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1.
B超引导下多弹头射频治疗肝癌100例   总被引:71,自引:2,他引:69  
Ma Q  Wu J  Gao D  Zhu Y  Zhao B  Bian L  Du X  Zhao H 《中华外科杂志》2000,38(4):272-274,I018
目的 总结多弹头射频治疗肝癌的近期疗效、证与并发症。方法 对100例肝癌患者行120次身频治疗,通过治疗前后肿瘤大小的比较,患者自觉症状的改善情况和AFP值改变进行对此观察。结果 100例于治疗后10天,30例于治疗后30天,10例于治疗后60天,进行了彩色B超及CT复查,10知后70%患者肿瘤体积缩小在20%发上,30天后80%患者肿瘤体积缩小在30%以上,部分瘤体钙化呈均质低密度区。60天后3  相似文献
2.
Background: Radiofrequency ablation (RFA) is increasingly used for the local destruction of unresectable hepatic malignancies. There is little information on its optimal approach or potential complications. Methods: Since late 1997, we have undertaken 91 RFA procedures to ablate 231 unresectable primary or metastatic liver tumors in 84 patients. RFA was performed via celiotomy (n=39), laparoscopy (n=27), or a percutaneous approach (n=25). Patients were followed with spiral computed tomographic (CT) scans at 1 to 2 weeks postprocedure and then every 3 months for 2 years. Results: Intraoperative ultrasound (IOUS) detected intrahepatic disease not evident on the preoperative scans of 25 of 66 patients (38%) undergoing RFA via celiotomy or laparoscopy. In 38 of 84 patients (45%), RFA was combined with resection or cryosurgical ablation (CSA), or both. RFA was used to treat an average of 2.8 lesions per patient, and the median size of treated lesions was 2 cm (range, 0.3–9 cm). The average hospital stay was 3.6 days overall (1.8 days for percutaneous and laparoscopic cases). Ten patients underwent a second RFA procedure (sequential ablations) and, in one case, a third RFA procedure for large (one patient), progressive (seven patients), and/or recurrent (three patients) lesions. Seven (8%) patients had complications: one skin burn; one postoperative hemorrhage; two simple hepatic abscesses; one hepatic abscess associated with diaphragmatic heat necrosis following sequential percutaneous ablations of a large lesion; one postoperative myocardial infarction; and one liver failure. There were three deaths, one (1%) of which was directly related to the RFA procedure. Three of the complications, including one RFA-related death, occurred after percutaneous RFA. At a median follow-up of 9 months (range, 1–27 months), 15 patients (18%) had recurrences at an RFA site, and 36 patients (43%) remained clinically free of disease. Conclusions: Celiotomy or laparoscopic approaches are preferred for RFA because they allow IOUS, which may demonstrate occult hepatic disease. Operative RFA also allows concomitant resection, CSA, or placement of a hepatic artery infusion pump, and isolation of the liver from adjacent organs. Percutaneous RFA should be reserved for patients at high risk for anesthesia, those with recurrent or progressive lesions, and those with smaller lesions sufficiently isolated from adjacent organs. Complications may be minimized when these approaches are applied selectively. Presented at the 53rd Annual Meeting of the Society of Surgical Oncology, March 16–19, 2000, New Orleans, Louisiana.  相似文献
3.
Background: Resection combined with radiofrequency ablation (RFA) is a novel approach in patients who are otherwise unresectable. The objective of this study was to investigate the safety and efficacy of hepatic resection combined with RFA.Methods: Patients with multifocal hepatic malignancies were treated with surgical resection combined with RFA. All patients were followed prospectively to assess complications, treatment response, and recurrence.Results: Seven hundred thirty seven tumors in 172 patients were treated (124 with colorectal metastases; 48 with noncolorectal metastases). RFA was used to treat 350 tumors. Combined modality treatment was well tolerated with low operative times and minimal blood loss. The postoperative complication rate was 19.8% with a mortality rate of 2.3%. At a median follow-up of 21.3 months, tumors had recurred in 98 patients (56.9%). Failure at the RFA site was uncommon (2.3%). A combined total number of tumors treated with resection and RFA >10 was associated with a faster time to recurrence (P = .02). The median actuarial survival time was 45.5 months. Patients with noncolorectal metastases and those with less operative blood loss had an improved survival (P = .03 and P = .04, respectively), whereas radiofrequency ablating a lesion >3 cm adversely impacted survival (HR = 1.85, P = .04).Conclusions: Resection combined with RFA provides a surgical option to a group of patients with liver metastases who traditionally are unresectable, and may increase long-term survival.  相似文献
4.
经皮射频微创治疗小肝癌   总被引:22,自引:3,他引:19  
目的 总结经皮射频消融 (PRFA)治疗肿瘤直径 <5cm小肝癌的疗效和经验。方法 1999年 8月至 2 0 0 2年 6月期间 ,以根治为目的 ,采用PRFA治疗肿瘤直径≤ 5cm的单个原发性肝癌共 84例 ,2 2例结合经皮肝动脉栓塞化疗 ;35例同时行PRFA联合瘤内无水酒精注射术。结果 肿瘤≤ 3cm组 5 5例中第 1年出现肝内复发者 2例 ,死亡 1例 ;第 2年出现肝内复发者 2例 ,死亡 1例。肿瘤大小介于 3~ 5cm组 2 9例中 ,第 1年出现肝内复发者 3例 ,死亡 2例 ;第 2年出现肝内复发者 4例 ,死亡 3例。结论 PRFA为小肝癌治疗提供了一种新的手段 ,经过近 3年技术的提高和经验的积累 ,射频消融完全有可能杀灭肿瘤直径 <5cm的小肝癌 ,达到根治性效果。本组对 84例小肝癌进行以射频消融为主的非手术微创治疗 ,近期疗效满意 ,远期疗效有待进一步随访观察 ,射频消融对小肝癌治疗有着良好的前景。  相似文献
5.
超声引导经皮射频治疗肝脏良恶性肿瘤   总被引:19,自引:1,他引:18  
目的 评价经皮射频(PRFA)治疗肝脏良恶性肿瘤的效果、安全性及实用性。方法 应用RF-2000射频仪和10电极LeVeen射频针经皮穿刺治疗肝脏恶性肿瘤114例153个病灶和良性肿瘤13例16个病灶,共计127例169个病灶。B超引导监测,局麻配合全身镇痛处理,对于肿瘤病灶大于2.5cm者进行分层多点叠合毁损,大于5.0cm或多发的恶性肿瘤配合肝动脉导管化疗栓塞术,随访观察治疗效果、并发症和生存情况。结果 实施成功率100%,PRFA治疗肝脏恶性肿瘤并发症发生率6.14%(7/114),均保守治愈,无相关死亡。PRFA治疗肝脏良性肿瘤未遇并发症,病人均健在。114例肝脏恶性肿瘤病人的3个月、6个月、1年、2年、3年生存率分别为100%(114/114)、97.4%(111/114)、74.6%(85/114)、59.4%(41/69)和36.8%(7/19)。结论 PRFA微创、有效、简捷、实用、可重复、相对安全,在肝脏恶性肿瘤的综合治疗中有重要价值,亦可作为肝脏良性肿瘤的一种选择疗法。  相似文献
6.
Radiofrequency ablation,PEIT, and TACE for hepatocellular carcinoma   总被引:17,自引:0,他引:17  
At detection or over time, hepatocellular carcinoma (HCC) is multicentric in origin, against a background of chronic hepatic disease at different stages. Orthotopic liver transplantation (OLT) is the only therapy able to definitely cure both diseases. When OLT is not feasible, all other options can be only palliative. Owing to the multicentricity, surgical resection may be one possible option at the initial detection in selected patients, whereas percutaneous interventional techniques (percutaneous ethanol injection [PEI], radiofrequency ablation [RFA], selected transcatheter arterial chemoembolization [TACE]) are the options more often used. The range of their indications is becoming wider. Although it is understood that partial resection assures the greatest local control, the survival rates after surgery are roughly comparable with those obtained with PEI. The explanation for this result reflects a balance among the advantages and disadvantages of the two therapies. PEI survival curves are better than curves of resected patients who present with adverse prognostic factors, and this means that a better selection of the patients for surgery is needed. An open question remains the choice among percutaneous techniques. In our department we currently use RFA in most patients but consider PEI and selected TACE complementary, and use them according to the features of the disease and the response. Received: February 19, 2002 / Accepted: March 8, 2002 RID="*" ID="*" Offprint requests to: T. Livraghi  相似文献
7.
射频消融治疗肝肿瘤315例报告   总被引:16,自引:1,他引:15  
目的总结1999年6月至2003年8月用射频消融(radiofrequency ablation,RFA)治疗315例肝肿瘤病人的病例资料,探索RFA治疗肝肿瘤近远期疗效。方法采用了一次定位、多点穿刺,RFA联合肝动脉栓塞(TAE)、选择性门静脉栓塞(SPVE)治疗直径5~13cm的大肝癌,及经皮经肺经膈肌RFA治疗膈顶部肝癌。结果总并发症发生率为5.1%,无一例住院期间死亡。AFP阳性的169例肝癌病人中,RFA后有124例(73.6%)明显降低,其中有95例(56.2%)转阴。半年生存率为89.5%,1年生存率为80.1%,18个月生存率为61.4%,24个月生存率为48.3%,〉36个月生存率为35.6%。结论采用TAE、SPVE及RFA一次定位多点穿刺法治疗无手术切除指征的中晚期(含大肝癌)的病人,疗效明显,总并发症发生率低。  相似文献
8.
BACKGROUND: Radiofrequency ablation (RFA) is a minimally invasive thermal ablation technique. This study reports the safety and efficacy of RFA as a minimally invasive strategy for breast cancers <3 cm diameter in postmenopausal women. METHODS: Twenty-two postmenopausal women (aged 60 years or older) with clinical T-1N0 core biopsy proven breast cancers were studied. Thermocoagulation was undertaken using a sonographically guided RF probe under local anesthesia and sedation. The ablated tumor was resected between 1 and 2 weeks later. Endpoints were technical success, completeness of tumor kill, marginal clearance, skin damage, and patient reports of pain and procedural acceptability. RESULTS: The procedure was well tolerated and cosmesis was excellent. Pathology revealed a central ablation zone surrounded by hyperemia. Coagulative necrosis was complete in 19 of 22 patients. Disease at the ablation zone margin was found in 3 patients and 5 patients had disease distant to the ablation zone consisting of multifocal tumors (2), in-transit metastasis (1), and extensive ductal carcinoma in situ with microinvasive carcinoma (2). Ninety-five percent of patients would be willing to have RFA again. CONCLUSIONS: Radiofrequency ablation can be safely applied in an outpatient setting with acceptable patient tolerance. By itself, RFA cannot be considered effective local therapy. Trials to evaluate RFA complemented with breast irradiation are justified.  相似文献
9.
Liu QD  Ma KS  He ZP  Ding J  Huang XQ  Dong JH 《中华外科杂志》2003,41(4):299-302
目的 评价射频消融(RFA)脾脏治疗继发性脾肿大和脾功能亢进的可行性和安全性。方法 14只健康杂种狗随机分为Ⅰ组(脾静脉结扎,n=4)和Ⅱ组(脾静脉结扎 RFA,n=10),通过结扎脾静脉主干和脾静脉属支引起淤血性脾肿大,3周末Ⅱ组剖腹行射频热能毁损脾脏。观察动物脾脏经RFA后的并发症,定期行CT扫描以及切取脾脏观察热毁损后脾脏病灶的影像学和组织病理学变化。结果 全组动物无死亡和并发症。CT显示脾静脉结扎后脾脏明显肿大并可持续2个月以上,RFA后脾脏病灶呈节段性毁损,包括高密度的坏死区和低密度的梗死区——后者称为“旁观者效应”;梗死区在RFA后4—6周内消失,残脾缩小;坏死区改变不明显。射频热能引起脾脏局部组织凝固性坏死和广泛的血栓性梗死形成。梗死区逐渐吸收、纤维化,血管闭塞、纤维素沉积和脾窦消失引起活性脾脏组织结构致密。结论 RFA治疗实验性脾肿大和脾亢是可行和安全的,将来可在开腹或腹腔镜下严格隔离脾脏周围器官后在临床安全实施。  相似文献
10.
Background: Radiofrequency ablation (RFA) is a promising technique for unresectable hepatic malignancies. We reviewed our RFA experience to identify variables affecting local recurrence.Methods: Patients undergoing RFA between 1997 and 2001 were reviewed for demographics, tumor size, pathology, diagnosis, recurrence, procedures, survival, and complications.Results: The 447 unresectable liver tumors were ablated in 198 procedures. The 153 patients averaged 61.9 years of age and 1.25 RFA procedures per patient. Follow-up averaged 11 months. Serial ablations were performed in 28 patients, 8 of whom are without evidence of disease. Tumors were most commonly carcinomas of colorectal, hepatocellular, breast, and melanoma histologies. Colorectal carcinomas and hepatomas individually recurred more frequently than all other tumor types combined in univariate analyses (P = .009 and P = .008, respectively). Patients with multiple tumors ablated recurred significantly more frequently (P = .001). Size was also significant in univariate and multivariate analyses (P = .0032 and &<.0001, respectively). Eighteen patients experienced 36 complications.Conclusions: Size has the highest correlation with local recurrence, but multiple tumors and pathology may also predict local recurrence risk. Large, complex lesions can be safely serially ablated, but because of morbidity and recurrence, RFA should not replace resection as the primary treatment of resectable liver tumors.Presented at the 55th Annual Cancer Symposium of the Society of Surgical Oncology, Denver, Colorado, March 14–17, 2002  相似文献
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