范存刚 刘如恩

    [摘要] 本文基于神經外科的专业特点，从神经外科基础理论和临床技能两大方面探讨神经外科临床教学困境。在基础理论方面，重点探讨神经解剖、神经系统查体和神经影像技术等方面的学习困境。在临床技能方面，主要探讨不断涌现的新型辅助诊断技术对初学者持续学习能力提出更高要求;十分娇嫩的神经组织和显微操作技术使术者手术操作培训周期明显延长;因颅腔和椎管腔的代偿容积有限，患者在围手术期可能会因数十毫升术区出血引发脑疝而危及生命，对神经外科医生的责任心提出更高要求;为适应神经外科显微手术操作而设计的专科器械设备与普外科等其他外科的常用工具有很大差异，需要不断学习和适应;由于神经外科手术显露范围受限，加之保护神经功能是手术操作的前提，由此提出的“先行囊内减压，再分块切除囊壁”的神经肿瘤切除原则与传统肿瘤学所倡导的“整块切除”的无瘤原则似有相悖之处。在系统分析和深入探讨上述神经外科教学所面临困境的基础上，结合作者多年来神经外科的带教经验提出相应的处理策略，以期为从事神经外科临床教学提供借鉴。

    [关键词] 神经外科学;教学;神经解剖学;影像诊断学

    [中图分类号] R741? ? ? ? ? [文献标识码] A? ? ? ? ? [文章编号] 1673-7210(2020)03(a)-0063-04

    [Abstract] Based on the characteristics of neurosurgery， this article discusses the clinical teaching dilemma of neurosurgery from the two aspects of neurosurgery， including basic theory and clinical skills. With regard to the basic theory of neurosurgery， the author focused on the learning dilemmas in neuroanatomy， neurological examination and neuroimaging technology. In terms of clinical skills in neurosurgery， the emerging auxiliary diagnostic technology places higher requirements on the continuous learning ability of beginners; the delicate neural tissue and microsurgical techniques of neurosurgery significantly extend the surgical training period for surgeons; the limited compensatory volume of the cranial cavity and spinal canal may lead to brain hernia and even endanger the life of the patient in the perioperative period due to tens of milliliters of bleeding in surgical field ......