_xray_3.jpg
+```
+
+- 来源：[ieee8023/covid-chestxray-dataset](https://github.com/ieee8023/covid-chestxray-dataset)（GitHub 公开）
+- 建议在前端 **影像诊断** 中类型选 **X_RAY / CT**，部位填「胸部」后上传测试
+
+### 2. 仿真医学图（本地生成，联调兜底）
+
+```
+sim_chest_xray_normal.png
+sim_chest_xray_opacity.png
+sim_chest_ct_nodule.png
+sim_brain_ct.png
+sim_knee_xray.png
+sim_ultrasound.png
+```
+
+灰度仿真图，便于无外网时继续测 UI/报告链路。
+
+### 3. 通用目标检测验证图（验证权重是否“真的在跑”）
+
+```
+ai-service/samples/bus.jpg
+ai-service/samples/zidane.jpg
+```
+
+- 来源：Ultralytics / YOLOv5 示例图  
+- 用 `yolov8n.pt` 推理时应能检出 **person / bus** 等 COCO 类别  
+- 用于确认：权重激活成功 + ultralytics 安装正确
+
+### 4. 业务端副本（方便对照）
+
+已复制一份医学样例到：
+
+```
+smart-hospital/uploads/images/samples/
+```
+
+---
+
+## 三、推荐手动测试流程
+
+### A. 验证「真实权重」链路
+
+1. 安装 `ultralytics` 并重启 AI 服务  
+2. 管理端激活 `yolov8n.pt`，模式 `auto`/`real`  
+3. 上传 `samples/bus.jpg` 到影像诊断并 AI 诊断  
+4. 查看报告：应出现检测框；引擎显示 `real`  
+5. 回到 **YOLO 权重** 页看可视化统计是否增加「真实权重推理」
+
+### B. 验证「医学影像」业务链路
+
+1. 上传 `samples/medical/covid_xray_1.jpg` 等  
+2. 类型选 X_RAY，部位「胸部」  
+3. 看标注图 + 诊断报告 + 置信度  
+4. （可选）无权重或 demo 模式下会出演示框，属预期
+
+### C. 仅演示模式（不装 torch）
+
+1. 不激活权重，或模式选 `demo`  
+2. 任意医学图均可出演示检测框与报告
+
+---
+
+## 四、目录速查
+
+| 内容 | 路径 |
+|------|------|
+| 权重 | `ai-service/data/weights/` |
+| 医学图片 | `ai-service/samples/medical/` |
+| 通用测试图 | `ai-service/samples/bus.jpg` 等 |
+| 权重配置（激活后生成） | `ai-service/data/yolo_config.json` |
+| 推理统计（诊断后生成） | `ai-service/data/yolo_stats.json` |
+
+---
+
+## 五、许可与合规
+
+- Ultralytics 权重：遵循 Ultralytics / AGPL 相关协议，仅作学习研究  
+- covid-chestxray-dataset：遵循原仓库许可证，仅作科研/教学  
+- 仿真图：项目内生成，无患者隐私  
+- **禁止将本素材与系统输出用于真实诊疗**