有这样一位仁兄，在美国西部的一个神经外科中心专门做听神经瘤，有一次完成了一例听神经瘤的切除，花了大约12个小时（肿瘤大小约3cm，操作包括磨开内听道，全切肿瘤，完整保留面神经，但内听神经未保留，因为患者术前的听力已经丧失）。术后对手术过程进行回顾，在谈到如何能够使自己在12个小时的操作中始终保持精力高度集中时，说了下面这样一段话：连云港市第一人民医院神经外科陈军
Obviously, there"s a lot of high tension that goes on in here -- is that you"ve got to be relaxed. If you"re not relaxed, you"re not comfortable, you cannot go long periods of time with doing this, so that"s always the first thing I -- when I sit down,how am I sitting? Am I rel-- is this chair -- we do this all under a microscope chair. There"s a special chair that we have that"s all electric: the arms go up and down, that goes backward and forward, I can raise it up and down in the air. You want to get in a good position that your arms are comfortable and that you"re comfortable in doing this. You can"t do these for 12 hours if you"re not comfortable, and if you"re in some cramped, cocked position, you"re going to -- you"re not going to do a good job. So that"s number one.Number two,you want to get a good view of the situation. You want to make sure that you know exactly what you"re doing on both ends of the -- of the tumor. And I think that that"s - - that part of it is really essential. But even before all that, you"ve got to be planned. You"ve got to sit down -- usually the night before, I"m going to sit down, I"m going to go over the patient"s history, I"m going to go over the x-rays, and I"m going to review exactly "what am I going to do in that operating room tomorrow? What are my goals? Are we going for a partial resection? Are we going to debulk it? Do we want to remove this tumor? What are his functions? What can we -- what parts of the nerves do we need to preserve on this? Where do I really have to take meticulous time in trying to accomplish those goals?" If you come into it, there are enough psychological studies that say that a successful surgery is 80% preparation. If you know what you"re going to do, if you know how you"re going to do it, and you go in, 20% of it is actually just doing it.
大概意思就是两点，
- 手术的时候，得让整个身体处于比较放松的状态，或者说在操作的过程中，至少要让自己坐的比较舒服！他坐的椅子很厉害，不但有肘托，而且整个椅子还是电动的，可以根据自己的需要做任意调整，以保证身体在很舒服的状态下进行操作（过于奢侈啊！）。不过虽然我们的条件达不到这种水平，但这个原则我是非常赞成的。我在每次手术前，总是强调患者的体位、手术台的摆放、术者与患者及术野的位置关系和手术显微镜的调节等，其实均是在强调如何保证在术中使术者保持一种较为舒适及放松的状态下完成操作。
- 术前准备。这里的准备是指手术前术者自身的准备工作。他在最后总结的时候说一例成功的手术，80％是医生在术前对即将进行的手术进行的准备，包括重新回顾患者的病史，重新回顾患者的影像学治疗，再次确定手术的目标，包括肿瘤究竟切到什么程度？次全切或全切？那些神经需要保留，哪一部分操作是最精细的部分？等等。当这些内容全部了若于胸时，剩下的20％的工作就看具体的操作了。其实这也就是“知己知彼，百战不殆”的一种体会而已。但真正能够做到这一点，是需要长期的一种养成，并非一蹴而就所能达到的。
