Objective: To analyze the treatment outcomes and influencing factors among pulmonary tuberculosis patients with positive etiological results in Anji County, Zhejiang Province from 2015 to 2024, so as to provide evidence for improving the successful treatment rate of pulmonary tuberculosis and interrupting its transmission. Methods: Data on pulmonary tuberculosis patients with positive etiological results registered and managed in Anji County from January 1, 2015 to December 31, 2024 were collected through the Tuberculosis Information Management System of the Chinese Disease Prevention and Control Information System. The data included demographic information, healthcare-seeking delay, treatment category, and etiological results. The successful treatment rate was analyzed. Factors affecting treatment outcomes among pulmonary tuberculosis patients with positive etiological results were identified using a multivariable logistic regression model. Results: A total of 1 249 pulmonary tuberculosis patients with positive etiological results registered and managed in Anji County from 2015 to 2024 were included. There were 858 males (68.69%) and 391 females (31.31%). The median age was 60.00 (interquartile range, 31.00) years. From 2015 to 2024, 1 128 patients achieved successful treatment, with a successful treatment rate of 90.31%. The trend was not statistically significant (P>0.05). There were 121 patients with adverse treatment outcomes, primarily consisting of treatment discontinuation due to adverse reactions and deaths, with 49 and 26 patients, respectively. Multivariable logistic regression analysis showed that female (OR=2.118, 95%CI: 1.300-3.451), age <80 years (<40 years, OR=4.166, 95%CI: 2.108-8.232; 40-<60 years, OR=3.211, 95%CI: 1.751-5.890; 60-<80 years, OR=3.137, 95%CI: 1.835-5.365), absence of healthcare-seeking delay (OR=1.535, 95%CI: 1.037-2.271), and initial treatment (OR=1.965, 95%CI: 1.131-3.414) were associated with a higher likelihood of successful treatment among pulmonary tuberculosis patients with positive etiological results. Conclusions The successful treatment rate among pulmonary tuberculosis patients with positive etiological results in Anji County from 2015 to 2024 was generally high and remained stable. Gender, age, healthcare-seeking delay, and treatment category were associated with treatment success.