[Survey analysis on the development and current status of pediatric digestive endoscopy over past 40 years].

内容摘要

Objective: To understand the development and current status of pediatric digestive endoscopy over the past 40 years, so as to provide strategic recommendations for the discipline's future development. Methods: A cross-sectional survey was conducted between February and March 2025 across 504 hospitals practicing pediatric endoscopy in 31 provinces, autonomous regions or municipalities. The structured questionnaire encompassed institutional and endoscopy center profiles, workforce demographics, technical capabilities, and continuing education requirements. Results: All 504 distributed questionnaires were returned valid. Pediatric endoscopy was first established in 1985 in Zhejiang Province and Beijing, with the Xizang Autonomous Region commencing services in 2023. The 5 leading provinces by center volume were Shandong (65 hospitals), Zhejiang (47 hospitals), Jiangsu (36 hospitals), Sichuan (34 hospitals) and Guangdong (29 hospitals). Geographic distribution revealed significant disparities: East China dominated with 187 centers (37.1%), North China accounted for 51 (10.1%), Southwest China accounted for 84 (16.7%), South China accounted for 65 (12.9%), Central China accounted for 41 (8.1%), Northwest China accounted for 60 (11.9%), while Northeast China accounted for merely 16 (3.2%). The workforce comprised 2 089 physicians and 1 920 nurses (physician-to-nurse ratio 1∶0.92), with general hospitals demonstrating superior staffing ratios (1∶1.06) compared to pediatric specialized and maternal-child hospitals (1∶0.51). Training predominantly relied on external fellowships (49.4%, 249/504) or combined institutional-external programs (40.9%, 206/504), supervised mainly by pediatric endoscopists (75.2%, 342/455). Diagnostic and therapeutic capabilities achieved comprehensive gastrointestinal coverage, with the five most prevalent procedures being gastroscopy (100.0%,504/504), foreign body retrieval (89.7%,452/504), colonoscopy (74.6%,376/504), polypectomy (62.5%,315/504), and hemostasis (54.0%,272/504). Conversely, advanced interventions, including endoscopic retrograde cholangiopancreatography, endoscopic retrograde appendicitis therapy and peroral endoscopic myotomy remained limited in adoption. Between 1996 and 2025, 18 practice guidelines, consensus statements and standard operating protocols were published. Conclusions: Pediatric gastrointestinal endoscopy has developed rapidly, with progress in discipline development, technical standards, talent cultivation, and consensus guideline formulation. However, challenges remain in achieving regional balance, optimizing the doctor-nurse ratio, and advancing high-level endoscopic therapeutic technologies. Future efforts should focus on refining minimally invasive technologies, integrating intelligent technologies, and achieving integrated management across the entire service chain. 目的： 了解儿童消化内镜开展40年的发展与现状，为儿童消化内镜学科的发展提供策略依据。 方法： 横断面研究。2025年2至3月通过问卷调查的方式，对我国31个省、自治区、直辖市开展儿童消化内镜的504家医院进行调研，内容涵盖医院及内镜中心基本情况、医护队伍结构与配置、内镜诊疗技术开展能力、继续教育与培训需求。 结果： 共发放问卷504份，回收有效问卷504份。调查显示1985年浙江省、北京市最早开展儿童消化内镜，西藏自治区于2023年开展。开展儿童消化内镜的单位数列前5位的地区分别为山东省（65家）、浙江省（47家）、江苏省（36家）、四川省（34家）、广东省（29家）；我国儿童消化内镜资源地域分布不均，华东地区187家（37.1%），华北地区51家（10.1%），西南地区84家（16.7%），华南地区65家（12.9%），东北地区16家（3.2%），华中地区41家（8.1%），西北地区60家（11.9%）。从业医护队伍人数为医师2 089名，护士1 920名，医护比为1∶0.92，综合医院医护比最高（1∶1.06），儿童专科医院和妇儿医院较低（均为1∶0.51）。继续教育模式以外出进修（49.4%，249/504）和“院内+外出”（40.9%，206/504）为主，带教老师主要为儿童消化内镜医师（75.2%，342/455）。我国已开展儿童消化内镜诊断和治疗各项技术，其中前5位分别是胃镜（100.0%，504/504）、异物钳取（89.7%，452/504）、肠镜（74.6%，376/504）、肠息肉切除（62.5%，315/504）、内镜下止血（54.0%，272/504），而高阶消化内镜治疗技术如内镜逆行胰胆管造影术、内镜下逆行性阑尾炎治疗术、经口内镜下肌切开术普及率较低。1996至2025年共发表儿童消化内镜相关操作常规、共识和指南18项。 结论： 儿童消化内镜发展迅速，在学科建设、技术规范、人才培养等方面取得进步，但在区域均衡发展、医护结构比例、高阶消化内镜治疗技术发展等方面仍面临挑战。未来需着力聚焦微创技术精细化、智能技术融合、全链条一体化管理。.