腹膜后淋巴结清扫是妇科恶性肿瘤手术分期及清除转移淋巴结的重要方式，但其分期价值并不等同于生存获益。随着临床证据的积累、前哨淋巴结示踪技术的推广，以及基于病理和分子特征的风险评估体系不断完善，淋巴结手术逐渐由常规系统性清扫转向个体化评估与选择性清扫。对于仍需清扫的患者，腹腔镜、机器人及经脐单孔技术的发展，以及经腹膜与腹膜外入路的合理应用，为减少手术损伤提供了更多选择。如何精准选择患者，并在保证清扫质量的同时降低并发症，是当前临床关注的重点。本文结合宫颈癌、子宫内膜癌和卵巢癌的治疗特点，综述腹膜后淋巴结清扫的适应证、清扫范围、入路选择及微创技术进展，探讨其在满足分期和治疗需要、保护长期生活质量方面的价值与局限。

Retroperitoneal lymphadenectomy is an important component of surgical staging and the removal of metastatic lymph nodes in gynecologic malignancies, but its staging value does not necessarily translate into a survival benefit. As clinical evidence accumulates, sentinel lymph node mapping becomes more widely used, and risk assessment based on pathological and molecular features improves, nodal surgery is moving from routine systematic dissection toward individualized assessment and selective lymphadenectomy. For patients who still require dissection, advances in laparoscopic, robotic, and transumbilical single-port surgery, together with appropriate selection of transperitoneal or extraperitoneal access, offer more options to reduce surgical morbidity. Selecting suitable patients and limiting complications without compromising the adequacy of dissection remain key clinical concerns. This review discusses the indications, extent of dissection, surgical approaches, and advances in minimally invasive techniques for retroperitoneal lymphadenectomy in cervical, endometrial, and ovarian cancers. It examines the benefits and limitations of the procedure in meeting staging and treatment needs while preserving long-term quality of life.