diff --git a/openhis-server-new/openhis-application/src/main/java/com/openhis/web/inhospitalnursestation/appservice/impl/NurseBillingAppService.java b/openhis-server-new/openhis-application/src/main/java/com/openhis/web/inhospitalnursestation/appservice/impl/NurseBillingAppService.java
index 8152b0d1..3c8bf7a9 100644
--- a/openhis-server-new/openhis-application/src/main/java/com/openhis/web/inhospitalnursestation/appservice/impl/NurseBillingAppService.java
+++ b/openhis-server-new/openhis-application/src/main/java/com/openhis/web/inhospitalnursestation/appservice/impl/NurseBillingAppService.java
@@ -665,7 +665,7 @@ public class NurseBillingAppService implements INurseBillingAppService {
         // 1. 校验：待删除项是否已收费，已收费则抛出异常阻止删除
         checkDeletedDeviceChargeStatus(requestIds);
         // 软删除执行记录
-        List<Procedure> procedureList = iProcedureService.listByIds(requestIds);
+        List<Procedure> procedureList = iProcedureService.getProcedureRecords(requestIds, serviceTable);
         List<Long> procedureIds = procedureList.stream().filter(Objects::nonNull) // 过滤掉null的Procedure对象
                 .map(Procedure::getId).filter(Objects::nonNull) // 过滤掉id为null的记录（按需添加）
                 .collect(Collectors.toList());
diff --git a/openhis-server-new/openhis-application/src/main/resources/mapper/clinicalmanage/SurgeryMapper.xml b/openhis-server-new/openhis-application/src/main/resources/mapper/clinicalmanage/SurgeryMapper.xml
index 5239fbd4..17c94402 100644
--- a/openhis-server-new/openhis-application/src/main/resources/mapper/clinicalmanage/SurgeryMapper.xml
+++ b/openhis-server-new/openhis-application/src/main/resources/mapper/clinicalmanage/SurgeryMapper.xml
@@ -331,8 +331,12 @@ PUBLIC "-//mybatis.org//DTD Mapper 3.0//EN"
             ) t
             WHERE rn = 1
         ) pi ON s.patient_id = pi.patient_id
+        <!-- 排除已生成医嘱的手术 -->
+        LEFT JOIN wor_service_request sr ON sr.activity_id = s.id AND sr.delete_flag = '0' AND sr.category_enum = 4
         <where>
             s.delete_flag = '0'
+            <!-- 只显示未生成医嘱的手术 -->
+            AND sr.id IS NULL
             <if test="ew.sqlSegment != null and ew.sqlSegment != ''">
                 <![CDATA[
                 AND ${ew.sqlSegment.replace('tenant_id', 's.tenant_id').replace('create_time', 's.create_time').replace('surgery_no', 's.surgery_no').replace('surgery_name', 's.surgery_name').replace('patient_name', 's.patient_name').replace('main_surgeon_name', 's.main_surgeon_name').replace('anesthetist_name', 's.anesthetist_name').replace('org_name', 's.org_name').replace('status_enum', 's.status_enum').replace('planned_time', 's.planned_time')}
diff --git a/sql/迁移记录-DB变更记录/202604251957_check_437_duplicate_charge_items.sql b/sql/迁移记录-DB变更记录/202604251957_check_437_duplicate_charge_items.sql
new file mode 100644
index 00000000..6c9e5524
--- /dev/null
+++ b/sql/迁移记录-DB变更记录/202604251957_check_437_duplicate_charge_items.sql
@@ -0,0 +1,59 @@
+-- Bug #437 数据排查：查询手术计费中的重复收费项
+-- 用法：在生产环境执行前先在测试环境验证
+-- 作者：荀彧
+
+-- 1. 查找手术计费中的重复收费项（同一手术+同一产品产生多条记录）
+SELECT 
+    encounter_id AS "就诊ID",
+    product_table AS "产品表",
+    product_id AS "产品ID",
+    service_table AS "服务表",
+    service_id AS "服务ID",
+    generate_source_enum AS "生成来源",
+    COUNT(*) AS "重复次数",
+    STRING_AGG(id::TEXT, ',') AS "收费项ID列表",
+    STRING_AGG(status_enum::TEXT, ',') AS "状态列表",
+    STRING_AGG(total_price::TEXT, ',') AS "金额列表",
+    STRING_AGG(create_time::TEXT, ',') AS "创建时间列表"
+FROM adm_charge_item
+WHERE delete_flag = '0'
+  AND generate_source_enum IN (1, 2)  -- 医生开立(1) 或 护士划价(2)
+  AND product_table IN ('cli_surgery', 'wor_device_request', 'wor_activity_definition')
+GROUP BY encounter_id, product_table, product_id, service_table, service_id, generate_source_enum
+HAVING COUNT(*) > 1
+ORDER BY COUNT(*) DESC;
+
+-- 2. 查找同一手术单号下是否有重复的收费项
+SELECT 
+    ci.product_id AS "手术ID",
+    cs.surgery_no AS "手术单号",
+    cs.surgery_name AS "手术名称",
+    COUNT(ci.id) AS "收费项数量",
+    STRING_AGG(ci.id::TEXT || '(' || ci.status_enum || ')' || '=' || ci.total_price, '; ') AS "收费项详情"
+FROM adm_charge_item ci
+LEFT JOIN cli_surgery cs ON ci.product_id = cs.id
+WHERE ci.delete_flag = '0'
+  AND ci.product_table = 'cli_surgery'
+  AND ci.generate_source_enum = 1
+GROUP BY ci.product_id, cs.surgery_no, cs.surgery_name
+HAVING COUNT(ci.id) > 1
+ORDER BY COUNT(ci.id) DESC;
+
+-- 3. 统计重复数据量（用于评估影响范围）
+SELECT 
+    generate_source_enum AS "生成来源(1=医生开立,2=护士划价)",
+    product_table AS "产品表",
+    COUNT(*) AS "重复组数",
+    SUM(cnt - 1) AS "多余记录数"
+FROM (
+    SELECT 
+        generate_source_enum,
+        product_table,
+        COUNT(*) AS cnt
+    FROM adm_charge_item
+    WHERE delete_flag = '0'
+    GROUP BY encounter_id, product_table, product_id, service_table, service_id, generate_source_enum
+    HAVING COUNT(*) > 1
+) sub
+GROUP BY generate_source_enum, product_table
+ORDER BY SUM(cnt - 1) DESC;
diff --git a/sql/迁移记录-DB变更记录/202604251957_fix_437_add_unique_constraint_adm_charge_item.sql b/sql/迁移记录-DB变更记录/202604251957_fix_437_add_unique_constraint_adm_charge_item.sql
new file mode 100644
index 00000000..bdca923f
--- /dev/null
+++ b/sql/迁移记录-DB变更记录/202604251957_fix_437_add_unique_constraint_adm_charge_item.sql
@@ -0,0 +1,28 @@
+-- Bug #437 修复：手术计费重复生成三条收费记录
+-- 根因：adm_charge_item 表缺少唯一约束，同一手术/耗材的收费项可被重复插入
+-- 影响范围：手术计费、护士划价等所有生成收费项的场景
+-- 作者：荀彧
+-- 日期：2026-04-25
+
+-- 1. 添加复合唯一约束：防止同一就诊下同一来源服务+产品产生重复收费项
+-- 约束字段：就诊ID + 医疗服务表 + 医疗服务ID + 产品表 + 产品ID + 账单生成来源
+-- 这些字段组合唯一确定一笔收费项，重复插入将被数据库拒绝
+ALTER TABLE adm_charge_item
+ADD CONSTRAINT uk_charge_item_encounter_service_product_source
+UNIQUE (encounter_id, service_table, service_id, product_table, product_id, generate_source_enum);
+
+-- 2. 添加索引：加速手术计费查询（按手术单号过滤）
+-- 前端手术计费页面使用 generate_source_enum=2 过滤手术计费项
+CREATE INDEX idx_charge_item_generate_source_product
+ON adm_charge_item (generate_source_enum, product_table, product_id)
+WHERE delete_flag = '0';
+
+-- 3. 添加索引：加速按就诊ID+状态查询收费项
+CREATE INDEX idx_charge_item_encounter_status
+ON adm_charge_item (encounter_id, status_enum)
+WHERE delete_flag = '0';
+
+-- DOWN 迁移（回滚脚本）
+-- ALTER TABLE adm_charge_item DROP CONSTRAINT IF EXISTS uk_charge_item_encounter_service_product_source;
+-- DROP INDEX IF EXISTS idx_charge_item_generate_source_product;
+-- DROP INDEX IF EXISTS idx_charge_item_encounter_status;