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91.
A.L. Andreev A.V. Protsenko A.V. Globin 《JSLS, Journal of the Society of Laparoendoscopic Surgeons》2010,14(3):410-413
Background:
Posttraumatic diaphragmatic hernias (PDH) are serious complications of blunt and penetrating abdominal or thoracic trauma. Traditional thoracic or abdominal operations are usually performed in these cases.Methods:
We present 2 cases of posttraumatic left-sided diaphragmatic hernia complicated by strangulation and colon obstruction. Both cases were successfully treated with laparoscopy.Results:
We found that laparoscopy is a safe, successful, and gentle procedure not only for diagnosis but also for treatment of complicated PDH. Strangulation and colon obstruction were not contraindications to performing laparoscopic procedures. The postoperative course and long-term follow-up (range, 12 to 30 months) were uneventful and short. We expect the same good long-term results after laparoscopic repair as after open conventional surgery.Conclusion:
We recommend the use a minimally invasive approach to treat posttraumatic diaphragmatic hernia complicated by strangulation and colon obstruction in hemodynamically stable patients. 相似文献92.
Background:
Port-site hernia is a rare but potentially serious complication of laparoscopic cholecystectomy. This study aimed to review the current literature, assess the incidence and causes of port-site hernias, and identify methods to reduce the risk.Methods:
A systematic search of the literature published in English from 1995 to 2010 was conducted using PubMed to identify all reports of port-site, trocar-site, or incisional hernia following laparoscopic cholecystectomy. Studies in over 100 patients were identified before the application of defined exclusion criteria. The incidence of port-site hernia was calculated and compared with historical data. Predisposing factors were reviewed.Results:
Seven studies met the search criteria, with 99 port-site hernias in 5984 patients. The overall incidence of port-site hernia was 1.7% (range, 0.3% to 5.4). The most important factors were older age, higher body mass index, preexisting hernia, trocar design, trocar diameter, increased duration of surgery, and extension of the port site for gallbladder extraction.Conclusion:
The incidence of port-site hernia is low but likely to be underestimated and has not declined over time. Awareness of the predisposing factors and modification of techniques may help to reduce the risk. 相似文献93.
Ernst J. P. Schoenmaeckers Eelco B. Wassenaar Johan T. F. J. Raymakers Srdjan Rakic 《JSLS, Journal of the Society of Laparoendoscopic Surgeons》2010,14(4):541-546
Background and Objectives:
To investigate the prevalence, diagnosis, clinical significance, and treatment strategies for bulging in the area of laparoscopic repair of ventral hernia that is caused by mesh protrusion through the hernia opening, but with intact peripheral fixation of the mesh and actually a still sufficient repair.Methods:
Medical records of all 765 patients who underwent laparoscopic ventral hernia repair were reviewed, and all patients with a swelling in the repaired area were identified and analyzed.Results:
Twenty-nine patients were identified. They all underwent a computed tomography assessment. Seventeen patients (2.2% of the total group) had a hernia recurrence; in an additional 12 patients (1.6%), radiologic examinations indicated only bulging of the mesh but no recurrence. Bulging was associated with pain in 4 patients who underwent relaparoscopy and got a new, larger mesh tightly stretched over the entire previous repair. Eight asymptomatic patients decided on “watchful waiting.” All patients remained symptom free during a median follow-up of 22 months.Conclusion:
Symptomatic bulging, though not a recurrence, requires a new repair and must be considered as an important negative outcome of laparoscopic ventral hernia repair. In asymptomatic patients, “watchful waiting” seems justified. 相似文献94.
袁凌竹 《中国现代手术学杂志》2007,11(5):358-359
目的探讨腱膜性腹股沟疝修补术治疗腹股沟疝的疗效。方法回顾性分析我院1996年9月~2004年9月采用腱膜性腹股沟疝修补术治疗54例腹股沟疝患者的临床资料。结果手术后所有病人切口疼痛轻微,无切口感染,1例并发阴囊血肿,经穿刺抽液治愈。手术后6~7 d拆线岀院。平均随访42(12~72)个月,无睾丸坏死或萎缩,无复发。结论应用腱膜性腹股沟疝修补术治疗腹股沟疝具有操作简单、效果良好、术后疼痛轻微、无严重并发症等优点,是治疗腹股沟疝较理想的手术方式。 相似文献
95.
Inguinal hernia is a known complication after radical retropubic prostatectomy (RRP). We have investigated whether other types
of lower midline incision surgery in males increase the risk of inguinal hernia. Male patients operated with open prostatectomy
for benign prostate hyperplasia (n = 95), pelvic lymph node dissection for staging of prostate cancer (n = 88), or cystectomy for bladder cancer (n = 76) were identified and were sent questionnaires in which they were asked about postoperative inguinal hernia morbidity.
Two-hundred and seventy-one men operated with RRP had previously received a similar questionnaire. The answers were compared
with those from a control group of 953 men who had not undergone surgery. Annual attributional hernia morbidity and Kaplan–Meier
hernia-free survival were calculated. The cumulative incidence of post-operative inguinal hernia and annual attributional
hernia morbidity after the respective surgical procedures were clearly higher during the early years post-operation than for
nonoperated patients. Inguinal hernia is a common postoperative complication in males after all the lower midline incision
surgery investigated. 相似文献
96.
Background: Abdominal lipectomy is becoming an increasingly common surgical procedure in patients with esthetic deformities
resulting from massive weight loss induced by bariatric surgery. Sometimes a midline incisional hernia coexists with the pendulus
abdomen. Herein presented is a technique to perform a retromuscular mesh repair of the incisional hernia while sparing the
umbilicus.
Methods: The abdominal lipectomy with concomitant retro-muscular mesh repair of a midline incisional hernia is done sparing
the vascular supply of the umbilicus on one side only.
Results: 5 consecutive women with pendulus abdomen resulting from bariatric surgery-induced massive weight loss and concomitant
midline incisional hernia underwent abdominal lipectomy and incisional hernia mesh repair. Mean BMI was 28.6 kg/m2 (range 26–35), one patient was a smoker, and another had type 2 diabetes requiring oral hypoglycemic agents. Two patients
had had a previous incisional hernia repair with intraperitoneal mesh. One patient had partial necrosis of the umbilicus and
another experienced necrosis of only the epidermis that recovered fully.
Conclusions: The umbilicus can be safely spared during abdominal lipectomy with concomitant midline incisional hernia mesh
repair. Recurrent incisional hernia and common risk factors for wound healing such as diabetes and obesity increase the risk
of umbilical necrosis. 相似文献
97.
Background Intestinal obstruction is a significant and increasingly recognized complication after laparoscopic and open gastric bypass.
Materials and methods The medical records of 3,463 patients who had gastric bypass during the study period from July 1997 to December 2004 at a
single bariatric center were evaluated. 1,120 patients had retrocolic, retrogastric Roux limb placement and 2,343 patients
had antecolic, antegastric.
Results 40 patients had 44 intestinal obstructions (1.27%). The onset ranged from 1 day to 7 years postoperatively (mean 16.9 months).
Internal hernia at the transverse mesocolon defect was the most common cause. 36 (3.2%) obstructions were observed in retrocolic,
retrogastric vs. 8 (0.3%) in antecolic, antegastric approach. Internal hernia repair at mesocolinic effect (n = 11), jejunojejunostomy mesenteric defect repair (n = 7), lysis of adhesions (n = 16) were the most common procedures. A total of 70.5% were done laparoscopically.
Conclusions A high index of suspicion is needed to diagnose bowel obstruction after gastric bypass. Radiological imaging of the abdomen
has significant limitations. Surgical exploration should be performed without delay. Diagnostic laparoscopy is a safe and
effective therapy. We recommend closing all mesenteric defects to prevent internal hernias. The antecolic, antegastric technique
reduces the incidence of internal hernias. 相似文献
98.
Internal Hernias: Clinical Findings,Management, and Outcomes in 49 Nonbariatric Cases 总被引:1,自引:0,他引:1
Saber Ghiassi Scott Q. Nguyen Celia M. Divino John C. Byrn Avraham Schlager 《Journal of gastrointestinal surgery》2007,11(3):291-295
Internal hernia, the protrusion of a viscus through a peritoneal or mesenteric aperture, is a rare cause of small bowel obstruction.
We report the clinical presentation, surgical management, and outcomes of one of the largest series of nonbariatric internal
hernias. Ten-year retrospective review of patients at our institution yielded 49 cases of internal hernias. Majority of patients
presented with symptoms of acute (75%) or intermittent (22%) small bowel obstruction. While 16% of CT scans were suspicious
for internal hernia, in no cases the preoperative diagnosis of internal hernia was made. The most frequent internal hernias
were transmesenteric (57.0%) and 34 hernias (69%) were caused by previous surgery. All internal hernias were reduced and the
defects were repaired. Compromised bowel was present in 22 cases and 11 patients underwent small bowel resection. The mean
postoperative hospitalization was 10.9 days. The overall mortality rate from our series is 2%, and the morbidity rate is 12%.
Transmesenteric hernias, as complications of previous surgeries, are the most prevalent internal hernias. Preoperative diagnosis
of internal hernia is extremely difficult because of the nonspecific clinical presentation. However, if discovered promptly,
internal hernias can be repaired with acceptable morbidity and mortality.
Poster presentation at Digestive Disease Week, May 22, 2006, Los Angeles, California, USA. 相似文献
99.
A 58-year-old woman underwent laparoscopy-assisted transverse colectomy for transverse colon cancer. On postoperative day
7, she experienced sudden abdominal pain accompanied by vomiting and fever. Computed tomography showed a small bowel obstruction
caused by an internal hernia. Laparotomy revealed an internal hernia through the mesenteric defect at the anastomotic colonic
stumps, which had not been closed in the previous operation. Almost the entire small bowel protruding through the mesenteric
defect was found in the omental bursa. We resected part of the jejunal loop, which was strangulated and congested by an adherent
band. Our experience suggests that if the mesenteric defect is relatively small, it should be closed completely during laparoscopy-assisted
colectomy; however, more studies are required to determine the indications for closure of the mesenteric defect to prevent
this complication. 相似文献
100.
Background Laparoscopic ventral hernia repair (LVHR) for morbidly obese patients with a body mass index (BMI) exceeding 35 kg/m2 has not been well investigated.
Methods Hernia recurrence was evaluated by surveillance computed tomography. A p value less than 0.05 was considered significant.
Results Between 2003 and 2006, LVHR was attempted for 27 patients with a BMI exceeding 35 kg/m2. There was one conversion to open surgery (3.7%). The 27 patients included 8 men (29.6%) and 19 women (70.4%) with a mean
age of 48 years (range, 33–73 years). The mean BMI was 46.9 kg/m2 (range, 35–70 kg/m2). Nine patients (33%) were superobese (BMI > 50 kg/m2), and five patients (22.7%) underwent emergency LVHR because of small bowel obstruction. Concomitant LVHR with laparoscopic
gastric bypass (LGB) was performed for 13 patients (48%). Primary, incisional, or recurrent incisional ventral hernia was
present in 7 (26%), 15 (55%), and 5 (19%) patients, respectively. A large hernia (>50 cm2) was found in 20 patients (74%). The mesh used was porcine submucosal small intestine extracellular matrix for 15 patients
(57%), Gore-Tex for 9 patients (35%), and Composix for 2 patients (8%). The mean hernia size was 158 cm2 (range, 12–806 cm2), and the mean mesh size was 374 cm2 (range, 117–2,400 cm2). The mean operative time was 190 min (range, 80–480 min), and the mean hospital length of stay (LOS) was 3.6 days (range,
1–11 days). Minor or major complications occurred in seven patients (25.9%), and five patients (18.5%) experienced recurrence
during a mean follow-up period of 14.9 months (range, 3–32 months). Emergency setting, BMI, concomitant LGB, hernia type,
hernia size, and mesh type had no statistically significant effect on operative time, LOS, morbidity, or recurrence rates.
Conclusions For morbidly obese patients, LVHR is safe and effective, but it is associated with higher likelihood of recurrence, and patients
should be appropriately informed.
Presented at the 10th World Congress of Endoscopic Surgery Meeting, Berlin, Germany, September 2006 相似文献