diff --git a/src/components/exam/ExamSignPanel.tsx b/src/components/exam/ExamSignPanel.tsx
index 31c351a..795b3a2 100644
--- a/src/components/exam/ExamSignPanel.tsx
+++ b/src/components/exam/ExamSignPanel.tsx
@@ -2,8 +2,8 @@ import { useEffect, useRef, useState } from 'react';
 import * as pdfjsLib from 'pdfjs-dist';
 import pdfjsWorker from 'pdfjs-dist/build/pdf.worker.min.mjs?url';
 
-import type { OutputTongyishuFileInfo, OutputTijianPdfFileInfo } from '../../api';
-import { signInMedicalExamCenter, submitTongyishuSign, submitDaojiandanSign, editDaojiandanPrintStatus, submitAddItemBillSign, getTijianPdfFile, getTongyishuPdf, getDaojiandanPdf } from '../../api';
+import type { OutputTongyishuFileInfo, OutputTijianPdfFileInfo, OutputPhysicalExamItemInfo } from '../../api';
+import { signInMedicalExamCenter, submitTongyishuSign, submitDaojiandanSign, editDaojiandanPrintStatus, submitAddItemBillSign, getTijianPdfFile, getTongyishuPdf, getDaojiandanPdf, getExamOptionalItemList, removeOptionalPackage } from '../../api';
 import type { SignaturePadHandle } from '../ui';
 import { Button, SignaturePad } from '../ui';
 
@@ -81,8 +81,13 @@ export const ExamSignPanel = ({ examId, onBusyChange }: ExamSignPanelProps) => {
   const [batchPrintLoading, setBatchPrintLoading] = useState(false);
   const addItemBillCanvasContainerRef = useRef<HTMLDivElement>(null);
 
+  // 可选项目列表相关状态
+  const [optionalItemList, setOptionalItemList] = useState<OutputPhysicalExamItemInfo[]>([]);
+  const [optionalItemLoading, setOptionalItemLoading] = useState(false);
+  const [selectedOptionalItem, setSelectedOptionalItem] = useState<number | null>(null);
+
   const busy =
-    signLoading || submitLoading || consentLoading || pdfLoading || daojiandanSubmitLoading || addItemBillSubmitLoading || batchPrintLoading;
+    signLoading || submitLoading || consentLoading || pdfLoading || daojiandanSubmitLoading || addItemBillSubmitLoading || batchPrintLoading || optionalItemLoading;
 
   useEffect(() => {
     onBusyChange?.(busy);
@@ -194,8 +199,24 @@ export const ExamSignPanel = ({ examId, onBusyChange }: ExamSignPanelProps) => {
       }
     };
 
+    // 加载可选项目列表
+    const loadOptionalItems = async () => {
+      if (!examId) return;
+      setOptionalItemLoading(true);
+      try {
+        const res = await getExamOptionalItemList({ physical_exam_id: examId });
+        if (res.Status === 200 && res.Data?.listOptionalItem) {
+          setOptionalItemList(res.Data.listOptionalItem);
+        }
+      } catch (err) {
+        console.error('获取可选项目列表失败', err);
+      } finally {
+        setOptionalItemLoading(false);
+      }
+    };
+
     // 先加载知情同意书和导检单，然后刷新所有PDF状态（包括签名状态）
-    Promise.all([loadTongyishu(), loadDaojiandan()]).then(() => {
+    Promise.all([loadTongyishu(), loadDaojiandan(), loadOptionalItems()]).then(() => {
       refreshTijianPdfs(examId);
     });
   }, [examId]);
@@ -268,6 +289,36 @@ export const ExamSignPanel = ({ examId, onBusyChange }: ExamSignPanelProps) => {
       setMessage('请先上传身份证照片');
       return;
     }
+    if (!examId) {
+      setMessage('缺少体检ID');
+      return;
+    }
+
+    // 如果有可选项目，先移除未选中的项目
+    if (optionalItemList.length > 0 && selectedOptionalItem != null) {
+      const unselectedCodes = optionalItemList
+        .map((item) => item.combination_code)
+        .filter((code): code is number => code != null && code !== selectedOptionalItem);
+
+      if (unselectedCodes.length > 0) {
+        try {
+          const combinationCodeIds = unselectedCodes.join(',');
+          const removeRes = await removeOptionalPackage({
+            physical_exam_id: examId,
+            combination_code_ids: combinationCodeIds,
+          });
+          if (removeRes.Status !== 200 || removeRes.Data?.is_success !== 1) {
+            setMessage('移除未选项目失败：' + (removeRes.Message || '未知错误'));
+            return;
+          }
+        } catch (err) {
+          console.error('移除未选项目失败', err);
+          setMessage('移除未选项目失败，请稍后重试');
+          return;
+        }
+      }
+    }
+
     setSignLoading(true);
     setMessage(null);
     try {
@@ -1620,6 +1671,7 @@ export const ExamSignPanel = ({ examId, onBusyChange }: ExamSignPanelProps) => {
     }
   };
 
+
   return (
     <div className='grid grid-cols-2 gap-4 text-sm'>
       <div className='p-4 rounded-2xl border bg-gray-50/60 flex flex-col gap-3'>
@@ -1652,6 +1704,42 @@ export const ExamSignPanel = ({ examId, onBusyChange }: ExamSignPanelProps) => {
         {message && (
           <div className={`text-xs ${message.includes('成功') ? 'text-green-600' : 'text-amber-600'}`}>{message}</div>
         )}
+        {/* 可选项目列表 */}
+        {optionalItemLoading ? (
+          <div className='text-xs text-gray-500'>加载可选项目...</div>
+        ) : optionalItemList.length > 0 ? (
+          <div className='mt-2 space-y-2'>
+            <div className='text-xs font-medium text-gray-700'>可选项目（必选其一）：</div>
+            <div className='max-h-32 overflow-y-auto custom-scroll space-y-1'>
+              {optionalItemList.map((item) => {
+                const combinationCode = item.combination_code;
+                const isSelected = combinationCode != null && combinationCode === selectedOptionalItem;
+                return (
+                  <label
+                    key={combinationCode ?? `item-${item.package_code}`}
+                    className='flex items-center gap-2 cursor-pointer text-xs'
+                  >
+                    <input
+                      type='radio'
+                      name='optional-item'
+                      checked={isSelected}
+                      onChange={() => {
+                        if (combinationCode != null) {
+                          setSelectedOptionalItem(combinationCode);
+                        }
+                      }}
+                      disabled={busy}
+                      className='w-3 h-3'
+                    />
+                    <span className={isSelected ? 'text-blue-600 font-medium' : 'text-gray-700'}>
+                      {item.combination_name || '未命名项目'}
+                    </span>
+                  </label>
+                );
+              })}
+            </div>
+          </div>
+        ) : null}
       </div>
       {showImagePreview && previewImage && (
         <div className='fixed inset-0 z-[80] bg-black/90 flex items-center justify-center p-6' onClick={() => setShowImagePreview(false)}>