1. 概述

光动力疗法是肿瘤综合治疗的手段之一，特色鲜明，具有一定意义上的不可替代性。众所周知，恶性肿瘤治疗技术在不断地发展，有效性得以提高的同时，其副作用也影响了患者的生存质量。光动力疗法以其无创、副作用小、可重复治疗等优点，获得了广泛关注，在我国接受该技术治疗的患者以每年10-30%的速度递增，应用的科室众多，涉及消化内科、胃肠外科、呼吸与重症医学科、胸外科、神经外科、泌尿外科、妇科、介入医学科、耳鼻咽喉科、口腔科、皮肤科等。

光动力疗法的抗肿瘤作用源于三个相互关联的机制——对肿瘤细胞的直接杀伤，对肿瘤微血管的损伤及诱导机体抗肿瘤免疫反应的发生。

随着医学技术的进步，以往光动力疗法所面临的临床问题如激光的穿透深度有限、缺氧微环境下作用效果差以及光敏剂靶向性不足等，国产药械企业长足发展，从无到有，从弱到强，已得到有效解决。如何将其尽快应用到光动力的临床治疗中，是肿瘤光动力治疗事业的未来发展方向，需各个相关领域的专家相互配合，不断探索与尝试。本报告着重国内、外肿瘤光动力治疗的研究进展，分析我国光动力研究的优势与不足，并对未来肿瘤光动力治疗的发展方向做出科学性的预测。最后总结出十大前沿进展。

4. 本学科发展趋势与对策

本学科未来发展趋势一定是从早期肿瘤和晚期股息治疗着手，取得疗效和得到数据后向和其他治疗手段的联合使用发展，如光动力联合手术、联合化疗、联合放疗、联合介入、联合靶向药及免疫、联合中药等。对策是（1）、在一些具备条件的医疗中心分别设立早期肿瘤或者是癌前病变的多中心研究，目前在口腔科口腔黏膜白班、女性下生殖道癌前病变、早起不具备手术切除条件的鼻咽肿瘤、皮肤癌等领域具备此条件；（2）、设立晚期肿瘤股息治疗多中心研究，目前在呼吸道、消化道肿瘤的补充治疗，具备此条件；（3）、开拓光动力治疗不可替代的治疗领域，如胆管癌，尿道癌等。

4.1 未来5年发展的战略需求

未来发展的战略需求主要有几个方面：（1）、政策支持，包括医保政策、药品价格的完善和落地；（2）、药械企业不断发展，生产出更加优质和便宜的药物和医疗器械；（3）、人才培养，大力培训学员，推广技术，规范化开展。

4.2 未来5年重点发展方向

未来5年重点发展方向聚焦在以下几个方面：（1）、机制基础研究，包括药代学、组织学、肿瘤微环境、免疫学等；（2）、药械方面你，高武纯度更高，激发激光穿透性更高的波长，可控的并发症研究；（3）、临床研究方面，更高级别的循证医学证据，范围更大的多中心研究，光动力疗法与肿瘤其他治疗的联合序贯治疗策略。

4.3 未来5年发展对策

未来5年发展对策：（1）、遴选一批具备一定条件的研究中心开展机制研究，以口腔粘膜病变和早期食管癌为突破口；（2）、对接药企、器械生产企业和高校科研院所，加强光敏剂、激光、光导纤维的研发；（3）、继续推动已经开展的八个方面的多中心研究；（4）、对接国外学术团体，掌握国际学术前沿，引领国内学科发展。

5. 2025年中国肿瘤光动力治疗学科十大前沿进展

（1）胜利油田中心医院崔永胜团队治疗引导方式研究进展：创新性地拓展了多种光动力治疗的导引路径：通过鼻饲管作为媒介，实现对食管及胃肿瘤的精准光动力治疗；利用导管导丝，成功开辟了结直肠肿瘤的光动力治疗新途径；针对胆管肿瘤，采用经皮穿刺导引的方法，有效解决了治疗过程中的定位与导入难题；在软组织实性肿瘤的治疗上，经皮穿刺导引技术也取得了显著进展，为临床治疗提供了更多有效的手段。这些创新方法的研究，为光动力治疗在不同类型肿瘤的应用中，提供了更广泛、更有效的治疗策略。

（2）国医华科(天津)医疗科技集团有限公司研发的1.1类小分子化学药光敏抗肿瘤药物“超级卟啉”，具备高效、低毒、避光周期短、广谱抗肿瘤的特点，该药物的肿瘤细胞光敏抑制率高达72-95%，避光周期约为1天。另外，该公司研发的石英材质医用激光光纤(柱状端)，传输效率高、承受功率大、柔韧性强、无光老化等特点，具备易定位、便于精准治疗、不易烧毁、节约手术时间等功能，最大功率上限为3W，传输效率达95%以上。

（3）青岛大学附属医院消化内科曹彬团队研究成果，改良内镜下胆道支架联合光动力和/或射频消融在肝外胆管癌姑息治疗中的应用，被美国国际消化大会采用，光动力疗法（PDT）或射频消融术（RFA）联合胆道支架术治疗肝外胆管癌（EHC）具有更好的疗效和安全性。在光动力疗法和/或射频消融治疗 EHC 前放置支架，取得了良好的疗效，显著提高手术成功率，减少术后并发症，缩短康复时间。

（4）北京大学深圳医院开展系统性光动力治疗宫颈癌前病变和早期宫颈癌，2020年牵头了全国多中心项目《光动力治疗下生殖道癌前病变的有效性与安全性的多中心对照研究》，鉴于目前的临床研究成果，由中国抗癌协会肿瘤光动力治疗专业委员会等制定了《血卟啉注射液光动力疗法治疗子宫颈高级别鳞状上皮内病变专家共识（2025版）》，发表在中国激光医学杂志（2025年2月第34卷第1期）。

（5）华西医院陈谦明团队首次通过真实世界研究发现PDT可以降低口腔白斑病的癌变风险，发现铁死亡通路的关键负调控因子SLC7A11、免疫检查点分子PD-1在口腔白斑病PDT治疗抵抗中发挥了重要作用，联用铁死亡诱导剂或PD-1单抗可增强PDT疗效。

（6）重庆新桥医院等多家医院研究证实，喜泊分在肿瘤精准治疗与诊断领域中实现了多项进展：在恶性胸腔积液（MPE）治疗中，通过光动力疗法联合化疗/免疫治疗的方式，实现通过活性氧杀伤与免疫激活的双重机制，显著提升积液控制率至85%以上，验证了其疗效和安全性。另外，在荧光诊断领域中也取得了进展如在脑胶质瘤中，光动力诊断（PDD）展现了独特的优势，PDD通过荧光标记肿瘤浸润区域，使外科医生能够在术中实时区分肿瘤与正常组织，从而最大程度地实现肿瘤全切。在肺癌、食管癌等手术中，PDD能够帮助识别微小转移灶和亚临床病灶，减少术后复发风险。实现 “诊断-治疗一体化”的模式。

（7）深圳市雷迈科技有限公司研发了PDT630-D2型光动力治疗设备，具有双路输出激光（即可以同时输出也可以分别设置输出）的特点，取批国家三类医疗器械注册证。其功能是同时进行治疗两位肿瘤患者或不同部位的肿瘤，在国内外同领域处于领先水平。另外，雷迈科技参与起草制定的国家相关行业标准优于欧美日等发达国家标准，为中国光动力设备的发展奠定了坚实的基础。

（8）青岛大学附属医院林存智团队关于气管支气管肺癌光动力研究成果：体外细胞实验证明了PDT对A549肺腺癌细胞凋亡是通过Caspase-3 和 Bax的上调，Bcl-2 和 Survivin 的下调表达来实现的，裸鼠移植瘤动物模型实验验证了PDT明显抑制肿瘤细胞增长，其作用机制是抑制VEGF和 HIF-1α 基因表达，上调Bax和 Caspase-3，下调Bcl-2 基因表达来促进肿瘤细胞凋亡的，PDT可以抑制肿瘤血管拟态形成，即抑制肿瘤血管的形成，是通过下调骨桥蛋白（OPN）和VEGF表达来实现的。在同一条件下PDT对腺癌、鳞癌、小细胞肺癌疗效评价，研究表明光敏剂在肿瘤细胞内定位于细胞浆，PDT对这三种类型肿瘤细胞都有杀伤作用，鳞癌效果更加明显，而且不损伤正常粘膜细胞。发现鳞癌以凋亡为主，而小细胞肺癌以自噬为主，且先行PDT治疗后，再行化疗联合免疫治疗效果更优，早期支气管肺癌可以达到完全根治效果。

（9）浙江省人民医院胡韶山团队通过术前成像元宇宙定位技术结合患者肿瘤组织样本单细胞测序技术对瘤周不同区域内的肿瘤细胞浸润及免疫微环境特征进行了评估，提出并验证了GBM的瘤周“高脑血流量界面”，为精准光动力靶向治疗提供实验依据。另外，该团队设计了一种能够穿越血脑屏障（BBB）的纳米复合材料，能够在还原性肿瘤微环境中精准且快速释放。通过靶向递送药物至肿瘤组织，诱导铁死亡，同时产生高水平活性氧，促进氧死亡的发生。通过结合光动力疗法与铁死亡和氧死亡新型死亡机制的协同治疗，或许能为GBM患者带来新的治疗希望。

（10）河南科技大学第一附属医院高社干团队：创制新型纳米硒化铜光热光敏剂，实现药物可控释放、肿瘤组织深部穿透及靶向蓄积；牵头制定“光动力疗法—CACA技术指南（食管癌）”和“中国食管癌光动力治疗临床应用专家共识2024版” 2项指南，实现低创伤、精准靶向的 “保器官”策略。

【主编】

胡效坤青岛大学附属医院

邹珩北京中医药大学东直门医院

李伟青岛大学附属医院

【副主编】

王洪武北京中医药大学东直门医院

胡韶山浙江省人民医院

王宏志中国科学院合肥肿瘤医院

张恒柱江苏省苏北人民医院

陈谦明浙江大学医学院附属口腔医院

李瑞珍北京大学深圳医院

陈昊兰州大学第二附属医院

崔永胜胜利油田中心医院

【编委】（按姓氏拼音排序）

毕红安徽大学材料科学与工程学院

但红霞四川大学华西口腔医院

范惠珍江西省宜春市人民医院

黄明东福州大学

胡林军北京桓兴肿瘤医院

林存智青岛大学附属医院

李长忠北京大学深圳医院

李媛北京中医药大学东直门医院

李敬四川大学华西口腔医院

刘昱北京大学深圳医院

唐瑶云湖南湘雅医院

田军中国医学科学院肿瘤医院深圳医院

王秀丽上海市皮肤病医院

王春喜解放军总医院第一医学中心

王佩茹上海市皮肤病医院

吴裕文江西省宜春市人民医院

谢蕊哈尔滨医科大学肿瘤医院

闫秀伟浙江省人民医院

杨洛琦北京中医药大学

阴慧娟中国医学科学院生物

曾昕四川大学华西口腔医院

张梦曦河南科技大学第一附属医院

赵行四川大学华西口腔医院

曹彬青岛大学附属医院

张兵中国科学院合肥肿瘤医院

张国龙上海市皮肤病医院

吴瑞芳北京大学深圳医院

吴平湖南湘雅医院

李新宇山东省立医院

★

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技术支持：乐问医学