diff --git a/src/views/trials/trials-panel/reading/dicoms3D/components/customize/QuestionFormItem.vue b/src/views/trials/trials-panel/reading/dicoms3D/components/customize/QuestionFormItem.vue
index e8115b57..8695a985 100644
--- a/src/views/trials/trials-panel/reading/dicoms3D/components/customize/QuestionFormItem.vue
+++ b/src/views/trials/trials-panel/reading/dicoms3D/components/customize/QuestionFormItem.vue
@@ -472,6 +472,12 @@ export default {
         }
       }
     })
+    DicomEvent.$on('operateImageMarker', (data) => {
+      let { operateStateEnum, QuestionId, picturePath } = data
+      if (this.question.Id === QuestionId) {
+        this.operateImageMarker({ operateStateEnum, question: this.question, picturePath })
+      }
+    })
   },
   methods: {
     numberInput(id) {
diff --git a/src/views/trials/trials-panel/reading/dicoms3D/components/customize/QuestionList.vue b/src/views/trials/trials-panel/reading/dicoms3D/components/customize/QuestionList.vue
index 2527679b..5e8a314f 100644
--- a/src/views/trials/trials-panel/reading/dicoms3D/components/customize/QuestionList.vue
+++ b/src/views/trials/trials-panel/reading/dicoms3D/components/customize/QuestionList.vue
@@ -577,7 +577,6 @@ export default {
       try {
         const answers = [{ id: obj.question.Id, answer: this.questionForm[obj.question.Id] }]
         const markInfo = []
-        console.log(this.questionMarkInfoList, 'this.questionMarkInfoList')
         const index = this.questionMarkInfoList.findIndex(
           item => item.QuestionId === this.operateQuestionId
         )
@@ -594,14 +593,16 @@ export default {
         }
         annotation = this.getAnnotationByRow(obj.question.Id, false)
         // 截图上传
-        let picturePath = ''
+        let picturePath = obj.picturePath
         if (annotation) {
           const base64Str = await this.getScreenshots({
             visitTaskId: this.visitTaskId,
             annotation
           })
-          const pictureObj = await this.uploadScreenshots(`${Date.now()}`, base64Str)
-          picturePath = pictureObj.isSuccess ? this.$getObjectName(pictureObj.result.url) : ''
+          if (!picturePath) {
+            const pictureObj = await this.uploadScreenshots(`${Date.now()}`, base64Str)
+            picturePath = pictureObj.isSuccess ? this.$getObjectName(pictureObj.result.url) : ''
+          }
           markInfo[0].PicturePath = picturePath
         }
         markInfo[0].MarkId = annotation ? annotation.annotationUID : null
@@ -615,6 +616,17 @@ export default {
           isSaved: true,
           OrderMarkName: this.questionMarkInfoList[index].OrderMarkName
         })
+        if (annotation) {
+          for (let i = 0; i < this.questionMarkInfoList.length; i++) {
+            const item = this.questionMarkInfoList[i]
+            if (!item.MeasureData || item.MeasureData.annotationUID !== annotation.annotationUID) continue
+            const isTableMode = item.TableQuestionId
+            if (!isTableMode && this.questionsMarkStatus[item.QuestionId] && !this.questionsMarkStatus[item.QuestionId].isSaved && this.questionsMarkStatus[item.QuestionId].isMarked) {
+              DicomEvent.$emit('operateImageMarker', { QuestionId: item.QuestionId, operateStateEnum: 5, picturePath })
+              break
+            }
+          }
+        }
       } catch (e) {
         console.error('保存失败:', e)
       } finally {
@@ -721,7 +733,6 @@ export default {
       return index > -1 ? this.questionMarkInfoList[index].MeasureData : null
     },
     async bindAnnotationToQuestion(annotation) {
-      console.log(this.operateStateEnum, 'bindAnnotationToQuestion')
       try {
         const VALID_STATES = [null, 0, 1, 3]
         const currentState = this.operateStateEnum