全文获取类型
收费全文 | 19731篇 |
免费 | 2076篇 |
国内免费 | 467篇 |
专业分类
耳鼻咽喉 | 118篇 |
儿科学 | 282篇 |
妇产科学 | 400篇 |
基础医学 | 1859篇 |
口腔科学 | 357篇 |
临床医学 | 2090篇 |
内科学 | 1685篇 |
皮肤病学 | 90篇 |
神经病学 | 847篇 |
特种医学 | 376篇 |
外国民族医学 | 1篇 |
外科学 | 6296篇 |
综合类 | 2665篇 |
预防医学 | 2457篇 |
眼科学 | 109篇 |
药学 | 1414篇 |
27篇 | |
中国医学 | 518篇 |
肿瘤学 | 683篇 |
出版年
2024年 | 18篇 |
2023年 | 533篇 |
2022年 | 614篇 |
2021年 | 601篇 |
2020年 | 585篇 |
2019年 | 482篇 |
2018年 | 626篇 |
2017年 | 339篇 |
2016年 | 812篇 |
2015年 | 1167篇 |
2014年 | 1586篇 |
2013年 | 1445篇 |
2012年 | 1208篇 |
2011年 | 1065篇 |
2010年 | 993篇 |
2009年 | 1017篇 |
2008年 | 853篇 |
2007年 | 716篇 |
2006年 | 575篇 |
2005年 | 621篇 |
2004年 | 917篇 |
2003年 | 417篇 |
2002年 | 319篇 |
2001年 | 298篇 |
2000年 | 178篇 |
1999年 | 199篇 |
1998年 | 267篇 |
1997年 | 378篇 |
1996年 | 380篇 |
1995年 | 351篇 |
1994年 | 473篇 |
1993年 | 279篇 |
1992年 | 287篇 |
1991年 | 284篇 |
1990年 | 249篇 |
1989年 | 177篇 |
1988年 | 188篇 |
1987年 | 78篇 |
1986年 | 119篇 |
1985年 | 105篇 |
1984年 | 88篇 |
1983年 | 61篇 |
1982年 | 104篇 |
1981年 | 72篇 |
1980年 | 39篇 |
1979年 | 32篇 |
1978年 | 25篇 |
1977年 | 21篇 |
1976年 | 12篇 |
1975年 | 13篇 |
排序方式: 共有10000条查询结果,搜索用时 15 毫秒
51.
Background: For patients with incurable malignant gastric outlet obstruction and cholestasis, laparoscopic gastrojejunostomy combined
with endoscopic biliary stent placement seems to offer a minimally invasive palliation.
Methods: We retrospectively analyzed the data of 16 patients submitted to laparoscopic gastrojejunostomy. Laparoscopic gastroenterostomy
was performed as an antecolic, side-to-side gastrojejunostomy with enteroenterostomy. In 12 patients cholestasis was relieved
preoperatively by stent placement via endoscopy (n= 6, 37.5%), percutaneous access (n= 5, 31%) or bilioenteric anastomosis (n= 1, 6.25%). One patient needed a percutaneous Yamakawa prosthesis postoperatively.
Results: Mean operative time was 126 min. There were no intraoperative complications. In one patient conversion to open surgery became
necessary because of extensive adhesions. The only postoperative complication was bleeding from a trocar site requiring reintervention;
there was no mortality. Median postoperative hospital stay was 7 days. Delayed gastric emptying was observed in 3 (18.7%)
patients. Median survival was 87 days after the operation. All patients died from their primary disease but could maintain
oral intake during the remaining survival time.
Conclusions: We conclude that laparoscopic gastrojejunostomy and endoscopic or percutaneous biliary stenting provide a good functional
result while impairing the quality of life only to a minimal extent.
Received: 7 May 1996/Accepted: 12 December 1996 相似文献
52.
In a sample of 55 consecutive methadone maintenance admissions to our clinic, 42% were diagnosed with antisocial personality disorder (ASPD) using the National Institute of Mental Health Diagnostic Interview Schedule NIMH DIS. Individuals with ASPD exhibited greater risk for HIV infection as defined by more sexual contacts, needle use and equipment sharing. Data at 1 year follow-up were obtained on this group of patients. The objective was to compare the ASPD and non-ASPD groups with regards to demographics, drug abuse history, outcome and retention in treatment. There were no significant differences between the groups on any demographic or treatment outcome variables. Survival analysis indicated that there were no group differences in treatment retention. In conclusion, although there were no differences in treatment outcome between ASPD and non-ASPD groups it is possible that ASPD patients who drop out of treatment will be at higher risk for contracting and spreading HIV within the IV drug using population. These data also suggest that in this population the diagnosis of ASPD using primarily behavioral traits as measured in the NIMH-DIS-III, has little utility in predicting treatment outcome. 相似文献
53.
Early experience with laparoscopic abdominoperineal resection 总被引:4,自引:0,他引:4
Background: Laparoscopic abdominoperineal resection (LAPR) has not been fully evaluated as a technique in the treatment of rectal and
anal cancer or inflammatory bowel disease. The purpose of our study was to evaluate the early experience with laparoscopic
abdominoperineal resection at Washington University Medical Center.
Methods: A prospective analysis was performed on the first 21 patients undergoing the procedure at Washington University Medical Center.
Indications for surgery included rectal cancer (14 patients), anal squamous cell cancer (four patients), inflammatory bowel
disease (two patients), and anal melanoma (one patient).
Results: The procedure was converted to open procedure in four patients (19%). The mean (±SEM) operative time and blood loss for completed
and converted LAPR were 239 ± 11 min and 424 ± 43 ml, respectively. Postoperative hematocrit dropped a mean of 8.3% ± 1.2%
SEM; five patients required blood transfusion (24%). Wound complication occurred in four patients (19%; three perineal, one
trocar site). Bowel function returned after a mean of 3 days, and mean postoperative hospital stay for the completed LAPR
group was 5 days. Mild pain was experienced by 81% of patients (17/21) while 19% (4/21) noted moderate pain, usually of the
perineal wound. The mean duration of patient-controlled analgesia use was 2 days. During the 1–44-month follow-up, six patients
(29%) died from cancer (stage III or IV at operation) and only one patient developed local recurrence in the pelvis (5%).
There were no trocar-site implants of cancer. Furthermore, there was no relationship between prior abdominal operations, the
amount of blood loss, postoperative drop of hematocrit, or blood transfusion requirement and the length of hospitalization
or complication rates.
Conclusion: Laparoscopic abdominoperineal resection is a feasible alternative to the conventional open technique in both cancer and colitis
patients.
Received: 23 April 1996/Accepted: 8 July 1996 相似文献
54.
Laparoscopic cryosurgery for hepatic tumors 总被引:2,自引:0,他引:2
Background: Hepatic cryosurgery has been shown to be a safe technique that may be well suited to a laparoscopic approach.
Methods: The technical feasibility and safety of laparoscopic cryosurgery was explored first in a pig model. Thereafter we performed
the first successful case of laparoscopic hepatic cryosurgery at our institution.
Results: In the animal model, we found that it is possible to safely identify, target, and cryoablate specific lesions in the liver.
Temperature in the peritoneal cavity remained above 35°C, and pathologic examination of the abdominal wall around the cryoprobe
site revealed no damage. We also successfully treated a 62-year-old man with a metastatic colorectal carcinoma deep in the
right lobe of the liver with laparoscopic cryosurgery using a transpleural approach.
Conclusion: We conclude that laparoscopic cryosurgery is feasible for lesions anywhere in the liver. For lesions high on the dome of
the liver, a transpleural approach may provide better access. 相似文献
55.
Background: Increasingly larger series of laparoscopic fundoplications (LF) are being reported. A well-documented advantage of the laparoscopic
approach is shortened hospital stay. Most centers report typical lengths of stay (LOS) for LF of 2–3 days. Our success with
LF with a LOS of 1 day led to an attempt at performing LF on an ambulatory basis.
Methods: Sixty-one consecutive patients with appropriate criteria for LF underwent surgery at our institution. Patients were counseled
by the authors as to the usual postop course and progression of diet. All patients received preemptive analgesia (PEA) consisting
of perioperative ketorolac and preincisional local infiltration with bupivicaine. Anesthetic management included induction
with propofol, high-dose inhalational anesthetics, minimizing administration of parenteral narcotics, and avoidance of reversal
of neuromuscular blockade. Immediate postop pain management included parenteral ketorolac and oral hydro- or oxycodone. All
patients were given oral fluids and soft solids after transfer from the recovery room to the postoperative observation unit.
Two patients were excluded from ambulatory consideration due to excessive driving distance from our hospital. Another two
were hospitalized for observation after experiencing intraoperative technical problems.
Results: Of 57 patients in whom same-day discharge was attempted, there were three failures requiring overnight hospitalization: All
were due to pain and nausea; one patient also suffered transient urinary retention. There were no adverse outcomes related
to early discharge, and there were no readmissions. One patient returned to the emergency room after delayed development of
urinary retention. Median time from conclusion of operation to discharge was less than 5 h. No patients expressed dissatisfaction
with early discharge on follow-up interview.
Conclusions: LF can be safely performed as an ambulatory procedure. Analgesic and anesthetic management should be tailored to minimize
nausea and provide adequate pain control.
Received: 1 April 1996/Accepted: 29 May 1997 相似文献
56.
Colleen E. Kelley MD James Mathews MD Gary A. Noskin MD 《The Journal of emergency medicine》1991,9(6):417-420
Acute transverse myelitis (ATM) is a neurologic condition that presents with bilateral lower extremity weakness and sensory loss associated with bowel and bladder dysfunction. Whereas the time of onset may be hours to days, the time to either partial or complete recovery may require months. The etiology is varied and may be idiopathic. Laboratory and radiographic evaluation may be nonrevealing. Corticosteriods have been used for treatment, but their efficacy is controversial. As illustrated by this case report, the essential aspect of the initial management of ATM is the elimination of potentially treatable causes. 相似文献
57.
Functional anatomy and biomechanics of the meniscus 总被引:2,自引:0,他引:2
George L. Caldwell Jr. MD Answorth A. Allen MD Freddie H. Fu MD 《Operative Techniques in Sports Medicine》1994,2(3):152-163
The meniscus is no longer considered the evolutionary remnant in the knee joint.Rather, it is now well established as an important structure that is integral to the complex biomechanics and proper functioning of the knee. The medial and lateral menisci form two crescent-shaped wedges of fibrocartilage between the femoral condyles and tibial plateaus.The knee joint biomechanics are based on a complex interaction of these intra-articular structures. The functions ascribed to the menisci include load transmission, shock absorption, stability, proprioception, joint lubrication, and joint nutrition. Load transmission generally is accepted as one of its primary functions. The menisci transmit a portion of the axial forces across the knee joint by converting this load into “hoop stresses.” This is accomplished by their unique shape, composition, and anatomic attachments. The menisci are relatively mobile structures and their motion during knee flexion also is determined by their shape and soft tissue attachments/constraints. Preservation of the meniscal functions is essential, and the authors review the basic anatomic and biomechanical concepts necessary to understand techniques for repair and restoration of these functions. 相似文献
58.
Atsushi Ota Nobuyasu Kano Hiroshi Kusanagi Shigetoshi Yamada Arty Garg 《Journal of hepato-biliary-pancreatic sciences》2003,10(2):172-175
Our basic techniques for the management of difficult cases of laparoscopic cholecystectomy (LC) are presented in this article. If access to Calot's triangle cannot be gained safely, dissection should be started at the fundus or body of the gallbladder (GB), rather than the neck (fundus-first method). In cases with a short and wide cystic duct, a transfixing suture should be applied for ligation instead of clipping. EndoGIA is useful for ligating and transecting this case to avoid a subsequent stricture caused by normal method of ligation. Intraoperative cholangiography should be performed near the neck of the GB in cases in which orientation is lost during dissection. More dissection should be performed in the direction of the junction of the bile ducts after orientation is regained. In cases with GB filled with stones accompanied by severe fibrosis, part of the GB is incised to remove the stones and expose the lumen of the GB. Confluence stones can be removed by placing an incision on the GB side of the junction of the duct. The incised part is closed with suture. A cystic tube (C-tube) is placed in the common bile duct through the cystic duct for decompression. In more difficult cases in which dissection cannot be started safely at any location, the body and the fundus of the GB are excised, and a drain is placed at the neck of the GB. Dissection can be carried out from the main surgeon's or the assistant's side depending on the situation, and cooperation between the two surgeons is mandatory to achieve safe LC in difficult cases. When performing the LC, one must have a low threshold for converting to open surgery if injuries cannot be managed safely. 相似文献
59.
Conversions and complications in 185 laparoscopic adjustable silicone gastric banding cases 总被引:9,自引:3,他引:6
E. Chelala G. B. Cadiére F. Favretti J. Himpens M. Vertruyen J. Bruyns L. Maroquin M. Lise 《Surgical endoscopy》1997,11(3):268-271
Background: Kuzmak's gastric silicone banding technique is the least invasive operation for morbid obesity. The purpose of this study
was to analyze the complications of this approach.
Methods: Between September 1992 and March 1996, 185 patients underwent laparoscopic gastroplasty by the adjustable silicone band technique.
A minimally invasive procedure using five trocars was performed.
Results: In 11 patients exposure of the hiatus was impeded because of hypertrophy of the left liver lobe which led to conversion in
eight patients and abortion of the procedure in three other patients. Anatomical complications: We observed two gastric perforations
and one band slippage at the early stage, one infection and three rotations of the access port. Functional complications:
There were eight (4%) cases of irreversible total food intolerance resulting in pouch dilation and eight cases (4%) of esophagitis.
One fatality on the 45th day in a patient with a Prader-Willi syndrome.
Conclusion: The most disturbing complications of gastric banding technique are gastric perforation and pouch dilation. Their incidence
may be reduced by improving the technique and by considering pitfalls of the procedure.
Received: 28 May 1996/Accepted: 25 July 1996 相似文献
60.
Yair Lotan Matthew T Gettman Claus G Roehrborn Margaret S Pearle Jeffrey A Cadeddu 《JSLS, Journal of the Society of Laparoendoscopic Surgeons》2003,7(2):111-115
BACKGROUND AND OBJECTIVES: To evaluate the experience with laparoscopic nephrectomy in a large county hospital and perform a cost comparison between uncomplicated open and laparoscopic nephrectomy. METHODS: Eleven consecutive patients who underwent an uncomplicated laparoscopic nephrectomy in a large county hospital were compared with 8 patients who underwent uncomplicated open nephrectomy during the same period. Patient charts and corresponding billing records were reviewed to determine overall hospitalization cost and individual cost components. RESULTS: No perioperative complications occurred in either the laparoscopic or open group, and no statistically significant differences existed between groups with regard to patient demographics or operative parameters. The overall operating room costs favored the open nephrectomy group by dollars 1070 (P=0.003). However, the overall cost of hospitalization, surgeon professional fees, duration of hospitalization, room and board costs, laboratory, and radiology costs, pharmacy costs, intravenous solution and infusion pump costs all significantly favored the laparoscopic patient group. The mean difference in overall hospital cost between laparoscopic and open nephrectomy was dollars 1211 in favor of laparoscopy (P=0.037). CONCLUSIONS: Our experience with laparoscopic nephrectomy in a large county hospital demonstrates a clear economic advantage in favor of the laparoscopic approach. Given limited funding for public hospitals and a clear patient benefit, laparoscopic nephrectomy should constitute first-line therapy when nephrectomy is indicated. 相似文献