diff --git a/IRaCIS.Core.Application/Service/Common/ExcelExportService.cs b/IRaCIS.Core.Application/Service/Common/ExcelExportService.cs
index 3daac6e4d..dafad5e04 100644
--- a/IRaCIS.Core.Application/Service/Common/ExcelExportService.cs
+++ b/IRaCIS.Core.Application/Service/Common/ExcelExportService.cs
@@ -2110,6 +2110,8 @@ namespace IRaCIS.Core.Application.Service.Common
 
             var translateDicNameList = list.SelectMany(t => t.QuestionAnswerList).Where(t => t.TranslateDicName.IsNotNullOrEmpty()).Select(t => t.TranslateDicName).Distinct().ToList();
 
+            var columNameList = list.SelectMany(t => t.QuestionAnswerList).Where(t => t.QuestionName.IsNotNullOrEmpty()).Select(t => t.QuestionName).Distinct().ToList();
+
             //针对1.1 整体肿瘤评估 有的两列要合并一列
             if (criterion.CriterionType == CriterionType.RECIST1Point1 || criterion.CriterionType == CriterionType.RECIST1Pointt1_MB || criterion.CriterionType == CriterionType.IRECIST1Point1)
             {
@@ -2188,7 +2190,7 @@ namespace IRaCIS.Core.Application.Service.Common
                 DynamicItemValueName = "QuestionValue",
                 DynamicListName = "QuestionAnswerList",
                 RemoveColunmIndexList = new List<int>() { },
-                ColumnNameList = list.FirstOrDefault()?.QuestionAnswerList.Select(t => t.QuestionName).ToList() ?? new List<string>(),
+                ColumnNameList = columNameList ?? new List<string>(),
                 TranslateDicNameList = translateDicNameList ?? new List<string>()
             };