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71.
IntroductionPsoas abscess is a rare retroperitoneal infection and is often difficult to diagnose. It affects debilitated subjects. The aim of our study is to report our experience with percutaneous minimally-invasive drainage in the treatment of this condition.Patients and methodsWe report on a retrospective series of 22 patients followed at the Urology service, Military Hospital Moulay Ismail in Meknes (Morocco) over a period of seven years from January 2005 to January 2012. All patients underwent percutaneous drainage of the abscess under guidance of ultrasound or CT, together with appropriate antibiotics.ResultsAll patients had constitutional symptoms, 10 (45%) were diabetic. The postoperative course was consistently favorable. Recurrent abscess was noted in two patients (9%) and was favorably treated by percutaneous drainage. Diagnostic, clinical, biological and radiological characteristics of the disease are described.ConclusionPercutaneous drainage is an easy and reliable technique. It is minimally invasive, can be repeated if necessary, and is convenient in generally debilitated patients.  相似文献   
72.
目的:探讨小儿肛周脓肿的治疗效果。方法该院肛肠科于2012年6月—2014年6月期间对该院收治的56例小儿肛周脓肿患者进行一期根治术进行治疗,设为实验组,另外的56例患者进行切开引流术治疗小儿肛周脓肿,设为对照组,手术后观察患者的治疗效果。结果56例小儿肛周脓肿患者通过一期根治术治疗(实验组),全部患者均有好转,治愈率为98.2%,进行切开引流术(对照组)的治愈率为87.5%,两组患儿的治愈率的比较,差异有统计学意义(P<0.05);实验组在复发率方面明显少于对照组,差异有统计学意义(P<0.05);实验组在切口愈合时间上明显短于对照组,差异有统计学意义(P<0.05)。结论对小儿肛周脓肿进行一期根治术的治疗效果明显,无并发症,具有重要的临床意义,值得推广应用。  相似文献   
73.
目的:采用中鼻道上颌窦造口术后放置引流支架治疗慢性鼻窦炎,观察其疗效,并与单纯行中鼻道上颌窦造口术疗效作对照。方法:采用Z型不锈钢丝为骨架、两面覆盖硅橡胶薄膜的卷曲型支架。在鼻内窥镜直视下放置支架,并摄片观察支架的位置和形态。结果:17例共放置23个支架,随访显示上颌窦引流通畅,慢性炎症均治愈。6个月后支架均被取出,再随访4-6个月,上颌窦口开放良好,效果明显优于单纯中鼻道上颌窦口造术。结论:中鼻道上颌窦造口术结合支架引流治疗慢性鼻窦炎较单纯造口术术后处理简便,引流效果好,治愈率较高。  相似文献   
74.
75.
Endoscopic ultrasonography (EUS) has gained wide acceptance as an important, minimally invasive diagnostic tool in gastroenterology, pulmonology, visceral surgery and oncology. This review focuses on data regarding risks and complications of non-interventional diagnostic EUS and EUS-guided fine-needle biopsy (EUS-FNB). Measures to improve the safety of EUS und EUS-FNB will be discussed. Due to the specific mechanical properties of echoendoscopes in EUS, there is a low but noteworthy risk of perforation. To minimize this risk, endoscopists should be familiar with the specific features of their equipment and their patients’ specific anatomical situations (e.g., tumor stenosis, diverticula). Most diagnostic EUS complications occur during EUS-FNB. Pain, acute pancreatitis, infection and bleeding are the primary adverse effects, occurring in 1% to 2% of patients. Only a few cases of needle tract seeding and peritoneal dissemination have been reported. The mortality associated with EUS and EUS-FNB is 0.02%. The risks associated with EUS-FNB are affected by endoscopist experience and target lesion. EUS-FNB of cystic lesions is associated with an increased risk of infection and hemorrhage. Peri-interventional antibiotics are recommended to prevent cyst infection. Adequate education and training, as well consideration of contraindications, are essential to minimize the risks of EUS and EUS-FNB. Restricting EUS-FNB only to patients in whom the cytopathological results may be expected to change the course of management is the best way of reducing the number of complications.  相似文献   
76.
Abstract

Low-field extremity magnetic resonance imaging (lfMRI) is currently commercially available and has been used clinically to evaluate rheumatoid arthritis (RA). However, one disadvantage of this new modality is that the field of view (FOV) is too small to assess hand and wrist joints simultaneously. Thus, we have developed a new lfMRI system, compacTscan, with a FOV that is large enough to simultaneously assess the entire wrist to proximal interphalangeal joint area. In this work, we examined its clinical value compared to conventional 1.5 tesla (T) MRI. The comparison involved evaluating three RA patients by both 0.3 T compacTscan and 1.5 T MRI on the same day. Bone erosion, bone edema, and synovitis were estimated by our new compact MRI scoring system (cMRIS) and the κ coefficient was calculated on a joint-by-joint basis. We evaluated a total of 69 regions. Bone erosion was detected in 49 regions by compacTscan and in 48 regions by 1.5 T MRI, while the total erosion score was 77 for compacTscan and 76.5 for 1.5 T MRI. These findings point to excellent agreement between the two techniques (κ = 0.833). Bone edema was detected in 14 regions by compacTscan and in 19 by 1.5 T MRI, and the total edema score was 36.25 by compacTscan and 47.5 by 1.5 T MRI. Pseudo-negative findings were noted in 5 regions. However, there was still good agreement between the techniques (κ = 0.640). Total number of evaluated joints was 33. Synovitis was detected in 13 joints by compacTscan and 14 joints by 1.5 T MRI, while the total synovitis score was 30 by compacTscan and 32 by 1.5 T MRI. Thus, although 1 pseudo-positive and 2 pseudo-negative findings resulted from the joint evaluations, there was again excellent agreement between the techniques (κ = 0.827). Overall, the data obtained by our compacTscan system showed high agreement with those obtained by conventional 1.5 T MRI with regard to diagnosis and the scoring of bone erosion, edema, and synovitis. We conclude that compacTscan is useful for diagnosis and estimation of disease activity in patients with RA.  相似文献   
77.
目的筛选全凭静脉麻醉下经内镜逆行胰胆管造影术(endoscopic retrograde cholangio-pancreatography,ERCP)术后恶心呕吐(postoperative nausea and vomiting,PONV)的独立危险因素。方法选择上海瑞金医院2016年7月18日至8月31日全凭静脉麻醉下行ERCP的患者90例,男47例,女43例,年龄≥18岁,ASAⅠ~Ⅲ级。收集患者的一般资料和术中情况,随访术后24h内恶心呕吐的发生情况。采用Logistic回归分析全凭静脉麻醉下ERCP术后恶心呕吐的独立危险因素。结果有33例(36.7%)患者发生恶心。进一步Logistic回归分析结果显示,女性(OR=3.73,95%CI 1.36~10.27)、有PONV/晕动症史(OR=4.39,95%CI 1.40~13.76)、术后3h血淀粉酶3倍正常值(OR=5.22,95%CI 1.30~20.95)是全凭静脉麻醉下ERCP术后恶心呕吐的独立危险因素。结论女性、有PONV/晕动症史、术后3h血淀粉酶3倍正常值是全凭静脉麻醉下ERCP术后恶心呕吐的独立危险因素。  相似文献   
78.
Recently in Japan, endoscopic surgery has become focused on minimally invasive treatment for early gastric cancer. Endoscopic mucosal resection (EMR) is used to treat small mucosal gastric cancers &#104 2 cm in size; however, total removal of the cancerous lesion in one session cannot be performed easily. Laparoscopic partial resection of the gastric wall is indicated for the same lesions as EMR, and we can achieve complete removal of cancer lesions more accurately. However, the extension of indication to depressed type cancer > 1 cm may carry the risk of lymph-node metastasis. Laparoscopic-assisted gastrectomy with lymph-node dissection is necessary for such lesions. It has many advantages over open gastrectomy in terms of postoperative pain, shorter febrile duration, reduced blood loss, earlier return to standing and earlier bowel movement. The wound is small and an almost-enclosed operation is possible. Furthermore, unlike other laparoscopic partial gastric resections, a major part of the regional lymph nodes can be extirpated, such as D1 + &#102. Laparoscopic gastrectomy will play a greater role in the future, especially in replacing open surgery in cases of early gastric cancer.  相似文献   
79.
The main advantages of preperitoneal and retroperitoneal endoscopic surgery over conventional laparoscopy or open surgery are the decreased risk of injury to organs and reduced postoperative adhesion formation. Exact knowledge of anatomy, as well as correct positioning of the patient, is essential for its success. While a blunt dissection technique, using either the fingers or an endoscope under pneumodissection, is preferred for preperitoneal surgery, the introduction of a balloon dissection device directly into the retroperitoneal cavity simplifies this procedure for retroperitoneoscopy. Different general surgical procedures are described for preperitoneal (hernia) and retroperitoneal (adrenalectomy, neurectomy/ sympathectomy) surgery. Urological/gynaecological procedures (kidney, tumor biopsy, lymphadenectomy) are excluded from this review. In recent years, the number of possible preperitoneal and retroperitoneal surgical procedures has increased, mainly as a result of the development of commercially-available balloon trocars and balloon-tipped trocars, which create and maintain a working space.  相似文献   
80.
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