Objective To analyze the factors affecting the occurrence of chylorrhea in patients with papillary thyroid carcinoma (PTC) after surgery. Methods The clinical data of 144 PTC patients who underwent lymph node dissection in our hospital from February 2022 to January 2024 were retrospectively collected. The incidence of chylorrhea was analyzed 72h after operation, and the patients were divided into two groups, the occurrence group and the non-occurrence group. The influencing factors of the occurrence of chylorrhea were analyzed. Results Among 144 PTC patients, 14 cases had chylorrhea (9.72%). Logistic regression analysis showed that bilateral neck dissection, lymph node metastasis in zone IV, extravascular invasion of metastatic lymph nodes, intraoperative chylorrhea, and low serum albumin (ALB) expression were the influential factors leading to the occurrence of chylorrhea after PTC (P < 0.05). Conclusion There is a certain probability of chylorrhea in patients with PTC after operation. Extrinsic lymph node invasion, lymph node metastasis in zone IV, bilateral neck dissection, intraoperative chylorrhea, and low serum ALB expression are the factors affecting the occurrence of chylorrhea.