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1.
经皮肾穿刺取石术治疗上尿路结石(20年经验)   总被引:228,自引:1,他引:227  
目的:对我院20年来使用经皮肾穿刺取石术(percutaneous nephrolithotomy,PCNL)治疗上尿路结石的经验进行总结,评价其临床疗效及安全性.方法:用经皮肾穿刺取石术共治疗上尿路结石4 014例,其中采用传统PCNL治疗358例,经皮肾微造瘘二期输尿管镜取石治疗520例,微创PCNL治疗3 136例.结果:三种方法手术成功率分别为90%、95%和98%,结石清除率分别为82%、86%和91%,严重并发症发生率分别为5.3%、1.2%和0.5%;其中单通道取石3 027例,多通道取石987例,手术例次共5 571次.结论:通过对经皮肾穿刺取石术的不断改进与创新,提高了该项技术的手术成功率与结石清除率,降低了并发症,扩大了其临床适应证.  相似文献
2.
经皮肾镜气压弹道联合超声碎石术的安全性及疗效分析   总被引:55,自引:0,他引:55  
Li JX  Niu YN  Tian XQ  Kang N  Wang XK 《中华医学杂志》2006,86(28):1975-1977
目的 评价经皮肾镜下气压弹道联合超声碎石术治疗肾结石的临床疗效及安全性。方法 自2003年9月至2005年8月,采用经皮肾镜下气压弹道联合超声碎石术治疗486例509侧肾结石患者,对其临床资料进行回顾性分析。结果 478例患者成功建立20.8-24F皮肾通道并Ⅰ期碎石,6例患者Ⅱ期碎石,2例因出血改开放手术。平均手术时间73min,平均结石处理时间为41min。本组未出现气胸、肠道损伤等手术并发症。术后复查KUB平片,438侧肾脏结石清除干净,净石率86.1%;71侧肾脏有结石残留,行二次肾镜取石,或辅助体外冲击波碎石治疗。结论 经皮肾镜下气压弹道联合超声碎石术处理肾结石具有高效、安全的特点,值得临床推广应用。  相似文献
3.
CONTEXT: In men who develop an elevated serum prostate-specific antigen level (PSA) after having undergone a radical prostatectomy, the natural history of progression to distant metastases and death due to prostate cancer is unknown. OBJECTIVE: To characterize the time course of disease progression in men with biochemical recurrence after radical prostatectomy. DESIGN: A retrospective review of a large surgical series with median (SD) follow-up of 5.3 (3.7) years (range, 0.5-15 years) between April 1982 and April 1997. SETTING: An urban academic tertiary referral institution. PATIENTS: A total of 1997 men undergoing radical prostatectomy, by a single surgeon, for clinically localized prostate cancer. None received neoadjuvant therapy, and none had received adjuvant hormonal therapy prior to documented distant metastases. MAIN OUTCOME MEASURES: After surgery, men were followed up with PSA assays and digital rectal examinations every 3 months for the first year, semiannually for the second year, and annually thereafter. A detectable serum PSA level of at least 0.2 ng/mL was evidence of biochemical recurrence. Distant metastases were diagnosed by radionuclide bone scan, chest radiograph, or other body imaging, which was performed at the time of biochemical recurrence and annually thereafter. RESULTS: The actuarial metastasis-free survival for all 1997 men was 82% (95% confidence interval, 76%-88%) at 15 years after surgery. Of the 1997 men, 315 (15%) developed biochemical PSA level elevation. Eleven of these underwent early hormone therapy after the recurrence and are not included in the study. Of the remaining 304 men, 103 (34%) developed metastatic disease within the study period. The median actuarial time to metastases was 8 years from the time of PSA level elevation. In survival analysis, time to biochemical progression (P<.001), Gleason score (P<.001), and PSA doubling time (P<.001) were predictive of the probability and time to the development of metastatic disease. An algorithm combining these parameters was constructed to stratify men into risk groups. Once men developed metastatic disease, the median actuarial time to death was 5 years. The time interval from surgery to the appearance of metastatic disease was predictive of time until death (P<.02). CONCLUSIONS: Several clinical parameters help predict the outcomes of men with PSA elevation after radical prostatectomy. These data may be useful in the design of clinical trials, the identification of men for enrollment into experimental protocols, and counseling men regarding the timing of administration of adjuvant therapies.  相似文献
4.
超声引导微创经皮肾镜碎石取石术治疗复杂性肾结石   总被引:36,自引:0,他引:36  
目的 评估超声引导微创经皮肾镜碎石取石术 (PCNL)治疗复杂性肾结石的方法及效果。方法 对 5 8例接受超声引导微创PCNL的患者进行回顾性分析 ,其中结石直径 >2 .5cm 2 8例、鹿角形结石 4例、多发结石 2 0例、感染性结石 5例、孤立肾结石 1例。结果 单通道取石 34例 ,双通道 2 2例 ,三通道 2例 ,总结石取尽率为 92 % ;手术时间为 0 .5~ 4 .3h ,平均 2 .2h。 2例患者分别于术后 6和 2 8h发生急性大出血。结论 超声引导微创PCNL治疗复杂性肾结石安全、有效。  相似文献
5.
OBJECTIVE--To evaluate longitudinal changes in prostate-specific antigen (PSA) levels in men with and without prostate disease. DESIGN--Case-control study of men with and without prostate disease who were participants in a prospective aging study. SETTING--Gerontology Research Center of the National Institute on Aging; the Baltimore (Md) Longitudinal Study of Aging. PATIENTS--Sixteen men with no prostate disease (control group), 20 men with a histologic diagnosis of benign prostatic hyperplasia (BPH), and 18 men with a histologic diagnosis of prostate cancer. OUTCOME MEASURES--Multiple PSA and androgen determinations on serum samples obtained from 7 to 25 years prior to histologic diagnosis or exclusion of prostate disease. RESULTS--Changes in androgen levels with age did not differ between groups. Control subjects did not show a significant change in PSA levels with age. There was a significant difference in the age-adjusted rate of change in PSA levels between groups (prostate cancer greater than BPH greater than control; P less than .01). At 5 years before diagnosis when PSA levels did not differ between subjects with BPH and prostate cancer, rate of change in PSA levels (0.75 micrograms/L per year) was significantly greater in subjects with prostate cancer compared with control subjects and subjects with BPH. Also, rate of change in PSA levels distinguished subjects with prostate cancer from subjects with BPH and control subjects with a specificity of 90% and 100%, respectively. CONCLUSIONS--The most significant factor affecting serum PSA levels with age is the development of prostate disease. Rate of change in PSA levels may be a sensitive and specific early clinical marker for the development of prostate cancer.  相似文献
6.
目的比较经尿道等离子体双极电切术(PKRP)和经尿道前列腺电切术(TURP)的安全性和疗效。方法对400例有症状的前列腺增生症(BPH)患者随机分成两组,分别行PKRP和TURP术。结果200例PKRP手术者,前列腺症状评分(IPSS)从术前的27·1±4·5分下降至术后6个月的11·3分±3·4分(P<0·01),最大尿流率(Qmax)由6·1ml/s±2·4ml/s上升至18·6ml/s±3·5ml/s(P<0·01),剩余尿量(RU)由102·3ml±43·3ml降至22·6ml±16·3ml(P<0·01)。TURP组200例,IPSS从术前的26·9分±4·2分下降至术后6个月的10·8分±3·6分(P<0·01),最大尿流率由5·7ml/s±2·4ml/s上升至19·1ml/s±3·7ml/s(P<0·01),剩余尿(RU)由102·3ml±43·3ml降至22·6ml±16·3ml(P<0·01)。两组比较差异无统计学意义(P>0·05)。平均留置导尿管时间PKRP组31·5h,TURP组61·5h,差异有统计学意义(P<0·01)。术后阳萎发生率:PKRP组14·3%,TURP组15·2%(P>0·05)。PKRP组术中无大出血及经尿道前列腺电切综合征(TURS)发生,无一例需要输血。TURP组5例发生TURS,输血18例。结论PKRP能达到与TURP完全相同的治疗效果,且并发症少,价格相对较低,近期效果满意。  相似文献
7.
The accuracy of (1) conventional wet-mount examination, (2) Papanicolaou-stained gynecologic smears, (3) a direct slide test using fluorescein-conjugated monoclonal antibodies against Trichomonas vaginalis, and (4) two different culture media for the diagnosis of trichomoniasis in a high-risk population of 600 women was compared. Use of Feinberg-Whittington or Diamond's culture medium resulted in a diagnosis of 82 and 78 cases, respectively, and the combination of two cultures identified 88 infected women. In comparison, wet-mount examination detected only 53 (60%) of the cases. Cytologic smears were interpreted as positive for T vaginalis in 49 (56%) of the 88 cases but also resulted in seven false-positive smears, and specimens from 18 women with negative cultures were interpreted as "suspicious" for trichomoniasis. Monoclonal antibody staining detected 76 (86%) of the 88 positive specimens, including 27 (77%) of the 35 cases missed by wet-mount examination. In summary, wet-mount and cytologic studies were insensitive, and cytology study was the least specific method for diagnosis of trichomoniasis. Direct immunofluorescence with monoclonal antibodies holds promise as a sensitive and specific alternative to cultures for rapid detection of T vaginalis in clinical specimens.  相似文献
8.
经皮肾微造瘘术后二期经皮输尿管镜取石术治疗鹿角形结石   总被引:21,自引:1,他引:20  
从88年2月至91年12月,我院应用经皮肾微造瘘后,二期采用经皮输尿管镜取石术,配合体外冲击波或经皮肾镜治疗鹿角形结石共68例,其中28例先行体外冲击波碎石,因结石未能击碎或排出,随后进行经皮肾微造瘘后,二期行经皮输尿管镜取石术。40例有计划先行经皮肾微造瘘后,二期行经皮输尿管镜或肾镜取石术,再配以体外冲击波碎石。68例,共行经皮输尿管镜或肾镜132次,术中无一例输血,也未发现有其他合并症如:术后出血,高热,狭窄等,三个月后结石清除率为81~84%。本文详细介绍经皮肾微造瘘术和经皮输尿管镜取石术,并对鹿角形结石处理,进行了讨论。  相似文献
9.
经尿道前列腺双极电切术   总被引:19,自引:0,他引:19  
目的 :探讨经尿道双极电切的安全性与有效性。方法 :该法使用生理盐水为冲洗液、无负极板。用经尿道双极电切行前列腺电切 (双极TURP) 15 0例 ,病人年龄 6 1~ 85岁 ,平均 71.5岁 ;前列腺体积 2 1~ 112 (49.5± 32 .7)g,术前带尿管者 39例 ,术后随访 1~ 3月。结果 :双极TURP手术时间 16~ 93(39± 2 9)min ,切除前列腺组织重量平均 7~ 90 (31± 2 6 )g ,无 1例需输血 ,无 1例TUR综合征发生 ;术后IPSS、QOL、PFR显著改善。结论 :双极电切进行TURP是一种新的安全、有效的手术方式  相似文献
10.
多房囊性肾细胞癌的诊断和治疗分析   总被引:18,自引:0,他引:18  
目的分析多房囊性肾细胞癌病例的临床资料.方法 1998年1月至2002年12月,北京大学第一医院泌尿外科共收治482例肾癌患者,其中多房囊性肾细胞癌22例,总结临床资料进行分析.结果多房囊性肾癌占同期肾癌病例的4.56%,男女比例是2.67∶ 1,与同期非多房囊性肾癌患者比较(男∶女为2.09∶ 1),其性别构成差异无显著意义(P>0.05),但其平均年龄(46.6岁)低于后者(57.83岁),P<0.01.其中pT1N0M0期肿瘤6例,pT2N0M0期肿瘤15例,pT3bN0M0期肿瘤1例;G1级肿瘤5例,G2级肿瘤17例.结论多房囊性肾细胞癌是肾癌的一种特殊类型,诊断主要依据影像学检查,术前鉴别非常困难.对诊断不清的病例,尤其对于Bosniak分类在三级或以上者,行术中冰冻病理检查或采用保留肾组织的手术治疗,可使患者受益.  相似文献
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