To explore the high risk factors of pelvic mass occurrence of patients after total hysterectomy, and to study its preventive measures. Methods: In 1 year after total hysterectomy, 30 patients with pelvic masses occurrence from January 2019 to January 2022 were selected in study group retrospectively, and 120 patients without pelvic masses occurrence were selected in control group. The general demographic data, the pregnancy history, the past medical history, the disease type, and the surgical data of the patients were compared between the two groups. Univariate analysis and multivariate logistic regression analysis were used to identify the influencing factors of the pelvic masses occurrence of the patients after total hysterectomy. The receiver operating characteristic (ROC) curve was used to analyze the predictive efficacy of the independent risk factors for their postoperative pelvic mass occurrence. Results: The diabetes mellitus, the renal complications, the preoperative anemia, the histories of endometriosis, pelvic surgery, and abdominal surgery, the treatment mode of fallopian tube, the operation time, and the intraoperative blood loss of the patients might be related to the occurrence of their pelvic mass occurrence after total hysterectomy (P＜0.05). Multivariate logistic regression analysis showed that the preoperative history of anemia (OR=2.969, 95%CI=1.348-6.540), the endometriosis history (OR=2.651, 95%CI=1.413-4.975), the abdominal surgery history (OR=2.280, 95%CI=1.236-4.206), the treatment of bilateral tubal retention (OR=2.528, 95%CI=1.271-5.028), the longer operation time (OR=1.106, 95%CI=1.016-1.204) of the patients were all the independent risk factors of their pelvic mass occurrence after total hysterectomy (P＜0.05). ROC curve analysis showed that the histories of preoperative history of anemia, endometriosis, and abdominal surgery, the treatment methods of bilateral tubal retention, and the operation time of the patients had certain predictive efficacy for the occurrence of their pelvic mass after total hysterectomy, and the area under the curve of which were 0.717, 0.621, 0.608, 0.633, and 0.652, respectively. Conclusion: The high risk factors of the pelvic mass occurrence after total hysterectomy of the patients should be paid attention to in clinic, and the perioperative management should be strengthened according to these high risk factors.