refactor: 统一耗材视觉算法并扩展语音确认至全量候选清单

- 以 ConsumableVisionAlgorithmService 替代 consumable_classifier 与 tear_action；
  可选手部检测权重，未配置时全帧分类；时间窗众数与 Excel 白名单配置。
- 语音待确认：ASR 先匹配 pending topk，再匹配本台 candidate_consumables；
  记账 item_id 与 vision 一致使用 name_to_code。
- 更新 config、Compose、.env.example、依赖（pandas/openpyxl）与测试。

Made-with: Cursor

tests/test_voice_resolution_service.py

@@ -61,20 +61,24 @@ def _make_service(
 def _active_session_with_pending(
     surgery_id: str = "123456",
     confirmation_id: str = "cid-a",
+    *,
+    candidate_consumables: list[str] | None = None,
+    pending_options: list[tuple[str, float]] | None = None,
 ) -> tuple[CameraSessionManager, str]:
     settings = Settings()
     mgr = CameraSessionManager(
         settings=settings,
-        consumable_classifier=MagicMock(),
-        tear_action=MagicMock(),
+        vision_algorithm=MagicMock(),
         hikvision_runtime=None,
         result_repository=None,
     )
-    st = SurgerySessionState(candidate_consumables=["纱布", "缝线"])
+    cands = candidate_consumables or ["纱布", "缝线"]
+    opts = pending_options or [("纱布", 0.4), ("缝线", 0.3)]
+    st = SurgerySessionState(candidate_consumables=cands)
     st.pending_by_id[confirmation_id] = PendingConsumableConfirmation(
         id=confirmation_id,
         status="pending",
-        options=[("纱布", 0.4), ("缝线", 0.3)],
+        options=opts,
         prompt_text="请确认",
         created_at=datetime.now(timezone.utc),
         model_top1_label="x",
@@ -193,6 +197,55 @@ async def test_resolve_rejected_audit(
         assert row.status == "rejected"
 
 
+@pytest.mark.asyncio
+async def test_resolve_recognizes_label_not_in_topk_but_in_surgery_candidates(
+    sqlite_session_factory,
+    monkeypatch: pytest.MonkeyPatch,
+) -> None:
+    """医生说出候选清单中的耗材（未出现在本次 pending 的模型 topk 里）也应记账。"""
+    settings = Settings()
+    sessions, cid = _active_session_with_pending(
+        candidate_consumables=["纱布", "缝线", "止血钳"],
+        pending_options=[("纱布", 0.4), ("缝线", 0.3)],
+    )
+    minio = MagicMock()
+    minio.configured = True
+    minio.ensure_bucket = MagicMock()
+    minio.upload_voice_wav = MagicMock(
+        return_value=StoredAudio(
+            object_key="k2.wav",
+            sha256_hex="d" * 64,
+            size_bytes=10,
+        )
+    )
+    baidu = MagicMock()
+    baidu.configured = True
+    baidu.asr = MagicMock(
+        return_value={"err_no": 0, "result": ["刚才用的是止血钳"]}
+    )
+    svc = _make_service(
+        settings=settings,
+        sessions=sessions,
+        minio=minio,
+        baidu=baidu,
+        sqlite_factory=sqlite_session_factory,
+        monkeypatch=monkeypatch,
+    )
+    result = await svc.resolve_from_wav(
+        surgery_id="123456",
+        confirmation_id=cid,
+        wav_bytes=_minimal_wav_16k_mono(),
+        filename="a.wav",
+        content_type="audio/wav",
+    )
+    assert result.rejected is False
+    assert result.resolved_label == "止血钳"
+    st = sessions._active["123456"].state
+    assert len(st.details) == 1
+    assert st.details[0].item_name == "止血钳"
+    assert st.details[0].source == "voice"
+
+
 @pytest.mark.asyncio
 async def test_audio_too_large_audit(
     sqlite_session_factory,