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111.
112.
Intrahepatic cholangiojejunostomy for unresectable malignant biliary tumors with obstructive jaundice 总被引:1,自引:0,他引:1
Shohachi Suzuki Kiyotaka Kurachi Yoshihiro Yokoi Yasuo Tsuchiya Kazuya Okamoto Takuya Okumura Keisuke Inaba Hiroyuki Konno Satoshi Nakamura 《Journal of Hepato-Biliary-Pancreatic Surgery》2001,8(2):124-129
We reviewed our experience with intrahepatic cholangiojejunostomy as a palliative therapy for patients with unresectable
malignant diseases involving the ductal confluence or the common hepatic duct. Fifteen patients with malignant biliary obstruction
were treated by cholangiojejunostomy at our hospital. Two patients had intrahepatic cholangiocarcinoma, 7 had gallbladder
carcinoma, 5 had bile duct carcionoma, and 1 had pancreatic carcinoma. Segment III cholangiojejunostomies were performed in
14 patients and segment V cholangiojejunostomy in 1. Contraindications for surgical resection were locoregional invasion of
tumors involving the proper and/or common hepatic artery and portal vein in 15 patients and the presence of hepatic metastases
in 6 patients. Liver metastases were detected in 5 of the 7 patients with gallbladder carcinoma. Postoperative complications
occurred in 2 patients (13%), but there was no leakage of the cholangioenteric anastomosis in our series. There was no operative
mortality after cholangiojejunostomy. Of the 9 patients who survived for more than 6 months after surgery, 7 showed a significant
improvement in performance status (PS) (82 ± 10%) 3 months after the surgery compared with the preoperative PS (70 ± 7%).
Four of the 9 patients had recurrent cholangitis as a late complication, but 4 were completely free from jaundice. Median
survival after cholangioenteric bypass was 9 months (range, 2–25 months). With respect to tumor location, the median survival
time was 4 months (range, 2–25 months) in patients with gallbladder carcinoma and 15.5 months (range, 12–22 months) in those
with bile duct carcinoma. While the median survival period after surgery was only 3 months (range, 2 to 8 months) in the 5
patients with hepatic metastases from gallbladder carcinoma, 2 patients without liver metastasis survived for 9 and 25 months
after segment III cholangioenteric bypass. In conclusion, cholangiojejunostomy can provide useful palliation for malignant
biliary obstruction when combined with careful patient selection.
Received: September 5, 2000 / Accepted: November 8, 2000 相似文献
113.
Clinical significance and prognostic value of apoptosis related proteins in superficial esophageal squamous cell carcinoma 总被引:7,自引:0,他引:7
Matsumoto M Natsugoe S Nakashima S Okumura H Sakita H Baba M Takao S Aikou T 《Annals of surgical oncology》2001,8(7):598-604
Background: The purpose of the present study was to examine the expression of cell cycle regulators [p53, p21WAF1/CIP1 (p21), and Rb] and apoptosis related proteins Bax and Bcl-XL and to evaluate the relationship between their expressions and clinicopathological findings in patients with superficial squamous cell carcinomas of the esophagus.Methods: We immunohistochemically investigated the expression of p53, p21, Rb, Bax, and Bcl-XL in 79 patients with superficial esophageal carcinoma.Results: p21 overexpression was found in mucosal carcinoma (P = 0.05) and a high Bcl-XL score was observed for submucosal carcinoma (P = 0.03). The patients with high Bcl-XL score had more frequent lymphatic invasion and lymph node metastasis than did those with low Bcl-XL score (P < 0.05). Univariate analysis revealed significantly shorter survival in patients with high Bcl-XL expression than in those with low Bcl-XL expression, but Bcl-XL expression was not identified as an independent prognostic factor by multivariate analysis.Conclusions: Because Bcl-Xl expression correlated well with depth of tumor invasion, lymphatic invasion, and lymph node metastasis, examination of Bcl-XL expression will help to estimate the properties in superficial squamous cell carcinoma of the esophagus. 相似文献
114.
Nakane Y Kanbara T Michiura T Inoue K Iiyama H Nakai K Okumura S Yamamichi K Hioki K 《Surgery today》2001,31(1):90-92
We describe herein our technique of performing gastrectomy followed by side-to-end gastroduodenostomy. Because the clamp
is removed at the resection line of the greater curvature, there is no need to perform an additional gastrotomy for insertion
of the instrument. This feature differentiates our technique from previous methods of anastomosis using the circular stapler.
We believe that our technique is superior in simplicity and security to the traditional hand-sewn anastomosis. Moreover, it
allows for a shorter operative time. This technique is recommended for practical surgery over conventional techniques.
Received: February 23, 2000 / Accepted: July 25, 2000 相似文献
115.
Hisato Takagi Toshiyuki Tanabashi Norikazu Kawai Takuya Umemoto 《European journal of cardio-thoracic surgery》2007,32(2):400; author reply 400-400; author reply 401
116.
Saito N Suzuki T Sugito M Ito M Kobayashi A Tanaka T Kotaka M Karaki H Kobatake T Tsunoda Y Shiomi A Yano M Minagawa N Nishizawa Y 《Surgery today》2007,37(10):845-852
Purpose Total pelvic exenteration (TPE) is the standard procedure for locally advanced rectal cancer involving the prostate and seminal
vesicles. We evaluated the feasibility of bladder-sparing surgery as an alternative to TPE.
Methods Eleven patients with advanced primary or recurrent rectal cancer involving the prostate or seminal vesicles, or both, underwent
bladder-sparing extended colorectal resection with radical prostatectomy. The procedures performed were abdominoperineal resection
(APR) with prostatectomy (n = 6), colorectal resection using intersphincteric resection combined with prostatectomy (n = 4), and abdominoperineal tumor resection with prostatectomy (n = 1). Local control and urinary and anal function were evaluated postoperatively.
Results Cysto-urethral anastomosis (CUA) was performed in seven patients and catheter-cystostomy was performed in four patients. Coloanal
or colo-anal canal anastomosis was also performed in four patients. There was no mortality, and the morbidity rate was 38%.
All patients underwent complete resection with negative surgical margins. After a median follow-up period of 26 months there
was no sign of local recurrence, and ten patients were alive without disease, although distant metastases were found in three
patients. Five patients had satisfactory voiding function after CUA, and three had satisfactory evacuation after intersphincteric
resection (ISR).
Conclusion These bladder-sparing procedures allow conservative surgery to be performed in selected patients with advanced rectal cancer
involving the prostate or seminal vesicles, without compromising local control. 相似文献
117.
Tokunaga T Inoue M Ideguchi K Okumura M Sawa Y 《General thoracic and cardiovascular surgery》2007,55(2):50-52
We report a 64-year-old woman treated with surgical intervention for late-onset chylothorax following a pleuropneumonectomy.
The patient underwent an extrapleural pneumonectomy for diffuse malignant mesothelioma and was uneventfully discharged on
postoperative day 29. Pleural effusion aspirated on postoperative day 9 was dark red. A chest roentgenogram taken at our outpatient
clinic revealed a mediastinal shift on postoperative day 56. No bacterial infection was found in the milky effusion. We made
a diagnosis of postoperative late-onset chylothorax based on the laboratory data obtained from tests of the pleural fluid.
A repeat thoracotomy to ligate the lymphatic duct was performed because conservative management with chest tube drainage and
no oral feeding was unsuccessful. The patient was discharged after the operation with a good clinical course. 相似文献
118.
BACKGROUND: To assess tissue characterization of oral tongue cancer and prediction of subclinical cervical lymph node metastasis, we investigated whether intraoral ultrasonography could be used in conjunction with a computer-aided diagnosis (CAD) system. METHODS: The study population comprised 109 patients with presurgical, clinical T1N0 or T2N0 oral tongue squamous cell carcinoma who underwent partial glossectomy. All the patients were examined by preoperative intraoral and postoperative ex vivo ultrasonography. To evaluate the ultrasonic images quantitatively, ultrasonographic parameters from tumor contour features were computed by using the proposed CAD system. The imaging results were correlated with histopathologic findings. RESULTS: Oral tongue cancer was clearly identified in all patients by intraoral ultrasonography. Ultrasonic images of oral tongue cancer reflected the histopathologic structures. Subclinical cervical lymph node metastasis was predicted by intraoral ultrasonography. In a logistic regression analysis using the proposed CAD system, the diagnostic sensitivity, specificity, and accuracy for prediction of subclinical lymph node metastasis were 87.2%, 84.3%, and 85.3%, respectively. CONCLUSIONS: Intraoral ultrasonography in conjunction with the proposed CAD system allows tissue characterization and prediction of subclinical cervical lymph node metastasis. 相似文献
119.
Clinical Implication of CXCL12 Expression in Gastric Cancer 总被引:1,自引:0,他引:1
Ishigami S Natsugoe S Okumura H Matsumoto M Nakajo A Uenosono Y Arigami T Uchikado Y Setoyama T Arima H Hokita S Aikou T 《Annals of surgical oncology》2007,14(11):3154-3158
PURPOSE: Recent research has revealed that tumor cells expressing chemokine receptors have a crucial impact on patient survival. However, there is no information regarding chemokine expression in gastro-intestinal cancer. This study immunohistochemically investigated CXCL12 expression in gastric cancer and evaluated its association with clinical factors, including patient prognosis. METHOD: A total of 185 gastric cancer patients receiving curative gastrectomy were assessed. CXCL12 expression was evaluated by immunohistochemical analysis. Tumors with CXCL12-positive cancer cells were regarded as CXCL12 positive, and according to the degree of CXCL12 expression, patients were divided into three groups (weak, 31 cases; moderate, 27 cases; strong, 20 cases). Correlations between CXCL12 expression and clinical factors in gastric cancer were then determined. RESULTS: CXCL12 was found in the cellular membrane of cancer cells. Seventy-four of 185 patients were classified into the CXCL12-positive group. Patients were divided into three groups according to the positivity of CXCL12 expression. Significant associations between CXCL12 and lymph node metastases (p < 0.05), depth of invasion (p < 0.01), lymphatic invasion (p < 0.01), tumor diameter (p < 0.05), and clinical stage (p < 0.01) were seen. Univariate analysis revealed that the CXCL12-positive group had significantly poorer surgical outcome than the CXCL12-negative group (p < 0.01). Multivariate analysis revealed CXCL12 to be an independent prognostic factor in gastric cancer (p = 0.02). CONCLUSION: Cancerous CXCL12 positivity was determined to be an independent prognostic factor in gastric cancer, with CXCL12-positive gastric cancer showing more-aggressive behavior. Autocrine CXCL12 secretion from tumor cells may activate CXCR-4 on the tumor cells, which may be related to of the viability of distant metastases. 相似文献
120.
Okumura Y Tanaka F Hasegawa S Fukuoka K Nakano T 《Kyobu geka. The Japanese journal of thoracic surgery》2007,60(1):25-29
The standard surgical procedure for patients with malignant pleural mesothelioma (MPM) is extrapleural pneumonectomy (EPP). However, high morbidity and mortality rates have been reported in patients who received EPP, whereas survival rates after EPP remain unsatisfactory. Thus, a carefully and precise preoperative assessment to select appropriate candidates for EPP is essential in patients with MPM, and we conducted a surgical staging with laparoscopy, mediastinoscopy and contralateral thoracoscopy for potentially resectable MPM patients. Among 5 consective patients who received the preoperative surgical staging during past 10 months, 1 patient was judged not to be a surgical candidate due to the presence of contralateral pleural metastasis. In conclusion, this surgical staging is a useful preoperative evaluation to prevent an unnecessary operation. 相似文献