The railway tunnel disease has a certain development process. Before further deterioration of tunnel diseases, it is necessary to take relevant instruments and equipment for effective detection and realtime monitoring, and then conduct quantitative scientific assessment, which is the problems and challenges faced in the field of railway tunnel detection, monitoring and evaluation. Through years of exploration and accumulation in the field of railway tunnel operation and maintenance, the current development status of detection, monitoring, evaluation and renovation technology of railway tunnel in operation are summarized, which has important reference significance for the daily operation and maintenance of railway tunnel in operation. Firstly, through the survey and investigation of railway tunnel diseases, the railway tunnel diseases in operation period are sorted out. And then the detection and monitoring system consisting of acceptance inspection, periodic inspection, daily inspection and key monitoring are used to timely grasp the operation status of the operating railway tunnel. Furthermore, based on the condition assessment method of the operating railway tunnel, the rapid assessment of the deterioration of the tunnel building is realized. Finally, through the induction of the types of railway tunnel diseases and the analysis of their causes, a set of technical system of disease treatment suitable for the railway tunnels in operation is summarized.