This paper aimed to explore pelvic lymphadenectomy for gynecological malignant tumors guided by computed tomography angiography (CTA) images under region-growing algorithm (RGA). 100 cases of malignant tumor patients who received pelvic lymphadenectomy in hospital from January 2018 to January 2020 were analyzed. Patients were classified into control group (CTA image) and experimental group (RGA-based CTA image), each with 50 cases. The overall accuracy (OA) of the pelvic CT image segmentation parameters under RGA, the watershed segmentation algorithm (WA), and the swarm intelligence optimization algorithm (SIOA) was compared. Comparisons of segmentation parameters, denoising performance, and CT imaging of patients as well as diagnosis rate and total efficiency rate were carried out. The results showed that overall accuracy (OA) of RGA was considerably higher versus watershed segmentation algorithm (WA) and swarm intelligence optimization algorithm (SIOA). However, false positive rate (FPR) and false negative rate (FNR) of RGA were greatly lower than those of other algorithms. RGA greatly improved the accuracy of pelvic tumor detection. The peak signal-to-noise ratio (PSNR) of RGA was superior to that of WA and SIOA, but differences in edge preservation index (EPI) value were not significant. The diagnosis rate of the experimental group was 48/50 (96%), while the diagnosis rate by manual means was 38/50 (76%). For the diagnosis rate and total efficiency, results of the experimental group were evidently higher in contrast to the control group ( P < 0.05 ). In conclusion, under RGA, CTA image-guided pelvic lymphadenectomy had good segmentation accuracy and denoising performance, and it was superior in total efficiency and diagnosis rate, which was worthy of clinical promotion.