diff --git a/openhis-ui-vue3/src/views/surgicalschedule/index.vue b/openhis-ui-vue3/src/views/surgicalschedule/index.vue
index c79fdbf2..cd275c40 100755
--- a/openhis-ui-vue3/src/views/surgicalschedule/index.vue
+++ b/openhis-ui-vue3/src/views/surgicalschedule/index.vue
@@ -1864,6 +1864,21 @@ function handleTemporaryMedicalRefresh() {
 function handleQuoteBilling() {
   // 重新拉取计费药品数据
   if (temporaryPatientInfo.value.visitId) {
+    // 🔧 修复 Bug #445: 在清空之前提取已提交项目的复合匹配键
+    // 原因：后续的 ID 匹配过滤依赖 temporaryAdvices，但 temporaryAdvices 会被先清空
+    // 新医嘱没有 requestId/chargeItemId，需用名称+规格+数量的复合键匹配
+    const submittedKeys = new Set(
+      (temporaryAdvices.value || [])
+        .map(a => {
+          const om = a.originalMedicine || {}
+          const name = om.medicineName || om.adviceName || a.adviceName || ''
+          const spec = om.specification || om.volume || ''
+          const qty = om.quantity ?? 0
+          return `${name}|||${spec}|||${qty}`
+        })
+        .filter(k => k !== '|||0')
+    )
+
     temporaryMedicalLoading.value = true // 🔧 新增：开始加载
     getPrescriptionList(temporaryPatientInfo.value.visitId, 6, temporaryPatientInfo.value.operCode).then((res) => {
             if (res.code === 200 && res.data) {
@@ -1997,27 +2012,57 @@ function handleQuoteBilling() {
         })
 
         // 🔧 修复 Bug #445: 过滤掉已生成医嘱的项目，避免"引用计费"后已提交项目重新出现在"待生成"列表
-        // 原因：后端返回的计费数据中，已生成医嘱的项目可能没有 requestId 字段
-        // 方案：用 chargeItemId/requestId/id 与已有的 temporaryAdvices 做匹配，排除已生成项目
-        if (temporaryAdvices.value.length > 0) {
-          const existingAdviceIds = new Set()
-          temporaryAdvices.value.forEach(a => {
-            const om = a.originalMedicine || {}
-            if (om.requestId) existingAdviceIds.add(String(om.requestId))
-            if (om.chargeItemId) existingAdviceIds.add(String(om.chargeItemId))
-            if (om.id) existingAdviceIds.add(String(om.id))
+        // 使用清空前提取的 submittedKeys（名称|||规格|||数量复合键）进行匹配
+        if (submittedKeys.size > 0) {
+          temporaryBillingMedicines.value = temporaryBillingMedicines.value.filter(m => {
+            const key = `${m.medicineName || ''}|||${m.specification || ''}|||${m.quantity ?? 0}`
+            return !submittedKeys.has(key)
+          })
+          // 同步更新 temporaryAdvices，保持两份数据一致
+          temporaryAdvices.value = temporaryBillingMedicines.value.map((medicine, index) => {
+            const specMatch = medicine.specification ? medicine.specification.match(/(\d+)(\D+)/) : null
+            const specValue = specMatch ? parseInt(specMatch[1]) : 1
+            const specUnit = specMatch ? specMatch[2] : 'ml'
+            const dosage = specValue * (medicine.quantity || 1)
+            let usageCode = 'iv'
+            let usageLabel = '静脉注射'
+            try {
+              const jsonContent = medicine.contentJson || medicine.content_json;
+              if (jsonContent) {
+                const contentData = JSON.parse(jsonContent);
+                if (contentData.methodCode) {
+                  usageCode = contentData.methodCode;
+                  usageLabel = getUsageLabel(contentData.methodCode);
+                }
+              }
+            } catch (e) {}
+            if (!usageCode || usageCode === 'iv') {
+              if (medicine.medicineName && medicine.medicineName.includes('注射液')) {
+                usageCode = 'iv'; usageLabel = '静脉注射';
+              } else if (medicine.medicineName && medicine.medicineName.includes('片')) {
+                usageCode = 'po'; usageLabel = '口服';
+              } else if (medicine.medicineName && medicine.medicineName.includes('胶囊')) {
+                usageCode = 'po'; usageLabel = '口服';
+              }
+            }
+            return {
+              id: index + 1,
+              adviceName: medicine.medicineName || '',
+              dosage,
+              unit: specUnit,
+              usage: usageCode,
+              usageLabel,
+              frequency: '临时',
+              executeTime: new Date().toLocaleString('zh-CN'),
+              originalMedicine: {
+                ...medicine,
+                medicineName: medicine.medicineName,
+                specification: medicine.specification,
+                quantity: medicine.quantity,
+                encounterId: temporaryPatientInfo.value.visitId
+              }
+            }
           })
-          if (existingAdviceIds.size > 0) {
-            temporaryBillingMedicines.value = temporaryBillingMedicines.value.filter(m => {
-              const mRequestId = m.requestId != null ? String(m.requestId) : null
-              const mChargeItemId = m.chargeItemId != null ? String(m.chargeItemId) : null
-              const mId = m.id != null ? String(m.id) : null
-              if (mRequestId && existingAdviceIds.has(mRequestId)) return false
-              if (mChargeItemId && existingAdviceIds.has(mChargeItemId)) return false
-              if (mId && existingAdviceIds.has(mId)) return false
-              return true
-            })
-          }
         }
 
         temporaryMedicalLoading.value = false // 🔧 新增：加载完成