In this paper,some confliction between randomization and medical ethics in surgical clinical research design were analysed.Owing to randomization may interfere with patient’s autonomy and limit surgeons’ freedom,so randomization could be difficult to carry out in surgical clinical research.It is most important that the medical needs of the patients must always be given priority,therefore,surgeons should make good communication with patients.A few alternative design could be employed in surgical clinical research,for example the adaptive design、objective performance criteria (OPC)、sequential design and non-randomized controlled design.