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61.
复杂性脾脏切除86例临床分析 总被引:1,自引:0,他引:1
目的总结复杂性脾脏切除的临床治疗体会。方法对86例复杂性脾脏切除病例进行系统回顾,总结分析手术前影像学资料、术中各种病理解剖特点、术中特殊处理措施、术后并发症的处理以及临床治疗效果。结果 86例病人均获得临床痊愈,无围手术期死亡及胃、肠道穿孔等严重损伤;其中62例恢复顺利,24例(27.9%)术后出现并发症或合并症,主要为肺部感染4例、左胸腔积液2例、肺不张2例、腹水6例以及脾静脉血栓性静脉炎6例、左膈下脓肿、胰尾部血管出血、胰漏、肺栓塞各1例。结论充分的术前检查和评估,规范的手术操作,脾周粘连的合理有效分离及脾蒂的微出血离断,是确保复杂性脾切除安全的关键。 相似文献
62.
Silvia Ceccanti Ilaria Falconi Simone Frediani Alessandro Boscarelli Marco Catani 《Minimally invasive therapy & allied technologies》2017,26(4):249-252
The advent of new energy sources for hemostasis has greatly facilitated advanced laparoscopic procedures. We describe a straightforward technique of laparoscopic splenectomy (LS) accomplished using the THUNDERBEAT? system (TS) (Olympus Medical Systems Corp., Tokyo, Japan) as the sole means of tissue dissection and hemostasis in two patients aged 19 and 6 years, respectively. The specimens were removed intact via a Pfannenstiel incision. Total operative time was 165 and 150?min, and length of hospital stay was three and 4 d, respectively. The TS is an appealing and reliable alternative to currently available energy devices, allowing fast dissection and secure hemostasis during laparoscopic splenectomy. 相似文献
63.
目的探讨门静脉插管防治脾切除断流术后门静脉血栓形成的安全性和有效性。方法自2004年4月至2005年5月,北京佑安医院肝胆外科共行脾切除断流术60例,其中35例留置门静脉插管,术后根据情况予以抗凝、溶栓等治疗。观察比较了该组患者手术前后血小板的变化、门静脉血流动力学变化、感染发生率、门静脉血栓的发生率和溶栓效果。结果脾切除断流术后患者血小板进行性升高,术后2周左右达到峰值,术后1月降至正常水平;术后门静脉最大流速、平均流速均明显减慢;门静脉插管感染1例;5例患者术前存在门静脉血栓,发生率为14.28%;术后7例患者出现门静脉血栓,发生率为20%;经门静脉插管予以溶栓抗凝治疗后,出院时复查门静脉血栓为6例,新发血栓者溶栓成功率为85.72%。结论经门静脉插管溶栓抗凝可有效防治脾切除断流术后门静脉血栓形成,为患者今后可能施行的肝移植手术保留条件。 相似文献
64.
J. A. Bar-Maor 《Pediatric surgery international》1989,4(3):205-207
A 13-year-old girl who suffered from Gaucher's disease had a partial splenectomy in 1983. Because of hypersplenism and mechanical problems a second partial splenectomy was performed in 1987 without complications. The rational and technical problems are discussed.
Offprint requests to: J. A. Bar-Maor 相似文献
65.
目的比较脾切除术与脾动脉栓塞术治疗乙肝肝硬化脾功能亢进的近期疗效。方法乙肝肝硬化并脾亢患者76例分成脾切除术组和脾栓塞术组,观察比较术后1周时脾亢改善情况及发热和腹痛等并发症的发生情况。结果两组患者脾亢均得到一定的改善,脾切除术组纠正脾亢的效果明显好于脾栓塞术组。脾栓塞术组的32例患者中,术后1周时有18例血小板<10.0×109/L(占56.3%),而脾切除术组44例患者血小板均>10.0×109/L。两组患者术后均有一定比例并发症的发生。结论脾切除术治疗乙肝肝硬化并发脾功能亢进的近期疗效明显好于脾动脉栓塞术。 相似文献
66.
Trias M Targarona EM Espert JJ Cerdan G Bombuy E Vidal O Artigas V 《Surgical endoscopy》2000,14(6):556-560
Background: Laparoscopic splenectomy (LS) is now regarded as the treatment of choice for autoimmune thrombopenia (ITP). However, there
have been few reports describing the application of LS to other splenic diseases, such as malignant entities and conditions
associated with splenomegaly. Hematological diseases have specific clinical features that can influence immediate outcome
after LS. Although the long-term effects of LS are unknown, a risk of splenosis has been suggested. Therefore, we designed
a study to analyze the impact of primary hematological disease on immediate and late outcome in a prospective series of LS
patients.
Methods: We performed a prospective analysis of 111 LS done between February 1993 and March 1999. The patients were classified by
hematological indications into the following four groups: (a) group 1, low platelet count. This group was further subdivided
into group 1A, idiopathic thrombocytopenic purpura (ITP) (n= 48) and group 1B, HIV-related ITP (n= 8); (b) group 2, anemia. This group was further subdivided into group 2A, autoimmune hemolytic anemia (n= 8), and group 2B, spherocytosis (n= 11); (c) group 3, malignancy (n= 28); and (d) group 4, others (n= 8). Immediate outcomes were recorded prospectively. Hematological status and late complications were reviewed after a mean
follow-up of 24 ± 18 months.
Results: There were no significant differences between the groups in terms of conversion, transfusion requirements, and morbidity,
although transfusion and morbidity were slightly higher in group 3. However, hospital stay was significantly longer in groups
3 and 4 than in groups 1 and 2. Long-term follow-up showed satisfactory hematological results in ≥75% of patients (group 1A,
82%; group 1B, 88%; group 2A, 88%; group 2B, 100%; group 3, 75%; group 4, 88%). Overall, late morbidity was 8.3% and mortality
was 6.2%, mainly due to deaths in group 4 (six of 22 patients).
Conclusion: LS is a safe and reproducible procedure for most hematological indications, with a similar immediate outcome for benign diseases
and a long-term hematological response comparable to the standard results that have been observed in open series.
Received: 1 April 1999/Accepted: 22 November 1999/Online publication: 8 May 2000 相似文献
67.
68.
Four cases of osteopetrosis, with manifestations within the first months of life, are presented. The first two cases were siblings. One of them received no therapy, the other 12 blood transfusions and antibiotics. Therapy had no influence on the thrombocytopenia and haemolytic process in Case 2, and he developed rachitic-like changes and a decrease in serum calcium during hospitalization. Both these two siblings died at the age of 5 months. The last two cases have been on prednisone therapy for 21 and 14 months, respectively. Case 3 is now doing well on prednisone, 7.5–10 mg every other day. Her mental and stato-motoric development has so far been normal. Optic nerve decompression was performed in March 1968, and the eye on which the operation was performed still retains some vision. Case 4 was started on steroids when he was about 3 months older than Case 3. Splenectomy had to be performed due to high prednisone requirements, and he still needs prednisone, 15 mg every other day. He seems, unfortunately, to be blind and slightly retarded. Heparin seems to be of no practical value in this disorder. Cellulose phosphate therapy resulted in impaired calcium absorption. The resulting hypocalcemia seems, however, to have very little, if any, effect on the underlying disease. 相似文献
69.
目的 :探讨思他宁对肝硬化门脉高压病人行脾切除手术前后门脉压力的影响。方法 :肝硬化门脉高压脾肿大、脾功能亢进病人 2 5例 ,随机分治疗组 (思他宁组 ) 15例 ,对照组 10例 ,术前 1d及术后第 2天用彩色多普勒测定门脉主干内径、血流速度及血流量。手术中开腹后和术毕关腹前分别经胃网膜右静脉分支测得门静脉压力。治疗组在使用思他宁 5min后测门脉压力一次 (思他宁静脉维持 4 8h) ,记录术中出血量、术后第 1天脾窝引流管引出量。结果 :治疗组 :①使用思他宁前后门脉压力差异有极显著性 (P <0 .0 1)。在思他宁维持过程中 ,行脾切除前后门脉压力差异有显著性 (P <0 .0 5 )。②使用思他宁前后和脾切除术前后门脉内径差异无显著性 ,最大流速及血流量差异有极显著性 (P <0 .0 1)。对照组 :①脾切除前后门脉压力、最大血流量及血液流速差异有显著性 (P <0 .0 5 )。②门脉内径差异无显著性。两组术中出血量 ,术后第 1天腹腔引流管引出量差异有极显著性 (P <0 .0 1)。结论 :周围静脉持续生长抑素维持能降低门脉高压病人脾切除术后的门脉压力 ,降低门脉压力的机制可能是通过降低门脉血流速率从而降低门静脉血流量。术中及术后使用思他宁能明显减少术中及术后创面渗血 相似文献
70.
Laparoscopic splenectomy (LS) has recently been gaining acceptance as an alternative to open splenectomy. However, several
aspects, such as learning curve, residual splenic function, and management of large spleens, remain controversial. In this
paper we present the analysis of technical details and immediate and late outcome of a consecutive series of 64 cases of splenic
disorders approached by laparoscopy. Between Feb-1993 and April-1997, 64 patients with a wide range of splenic disorders were
treated by laparoscopy, and prospectively recorded. Age, body mass index, operative time, number of trocars, perioperative
transfusion, spleen weight, conversion rate, mode of spleen retrieval (bag or accessory incision), postoperative analgesia,
stay and morbidity were analyzed. Late failures after LS were reevaluated with 99mTc-heat-damaged red blood cells scintigraphy and CT. LS was performed in 61 patients, and two cases with splenic cyst and
one splenic artery aneurysm received a laparoscopic partial cystectomy and aneurysmectomy. LS was performed through an anterior
approach in 12 patients and laterally in 49. Conversion rate was 6.5%. Accessory spleens were found in 7 patients (7/61, 11.5%).
Morbidity was 16%. There was no correlation between the weight of the spleen, platelet count or obesity with operative time.
A lateral approach was associated with a decrease in operative time (p < 0.002), postoperative stay (p < 0.001), transfusion
(p < 0.04) and number of trocars (p < 0.001). Operative time was significantly longer in large spleens (>1000 gr) (p < 0.001).
However, there were no differences in transfusion rate, stay, morbidity or conversion rate. After a follow up of 12 m, 10
patients revealed a low platelet count. Scintigraphy showed residual splenic tissue in 3 (ITP). A wide range of splenic disorders
can be treated by laparoscopy, including enlarged spleens. This technique should be continually audited, but initial results
reflect the approach's safety and advantages provided that great technical care is taken and an exhaustive search for accessory
spleens is conducted.
Received: 29 January 1997/Accepted: 22 May 1997 相似文献