全文获取类型
收费全文 | 29055篇 |
免费 | 1453篇 |
国内免费 | 241篇 |
专业分类
耳鼻咽喉 | 295篇 |
儿科学 | 712篇 |
妇产科学 | 276篇 |
基础医学 | 3577篇 |
口腔科学 | 629篇 |
临床医学 | 1759篇 |
内科学 | 7954篇 |
皮肤病学 | 551篇 |
神经病学 | 2196篇 |
特种医学 | 1092篇 |
外科学 | 4884篇 |
综合类 | 126篇 |
一般理论 | 1篇 |
预防医学 | 706篇 |
眼科学 | 364篇 |
药学 | 1885篇 |
中国医学 | 55篇 |
肿瘤学 | 3687篇 |
出版年
2023年 | 181篇 |
2022年 | 301篇 |
2021年 | 689篇 |
2020年 | 357篇 |
2019年 | 536篇 |
2018年 | 691篇 |
2017年 | 532篇 |
2016年 | 682篇 |
2015年 | 705篇 |
2014年 | 961篇 |
2013年 | 1105篇 |
2012年 | 1732篇 |
2011年 | 1923篇 |
2010年 | 1088篇 |
2009年 | 902篇 |
2008年 | 1625篇 |
2007年 | 1864篇 |
2006年 | 1856篇 |
2005年 | 1891篇 |
2004年 | 1789篇 |
2003年 | 1738篇 |
2002年 | 1680篇 |
2001年 | 518篇 |
2000年 | 414篇 |
1999年 | 457篇 |
1998年 | 428篇 |
1997年 | 333篇 |
1996年 | 317篇 |
1995年 | 267篇 |
1994年 | 245篇 |
1993年 | 224篇 |
1992年 | 298篇 |
1991年 | 257篇 |
1990年 | 260篇 |
1989年 | 212篇 |
1988年 | 205篇 |
1987年 | 190篇 |
1986年 | 155篇 |
1985年 | 167篇 |
1984年 | 130篇 |
1983年 | 100篇 |
1982年 | 71篇 |
1981年 | 63篇 |
1980年 | 56篇 |
1979年 | 72篇 |
1978年 | 50篇 |
1977年 | 49篇 |
1975年 | 42篇 |
1974年 | 47篇 |
1972年 | 40篇 |
排序方式: 共有10000条查询结果,搜索用时 156 毫秒
991.
Yasuo Hironaka Tetsuya Morimoto Yasushi Motoyama Young-Su Park Hiroyuki Nakase 《Neurologia medico-chirurgica》2013,53(12):861-869
Surgical treatment for degenerative spinal disorders is controversial, although lumbar fusion is considered an acceptable option for disabling lower back pain. Patients underwent instrumented minimally invasive anterior lumbar interbody fusion (mini-ALIF) using a retroperitoneal approach except for requiring multilevel fusions, severe spinal canal stenosis, high-grade spondylolisthesis, and a adjacent segments disorders. We retrospectively reviewed the clinical records and radiographs of 142 patients who received mini-ALIF for L4-5 degenerative lumbar disorders between 1998 and 2010. We compared preoperative and postoperative clinical data and radiographic measurements, including the modified Japanese Orthopaedic Association (JOA) score, visual analog scale (VAS) score for back and leg pain, disc height (DH), whole lumbar lordosis (WL), and vertebral wedge angle (WA). The mean follow-up period was 76 months. The solid fusion rate was 90.1% (128/142 patients). The average length of hospital stay was 6.9 days (range, 3–21 days). The mean blood loss was 63.7 ml (range, 10–456 ml). The mean operation time was 155.5 min (range, 96–280 min). The postoperative JOA and VAS scores for back and leg pain were improved compared with the preoperative scores. Radiological analysis showed significant postoperative improvements in DH, WL, and WA, and the functional and radiographical outcomes improved significantly after 2 years. The 2.8% complication rate included cases of wound infection, liquorrhea, vertebral body fractures, and a misplaced cage that required revision. Mini-ALIF was found to be associated with improved clinical results and radiographic findings for L4-5 disorders. A retroperitoneal approach might therefore be a valuable treatment option. 相似文献
992.
Hiroyuki Yamasaki Kayoko Takahashi Shunsuke Yamamoto Yoko Yamamoto Yoshihisa Miyata Takekazu Terai 《Journal of anesthesia》2013,27(6):822-826
Purpose
Although attenuation of tube-induced coughing is necessary in specific types of surgery, the best method for such attenuation is still unclear. We studied the combined intervention of endotracheal lidocaine and intravenous remifentanil compared to intravenous remifentanil alone with respect to coughing during emergence from anesthesia.Methods
We examined 60 ASA 1–2 patients (age, 20–69 years) undergoing tympanoplasty under general anesthesia. Anesthesia was induced with propofol, remifentanil, and rocuronium. The trachea was intubated using a laryngotracheal instillation of topical anaesthetic (LITA) tracheal tube. Anesthesia was maintained with propofol and remifentanil (0.1–0.3 μg/kg/min). Propofol was discontinued and remifentanil (0.1 μg/kg/min) was continued at the end of the operation. Patients were randomly allocated to the lidocaine (n = 30) and control groups (n = 30). We administered 3 ml 4 % lidocaine via the LITA tube to patients in lidocaine group at the end of the operation. The trachea was extubated when the patient regained consciousness and followed orders. Coughing was evaluated using a 4-point scale by an observer who examined the video records at extubation.Results
Fewer patients in lidocaine group (8 of 30) than in control group (18 of 30, p < 0.01) coughed. Fewer patients in lidocaine group (2 of 30) than in control group (12 of 30, p < 0.01) had moderate or severe cough (scale 2 or 3).Conclusions
This study is consistent with the finding that endotracheal lidocaine administration and continuous infusion of remifentanil before extubation is useful to prevent coughing on emergence from anesthesia. 相似文献993.
994.
Tsuyoshi Hamada Yousuke Nakai Hiroyuki Isayama Takashi Sasaki Hirofumi Kogure Kazumichi Kawakubo Naoki Sasahira Natsuyo Yamamoto Osamu Togawa Suguru Mizuno Yukiko Ito Kenji Hirano Nobuo Toda Minoru Tada Kazuhiko Koike 《Surgical endoscopy》2013,27(4):1243-1248
Background
Although the combination of biliary and duodenal self-expandable metal stents (SEMS) is useful, the exacerbating effect of duodenal SEMS placement on biliary SEMS has not been documented. We conducted a multicenter retrospective study to evaluate the effect of duodenal SEMS placement on biliary SEMS.Methods
Patients who underwent first-time biliary SEMS placement for a distal malignant biliary obstruction between September 1994 and November 2010 were included. Time to dysfunction of biliary SEMS was analyzed to identify risk factors for biliary SEMS dysfunction. Duodenal SEMS placement was analyzed as a time-dependent covariate.Results
In total, 410 eligible patients were identified. Duodenal SEMS were placed in 33 patients (8 %). The median time to dysfunction of biliary SEMS was 170 days. Male gender (hazard ratio 1.37, 95 % confidence interval 1.03–1.83, P = 0.029) and duodenal SEMS placement (hazard ratio 2.00, 95 % confidence interval 1.16–3.45, P = 0.013) were risk factors in the multivariate Cox model. In patients undergoing duodenal SEMS, biliary SEMS dysfunction was observed in 17 (52 %) with a median time to dysfunction of 64 days after duodenal SEMS placement. As many as 60 % of the patients with biliary SEMS dysfunction after duodenal SEMS placement needed permanent percutaneous transhepatic biliary external drainage.Conclusions
Duodenal SEMS placement is a risk factor for biliary SEMS dysfunction. Alternative methods for biliary drainage should be considered for better biliary drainage in patients with a gastric outlet obstruction. 相似文献995.
Clinical utility of an endoscopic ultrasound-guided rendezvous technique via various approach routes
Kazumichi Kawakubo Hiroyuki Isayama Naoki Sasahira Yousuke Nakai Hirofumi Kogure Tsuyoshi Hamada Koji Miyabayashi Suguru Mizuno Takashi Sasaki Yukiko Ito Natsuyo Yamamoto Kenji Hirano Minoru Tada Kazuhiko Koike 《Surgical endoscopy》2013,27(9):3437-3443
Background
The endoscopic ultrasound-guided rendezvous techniques (EUS-rendezvous) provide reliable biliary access after failed endoscopic retrograde cholangiopancreatography (ERCP) cannulation. We evaluated the clinical utility of an EUS-rendezvous technique using various approach routes.Methods
Patients undergoing EUS-rendezvous for biliary access after failed bile duct cannulation in ERCP were included. EUS-rendezvous was performed via three approach routes depending on the patient’s condition: transgastric, transduodenal in a short endoscopic position, or transduodenal in a long endoscopic position. The main outcomes were the technical success rates. Secondary outcomes were procedure time and complications.Results
Fourteen patients (median age, 77 years) underwent EUS-rendezvous for biliary access resulting from failed biliary cannulation. The reasons for biliary drainage were malignant biliary obstruction in five patients and choledocholithiasis in nine. Transgastric, transduodenal in a short position, and transduodenal in a long position EUS-rendezvous was performed in five, five, and four patients, respectively. Bile duct puncture occurred in the left intrahepatic duct in four patients, right hepatic duct in one, middle common bile duct in four, and lower common bile duct in five. The technical success rate was 100 %. In four patients, the approach route was modified from transduodenal in a short position to transduodenal in a long position or transgastric route. The median procedure time was 81 min. One case each of biliary peritonitis and pancreatitis occurred and were managed conservatively.Conclusions
EUS-rendezvous provided safe and reliable transpapillary bile duct access after failed ERCP cannulation. The selection of the appropriate approach routes, depending on patient condition, is critical. 相似文献996.
997.
998.
Hiroyuki Aono Shigeki KakunagaShuji Koide MD Hidekazu TobimatsuMasayuki Kuroda MD Ikuo KudawaraKiyoshi Mori MD PhD Eiichi KonishiTakafumi Ueda MD PhD 《The spine journal》2013,13(10):e27-e30
Background context
Localized amyloid deposits result in a mass, that is, so-called amyloidoma; it has been reported in every anatomic site, although systemic amyloid deposition is much more common. However, primary lumbar epidural amyloidoma without bony involvement is extremely rare. To the best of our knowledge, only one case has been reported previously.Purpose
To report and review the clinical presentations, imaging studies, and treatment of epidural and paravertebral amyloidoma.Study design
A case report and review of the literature.Methods
Lumbar epidural and paravertebral amyloidoma in a 75-year-old man with neurologic compromise is presented. Laminectomy with mass resection was performed.Results
After surgery, almost complete neurologic improvement was observed. Histologically, definite diagnosis was obtained only after the specific staining of tissue. No sign of local recurrence was evident 1 year after surgery.Conclusions
Primary amyloidoma, although rare, should be included in the differential diagnosis of epidural mass of the spine. Diagnosis before surgery is difficult as there were no characteristic findings in clinical and imaging studies. Special histologic technique and stains are useful to make a definite diagnosis. 相似文献999.
1000.
Masashi Uehara Jun Takahashi Hiroki Hirabayashi Jun Kitahara Tetsuyoshi Kamijyo Sohei Ebara Hiroyuki Kato 《The spine journal》2013,13(8):e59-e63
Background contextHodgkin's disease rarely occurs in the spine, which is usually a setting for the advanced form of the disease.PurposeTo describe an unusual case of isolated, primary spinal Hodgkin's disease and to draw attention to this disease as a possible diagnosis in patients with mixed inflammatory cell infiltrate lesions located in the thoracic spine.Study design/settingA case report of a 28-year-old woman who presented with back pain and progressive weakness in the lower extremities as a result of spinal cord compression from Hodgkin's disease of the thoracic vertebrae.MethodsWe report a new case of spinal cord compression resulting from Hodgkin's disease of the thoracic vertebrae. Decompression surgery was performed in the patient, followed by antibiotic treatment.ResultsAntibiotic therapy temporarily improved inflammation and fever. However, magnetic resonance imaging (MRI) evaluation showed that the inflammatory reaction in the lesion was not completely resolved. The disease progressed and later investigations revealed Hodgkin's disease, which improved with a course of chemotherapy and radiation.ConclusionsHodgkin's disease should be considered in the differential diagnosis of spinal neoplastic lesions with clinical features similar to spondylitis. Because MRI evaluation showed that the vertebral disc was maintained in this case, the presence of a tumor rather than inflammation should have been suspected. 相似文献