diff --git a/openhis-server-new/openhis-application/src/main/java/com/openhis/web/patientmanage/appservice/impl/PatientInformationServiceImpl.java b/openhis-server-new/openhis-application/src/main/java/com/openhis/web/patientmanage/appservice/impl/PatientInformationServiceImpl.java
index fd72e0ca..8018fd8d 100644
--- a/openhis-server-new/openhis-application/src/main/java/com/openhis/web/patientmanage/appservice/impl/PatientInformationServiceImpl.java
+++ b/openhis-server-new/openhis-application/src/main/java/com/openhis/web/patientmanage/appservice/impl/PatientInformationServiceImpl.java
@@ -308,12 +308,20 @@ public class PatientInformationServiceImpl implements IPatientInformationService
      * @return 患者信息
      */
     private Patient handlePatientInfo(PatientBaseInfoDto patientInfoDto) {
-        Patient patient = new Patient();
-        patient.setId(patientInfoDto.getId());
-        if (patientInfoDto.getId() == null) {
+        Patient patient;
+        if (patientInfoDto.getId() != null) {
+            // 更新现有患者信息
+            patient = patientService.getById(patientInfoDto.getId());
+            if (patient == null) {
+                throw new ServiceException("患者信息不存在，无法更新");
+            }
+        } else {
+            // 新增患者信息
+            patient = new Patient();
             patient.setBusNo(assignSeqUtil.getSeq(AssignSeqEnum.PATIENT_NUM.getPrefix(), 10));
-            patientInfoDto.setActiveFlag(PublicationStatus.ACTIVE.getValue()); // 默认启用
+            patient.setActiveFlag(PublicationStatus.ACTIVE.getValue()); // 默认启用
         }
+
         patient.setName(patientInfoDto.getName()); // 患者姓名
         patient.setPyStr(ChineseConvertUtils.toPinyinFirstLetter(patientInfoDto.getName())); // 拼音首拼
         patient.setWbStr(ChineseConvertUtils.toWBFirstLetter(patientInfoDto.getName())); // 五笔首拼
@@ -337,7 +345,14 @@ public class PatientInformationServiceImpl implements IPatientInformationService
         patient.setDeceasedDate(patientInfoDto.getDeceasedDate()); // 死亡时间
         patient.setNationalityCode(patientInfoDto.getNationalityCode());// 民族
         patient.setActiveFlag(patientInfoDto.getActiveFlag());// 活动标识
-        patientService.saveOrUpdate(patient);
+
+        if (patientInfoDto.getId() != null) {
+            // 更新操作
+            patientService.updateById(patient);
+        } else {
+            // 新增操作
+            patientService.save(patient);
+        }
 
         return patient;
     }
diff --git a/openhis-server-new/openhis-domain/src/main/java/com/openhis/administration/service/impl/PatientServiceImpl.java b/openhis-server-new/openhis-domain/src/main/java/com/openhis/administration/service/impl/PatientServiceImpl.java
index 449d1b6e..0aa2eb59 100644
--- a/openhis-server-new/openhis-domain/src/main/java/com/openhis/administration/service/impl/PatientServiceImpl.java
+++ b/openhis-server-new/openhis-domain/src/main/java/com/openhis/administration/service/impl/PatientServiceImpl.java
@@ -32,18 +32,11 @@ public class PatientServiceImpl extends ServiceImpl<PatientMapper, Patient> impl
      */
     @Override
     public boolean saveOrUpdatePatient(Patient patient) {
-
-        // 身份证ID，患者ID，确定唯一患者
-        LambdaQueryWrapper<Patient> queryWrapper = new LambdaQueryWrapper<>();
-        queryWrapper.eq(Patient::getId, patient.getId()).eq(Patient::getIdCard, patient.getIdCard());
-
-        Patient existingPatient = baseMapper.selectOne(queryWrapper);
-        if (existingPatient != null) {
-            // 如果记录存在，更新记录
-            patient.setId(existingPatient.getId());
+        if (patient.getId() != null) {
+            // 如果提供了ID，则直接更新该ID的记录
             return baseMapper.updateById(patient) > 0;
         } else {
-            // 如果记录不存在，插入新记录
+            // 如果没有提供ID，则插入新记录
             return baseMapper.insert(patient) > 0;
         }
     }