diff --git a/TUICallKit-Vue3/TUIKit/components/CallView/CallView.vue b/TUICallKit-Vue3/TUIKit/components/CallView/CallView.vue
index 5776f590..92f9616b 100644
--- a/TUICallKit-Vue3/TUIKit/components/CallView/CallView.vue
+++ b/TUICallKit-Vue3/TUIKit/components/CallView/CallView.vue
@@ -164,7 +164,7 @@
 
 <script lang="ts" setup>
 import { ref, watch, computed } from 'vue';
-import { onHide, onUnload } from '@dcloudio/uni-app'
+import { onUnload } from '@dcloudio/uni-app'
 import Avatar from '../Avatar/Avatar.vue';
 import TRTCPusher from '@tencentcloud/trtc-component-uniapp/src/components/TRTCPusher.vue';
 import TRTCPlayer from '@tencentcloud/trtc-component-uniapp/src/components/TRTCPlayer.vue';
@@ -337,6 +337,8 @@ onUnload(() => {
   const callRole = callParticipantInfo?.value?.selfInfo?.role;
 
   if (callStatus === CallStatus.IDLE) return;
+  // 已接通：页面卸载（返回、切后台、关闭小程序等）不主动 signaling 挂断，医生端可继续面诊；结束请点「挂断」
+  if (callStatus === CallStatus.CONNECTED) return;
   if (callStatus === CallStatus.CALLING) {
     if (callRole === CallRole.CALLER) {
       hangup();
@@ -344,9 +346,6 @@ onUnload(() => {
       reject();
     }
   }
-  if (callStatus === CallStatus.CONNECTED) {
-    hangup();
-  }
 });
 
 </script>
diff --git a/TUICallKit-Vue3/TUIKit/pages/chat/chat.vue b/TUICallKit-Vue3/TUIKit/pages/chat/chat.vue
index 8fc56392..3ae7a849 100644
--- a/TUICallKit-Vue3/TUIKit/pages/chat/chat.vue
+++ b/TUICallKit-Vue3/TUIKit/pages/chat/chat.vue
@@ -277,6 +277,8 @@ const { proxy } = getCurrentInstance()
 	let unsubscribeWxAppShow = null;
 	let allowChatForegroundRelogin = false;
 	let foregroundReloginTimer = null;
+	/** 避免 onUnload 重复上报离开 */
+	let patientLeaveNotified = false;
 	
 	const CONFIRMATION_MESSAGE = `我已确认以下信息:
 1、本人确认已在线下确诊;
@@ -611,6 +613,7 @@ const { proxy } = getCurrentInstance()
 	}
 	onLoad(async (options) => {
 		try {
+		patientLeaveNotified = false;
 		console.log('进入onMounted:', options);
 			const app = getApp();
 			const userID = options.userID|| app.globalData.userID;
@@ -790,6 +793,11 @@ const { proxy } = getCurrentInstance()
 	});
 	
 	onUnload(() => {
+		// 患者退出聊天页：通知后端（与 notifyOpen 对称，供管理端轮询）
+		if (!patientLeaveNotified && targetUserID && String(targetUserID).startsWith('doctor_')) {
+			patientLeaveNotified = true;
+			void notifyDoctorOnChatClose();
+		}
 		allowChatForegroundRelogin = false;
 		// #ifdef MP-WEIXIN
 		if (typeof unsubscribeWxAppShow === 'function') {
@@ -855,6 +863,47 @@ const { proxy } = getCurrentInstance()
 			console.warn('后端通知失败:', e);
 		}
 	}
+
+	/** 离开会话页时通知医生：IM 自定义消息 + 后端全局事件 */
+	async function notifyDoctorOnChatClose() {
+		if (!targetUserID || !targetUserID.startsWith('doctor_')) return;
+		const doctorId = targetUserID.replace('doctor_', '');
+		const userData = uni.getStorageSync('userData') || {};
+		const patientName = userData.name || patient_data.value?.patient_name || '患者';
+		const patientId = (currentUserID || '').replace('patient_', '') || '';
+		try {
+			if (chat) {
+				const customPayload = {
+					businessID: 'patient_closed_chat',
+					patientId,
+					patientName,
+					doctorId,
+					time: Date.now()
+				};
+				const imMsg = chat.createCustomMessage({
+					to: targetUserID,
+					conversationType: TencentCloudChat.TYPES.CONV_C2C,
+					payload: { data: JSON.stringify(customPayload) }
+				});
+				await chat.sendMessage(imMsg);
+			}
+		} catch (e) {
+			console.warn('IM 离开通知发送失败:', e);
+		}
+		try {
+			await proxy.apiUrl({
+				url: '/api/chat/notifyClose',
+				method: 'POST',
+				data: {
+					doctor_id: doctorId,
+					patient_id: patientId,
+					patient_name: patientName
+				}
+			}, false);
+		} catch (e) {
+			console.warn('后端离开通知失败:', e);
+		}
+	}
 	
 	function applyDoctorEnteredSignalFromRawMessage(msg) {
 		if (!msg || msg.type !== TencentCloudChat.TYPES.MSG_CUSTOM) return;
@@ -956,6 +1005,9 @@ const { proxy } = getCurrentInstance()
 					if (customData.businessID === 'patient_opened_chat') {
 						return null; // 返回null表示不显示此消息
 					}
+					if (customData.businessID === 'patient_closed_chat') {
+						return null;
+					}
 					// 医生进入诊室信令（admin 发送）：仅更新顶部卡片，不在聊天列表展示
 					if (customData.businessID === 'doctor_entered_consult_room') {
 						return null;
diff --git a/admin/src/components/chat-notify-toast/index.vue b/admin/src/components/chat-notify-toast/index.vue
index 9d4b69b5..ee840b71 100644
--- a/admin/src/components/chat-notify-toast/index.vue
+++ b/admin/src/components/chat-notify-toast/index.vue
@@ -9,17 +9,35 @@
                 v-for="item in notifications"
                 :key="item.id"
                 class="chat-notify-card"
-                :class="{ 'chat-notify-card-complete': item.type === 'consultation_complete' }"
+                :class="{
+                    'chat-notify-card-complete': item.type === 'consultation_complete',
+                    'chat-notify-card-left': item.type === 'patient_left_chat'
+                }"
                 @click="handleClick(item)"
             >
-                <div class="chat-notify-icon" :class="{ 'chat-notify-icon-complete': item.type === 'consultation_complete' }">
+                <div
+                    class="chat-notify-icon"
+                    :class="{
+                        'chat-notify-icon-complete': item.type === 'consultation_complete',
+                        'chat-notify-icon-left': item.type === 'patient_left_chat'
+                    }"
+                >
                     <el-icon :size="22">
-                        <ChatDotRound v-if="item.type !== 'consultation_complete'" />
-                        <CircleCheck v-else />
+                        <ChatDotRound v-if="item.type !== 'consultation_complete' && item.type !== 'patient_left_chat'" />
+                        <CircleCheck v-else-if="item.type === 'consultation_complete'" />
+                        <Right v-else />
                     </el-icon>
                 </div>
                 <div class="chat-notify-body">
-                    <div class="chat-notify-title">{{ item.type === 'consultation_complete' ? '面诊结束' : '患者打开会话' }}</div>
+                    <div class="chat-notify-title">
+                        {{
+                            item.type === 'consultation_complete'
+                                ? '面诊结束'
+                                : item.type === 'patient_left_chat'
+                                  ? '患者离开会话'
+                                  : '患者打开会话'
+                        }}
+                    </div>
                     <div class="chat-notify-desc">
                         <template v-if="item.type === 'consultation_complete'">
                             <span class="patient-name">{{ item.patient_name || '患者' }}</span>
@@ -27,6 +45,10 @@
                             <span class="doctor-name">{{ item.doctor_name || '医生' }}</span>
                             完成，请及时跟进
                         </template>
+                        <template v-else-if="item.type === 'patient_left_chat'">
+                            <span class="patient-name">{{ item.patient_name || '患者' }}</span>
+                            已离开问诊会话页面
+                        </template>
                         <template v-else>
                             <span class="patient-name">{{ item.patient_name || '患者' }}</span>
                             已打开与您的会话，请及时查看
@@ -45,14 +67,14 @@
 <script setup lang="ts">
 import { ref, onMounted, onUnmounted } from 'vue'
 import { useRouter } from 'vue-router'
-import { ChatDotRound, CircleCheck, Close } from '@element-plus/icons-vue'
+import { ChatDotRound, CircleCheck, Close, Right } from '@element-plus/icons-vue'
 import { getChatNotifications } from '@/api/chat'
 
 const router = useRouter()
 
 export interface ChatNotifyItem {
     id: string
-    type?: 'patient_opened_chat' | 'consultation_complete'
+    type?: 'patient_opened_chat' | 'patient_left_chat' | 'consultation_complete'
     doctor_id?: number
     assistant_id?: number
     patient_id?: string
@@ -173,6 +195,15 @@ html.dark .chat-notify-card:hover {
     background: linear-gradient(135deg, #3b82f6 0%, #2563eb 100%);
 }
 
+.chat-notify-card-left {
+    border-color: rgba(148, 163, 184, 0.35);
+    box-shadow: 0 4px 20px rgba(0, 0, 0, 0.06), 0 0 0 1px rgba(148, 163, 184, 0.08);
+}
+
+.chat-notify-icon-left {
+    background: linear-gradient(135deg, #94a3b8 0%, #64748b 100%);
+}
+
 .chat-notify-body {
     flex: 1;
     min-width: 0;
diff --git a/admin/src/utils/im-business-message-parse.ts b/admin/src/utils/im-business-message-parse.ts
index b243a2ca..6275875f 100644
--- a/admin/src/utils/im-business-message-parse.ts
+++ b/admin/src/utils/im-business-message-parse.ts
@@ -99,6 +99,15 @@ export function parseImBusinessPayload(raw: string): FriendlyParse | null {
         return { main: '患者进入聊天', sub: parts.length ? parts.join(' · ') : undefined, tag: '诊室' }
     }
 
+    if (o.businessID === 'patient_closed_chat') {
+        const parts: string[] = []
+        if (o.patientName) parts.push(`患者：${String(o.patientName)}`)
+        if (o.patientId != null && o.patientId !== '') parts.push(`患者 ID：${String(o.patientId)}`)
+        const t = formatBizTime(o.time)
+        if (t) parts.push(t)
+        return { main: '患者离开聊天页', sub: parts.length ? parts.join(' · ') : undefined, tag: '诊室' }
+    }
+
     if (o.businessID === 'user_typing_status') {
         return { main: '对方正在输入…', tag: '状态' }
     }
diff --git a/server/app/api/controller/ChatController.php b/server/app/api/controller/ChatController.php
index e973d127..478d9b2b 100644
--- a/server/app/api/controller/ChatController.php
+++ b/server/app/api/controller/ChatController.php
@@ -10,7 +10,7 @@ use think\facade\Db;
  */
 class ChatController extends BaseApiController
 {
-    public array $notNeedLogin = ['notifyOpen', 'logAvPermission'];
+    public array $notNeedLogin = ['notifyOpen', 'notifyClose', 'logAvPermission'];
 
     /**
      * 上报音视频权限拒绝日志
@@ -55,4 +55,21 @@ class ChatController extends BaseApiController
         ChatNotifyLogic::addNotify($doctorId, $patientId ?: '0', $patientName);
         return $this->success('已通知');
     }
+
+    /**
+     * 患者离开会话页时通知医生（管理后台轮询 + 可与 IM 信令配合）
+     */
+    public function notifyClose()
+    {
+        $doctorId = (int) ($this->request->post('doctor_id') ?: $this->request->post('doctorId'));
+        $patientId = trim((string) ($this->request->post('patient_id') ?: $this->request->post('patientId') ?: ''));
+        $patientName = trim((string) ($this->request->post('patient_name') ?: $this->request->post('patientName') ?: '患者'));
+
+        if ($doctorId <= 0) {
+            return $this->fail('医生ID无效');
+        }
+
+        ChatNotifyLogic::addPatientLeftNotify($doctorId, $patientId ?: '0', $patientName);
+        return $this->success('已通知');
+    }
 }
diff --git a/server/app/api/logic/ChatNotifyLogic.php b/server/app/api/logic/ChatNotifyLogic.php
index 04b35e4b..f974d89e 100644
--- a/server/app/api/logic/ChatNotifyLogic.php
+++ b/server/app/api/logic/ChatNotifyLogic.php
@@ -43,6 +43,30 @@ class ChatNotifyLogic extends BaseLogic
         return true;
     }
 
+    /**
+     * 患者离开会话页/诊室时通知医生端（管理后台轮询）
+     */
+    public static function addPatientLeftNotify(int $doctorId, string $patientId, string $patientName): bool
+    {
+        $key = self::CACHE_PREFIX . $doctorId;
+        $item = [
+            'id' => uniqid('', true),
+            'type' => 'patient_left_chat',
+            'doctor_id' => $doctorId,
+            'patient_id' => $patientId,
+            'patient_name' => $patientName,
+            'created_at' => time(),
+        ];
+        $list = Cache::get($key) ?: [];
+        if (!is_array($list)) {
+            $list = [];
+        }
+        array_unshift($list, $item);
+        $list = array_slice($list, 0, self::MAX_PER_DOCTOR);
+        Cache::set($key, $list, self::CACHE_TTL);
+        return true;
+    }
+
     /**
      * 添加面诊结束通知（医生完成接诊后通知对应医助）
      * @param int $assistantId 医助ID (admin_id)