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Dr. Steven A. Curley MD Robert A. Newman PhD Thomas B. Dougherty MD PhD George M. Fuhrman MD Diana L. Stone BS Jeffrey A. Mikolajek CRNA Sal Guercio CCP Ann Guercio CCP C. Humberto Carrasco MD M. Tien Kuo PhD David C. Hohn MD 《Annals of surgical oncology》1994,1(5):389-399
Background: We performed a phase I study of a novel system of complete hepatic venous isolation and extracorporeal chemofiltration in
patients with unresectable hepatocellular carcinoma (HCC) to determine (a) whether systemic exposure to doxorubicin could
be limited after high-dose hepatic arterial infusion (HAI), and (b) the hepatic maximum tolerated dose (MTD) of doxorubicin.
Methods: Ten patients with biopsy-proven HCC were treated with 20-min HAI of doxorubicin (17 total treatments). Two patients were
treated with doxorubicin 60 mg/m2, three patients were treated at 90 mg/m2, and five patients received 120 mg/m2. A newly developed dual-balloon vena cava catheter was advanced from the femoral vein, and the balloons were inflated to
isolate and capture total hepatic venous outflow. The hepatic venous blood was pumped through extracorporeal carbon chemofilters
before return of the blood to the systemic circulation.
Results: Peak systemic doxorubicin levels were an average 85.6% lower than were peak prefilter levels (p<0.01). Because all catheters
were placed percutaneously and because the chemofiltration markedly limited systemic chemotherapy exposure, patients were
discharged 1 day after 16 of the 17 treatments. The hepatic and systemic MTD of doxorubicin in this treatment protocol was
120 mg/m2.
Conclusions: This novel system of complete hepatic venous isolation and chemofiltration limits systemic chemotherapy toxicity and will
allow use of higher doses of chemotherapeutic agents to treat HCC.
The results of this study were presented at the 46th Annual Cancer Symposium of The Society of Surgical Oncology, Los Angeles,
California, March 18–21, 1993. 相似文献
996.
Dr. Joseph A. Kuhn MD Lawrence D. Wagman MD John A. Lorant MD Fredrick W. Grannis MD Mordecai Dunst MD William R. Dougherty MD Daniel I. Jacobs MD 《Annals of surgical oncology》1994,1(4):353-359
Background: A radical forequarter amputation with partial chest wall resection (one to four ribs) has been reported for benign and malignant
lesions involving the shoulder and chest wall region. Concerns about reconstruction and postoperative pulmonary function have
previously limited more extensive chest wall resections. The current report describes the first case in which a complete unilateral
anterior and posterior chest wall resection and pneumonectomy (hemithoracectomy) accompany a forequarter amputation. A novel
reconstructive technique used the full circumference of the forearm tissue with an intact ulna as a free osseomyocutaneous
flap.
Methods: In this case, a 21-year-old patient presented with an extensive recurrent desmoid tumor that involved the shoulder, brachial
plexus, subclavian vein, and chest wall from the lateral sternal border to the midportion of the scapula and down to the eighth
rib. The operative technique involved removal of the entire right hemithorax from the midline sternum to the transverse process
posteriorly, down to the ninth rib inferiorly. Due to the absence of a rigid hemithorax, the uninvolved ipsilateral lung was
also removed. The forearm flap was prepared before final separation of the specimen and division of the subclavian vessels.
Results: Postoperatively, the patient maintained excellent oxygenation without atelectasis or fever and was extubated on the 15th
postoperative day. As expected after pneumonectomy, significant decreases from preoperative to immediate postoperative values
were noted for the vital capacity (VC) (from 4.87 L to 1.29 L), forced 1-s expiratory volume (FEV1) (from 3.77 L to 1.02 L),
and inspiratory capacity (IC) (3.33 1 to 0.99 1). Rehabilitation included a specially designed external prosthesis to provide
cosmesis and prevent scoliosis. By the 15th postoperative week the patient had returned to normal social and physical activities,
with a gradual improvement in all respiratory parameters: VC 1.52 L, FEV1 1.29 L, IC 1.04 L. There has been no evidence of
tumor recurrence at 1 year.
Conclusions: This report provides evidence that a complete hemithoracectomy, pneumonectomy, and forequarter amputation can be safely performed
for selective tumors involving the shoulder region with extensive chest wall invasion. Reconstruction may be achieved with
an extended forearm osseomyocutaneous free flap with an excellent functional outcome.
Presented at the 46th Annual Cancer Symposium of The Society of Surgical Oncology, Los Angeles, California, March 18–21, 1993. 相似文献
997.
998.
Robert L. Kriel MD Linda E. Krach MD Martha M. Bergland MS Laurel A. Panser MS 《Pediatric neurology》1988,4(6):337-341
This report describes the outcomes of 28 children who had severe head injuries between 13–18 years of age. All were unconscious at least 24 hours and have been followed at least 2 years after injury. At present, their ages range from 18 to 27 years. Their educational achievements, social activities, marital status, functional independence, and employment at follow-up are described. 相似文献
999.
Wayne S. Gradman MD Paul Bressman MD J. David Sernaque MD 《Annals of vascular surgery》1994,8(6):549-556
Management of subclavian vein occlusive disease in persons with an ipsilateral arteriovenous fistula can be challenging. From July 1991 to May 1993, nine patients underwent direct exploration and repair of an obstructed subclavian vein following medial claviculectomy. Eight patients had polytetrafluoroethylene (PTFE) grafts; one patient had a Brescia-Cimino fistula. Intractable arm edema was the major symptom in five of eight. The site of the occlusive disease ranged from the midsubclavian vein to the proximal innominate vein. Pathology varied from a focal occluding web to a long segment of intimai fibroplasia. Five veins were occluded; four were stenotic. Surgical procedures consisted of endovenectomy and vein patch (four), endovenectomy and PTFE patch (one), resection of a focal stricture with end-to-end anastomosis (two), resection with PTFE interposition (one), and end-to-end internal jugular to subclavian vein transposition (one). Postoperative contrast venograms revealed a patent subclavian vein in eight of eight patients. One patient died postoperatively from unrelated causes; two patients died with a functioning fistula 8 and 12 months, respectively, after surgery. Two grafts were removed for infection and one deteriorated graft was abandoned because of repeated thrombosis. Only three of nine original grafts are currently in use, including one in which the ipsilateral subclavian vein rethrombosed. Although stent placement may now be the preferred treatment for subclavian vein stenosis, vein repair may still have a role in the treatment of subclavian vein occlusion, particularly in patients with a Brescia-Cimino fistula.Presented at the Twelfth Annual Meeting of the Southern California Vascular Surgical Society, Coronado, Calif., September 17–19, 1993. 相似文献
1000.