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951.
952.
肛门直肠周围脓肿一期根治术的临床疗效观察 总被引:1,自引:0,他引:1
目的 :观察和评估一期根治术治疗肛门直肠周围脓肿的临床疗效。方法 :将 12 6例急性肛门直肠周围脓肿病例分成一期根治性切开术组 (PCID组 ) ,和单纯切开引流组 (TID组 ) ,观察一期根治性手术治疗肛门直肠周围脓肿的临床疗效。观察 2组病例术后感染控制情况 ,创面愈合时间 ,随访术后 2年内的脓肿复发情况和肛瘘发生情况。结果 :PCID组病例术后感染控制时间 (5± 3d)较 TID组病例 (7± 4 d)明显缩短 ,2者存在显著差异 (P <0 .0 5 ) ;2组病例创面愈合时间无显著差异 (P >0 .0 5 ) ;PCID组病例术后脓肿复发需再次手术的病例为 2例 (发生率 3.13% ) ,TID组病例术后脓肿复发需再次手术的病例为 12例 (发生率 18.75 % ) ,2组病例存在非常显著差异 (P <0 .0 1) ;PCID组病例术后后遗肛瘘的病例为 2例(发生率 3.13% ) ,TID组病例术后后遗肛瘘的病例为 2 9例 (发生率 4 6 .77% ) ,2组病例存在非常显著差异 (P <0 .0 1)。结论 :一期根治术治疗肛门直肠周围脓肿较单纯切开引流手术存在明显的优越性 ,能明显地缩短术后感染控制时间 ,降低术后脓肿的复发率和肛瘘的发生率 ,缩短了病程 ,降低了再次手术的机率 ,减轻了病人的痛苦 相似文献
953.
Vesicovaginal fistula resulting from a well-cared-for pessary 总被引:2,自引:2,他引:0
An 84-year-old vaginally grand multiparous woman presented with a vesicovaginal fistula (VVF) after appropriate use of a Gehrung
pessary for the past 12 years for stage III pelvic organ prolapse. The patient reported strict adherence to removing her pessary
nightly and replacing it in the morning for the last 12 years. One morning, she awoke and noted a sudden gush of urine through
the vagina followed by continuous leakage. Given the complex nature of VVF repair with concurrent stage III pelvic organ prolapse,
the patient was referred to urogynecologic care. A Latzko fistula repair and LeFort colpocleisis were performed without complication.
The patient recovered well with complete resolution of her pelvic organ prolapse and VVF based on negative cystogram findings
at 3 weeks postoperatively. At 12 weeks postoperatively the patient denied any urine leakage or pelvic organ prolapse. 相似文献
954.
Pelvic organ prolapse is an increasingly common problem as women are living longer. With the growing numbers of surgeries
performed to correct this problem, further research is needed to understand the long-term success as well as possible complications
of these procedures. One potential complication that needs further study is de novo rectal prolapse after repair of pelvic
organ prolapse, specifically after colpocleisis. Defacography may be an important part of the preoperative workup in the patient
with pelvic organ prolapse. Currently, there is a controversy as to whether internal, or occult, rectal prolapse on defacography
should be repaired at the time of other pelvic reconstructive surgery. We report on a case of overt rectal prolapse after
repair of Stage IV vaginal vault prolapse with a colpocleisis, levator ani plication, and a minimally invasive midurethral
sling. We discuss the issues surrounding preoperative management of these patients and propose a theory explaining why prolapse
in other areas of the pelvis may occur after reconstructive surgery. 相似文献
955.
X. Deffieux R. de Tayrac C. Huel J. Bottero A. Gervaise K. Bonnet R. Frydman H. Fernandez 《International urogynecology journal》2007,18(1):73-79
The objective of this study was to compare mesh erosion after transvaginal repair of cystocele using Gynemesh or Gynemesh-Soft mesh. We retrospectively analyzed 138 consecutive cases of transvaginal repair of cystocele using synthetic mesh. The study endpoint was the pathological evidence of vaginal erosion. Multiple logistic regression was used to determine independent predictors of vaginal erosion. One hundred and thirty eight women (ages 30-83 years) with cystocele between October 1999 and October 2004, from a French University Hospital, participated in this study. Cystocele repair was performed in all patients according to the technique of tension-free polypropylene mesh. The median follow-up was 32.1 months (range 7.5-59.9) in the Gynemesh group and 7.1 months (range 1-21.9) in the Gynemesh-Soft group. Vaginal erosion was reported in 27 (20%) of the patients. Anatomically, the success rate was 95% (131/138). There was no statistically significant difference between the Gynemesh and the Gynemesh-Soft meshes [the rate of vaginal erosion of the mesh was 16% (15/89) vs 24% (12/49), respectively, p=0.39]. Univariate analysis only identified age class as factor significantly associated with the probability of vaginal erosion. Multivariate analysis revealed that age class is an independent predictive factor of vaginal erosion (age > 70 years, odds ratio (OR) 3.6, 95% confidence interval (CI) 1.3-9.7, p=0.010). Furthermore cystocele stage > 2 (Baden and Walker classification) is a protective factor against vaginal erosion (OR 0.3, 95% CI 0.1-0.8, p=0.016). Thirteen symptomatic patients (13/27, 48%) necessitated a partial excision of the mesh, associated with a vaginal mucosal closure. Two patients (2/27, 7%) underwent a complete excision of the mesh. The incidence of de novo dyspareunia was 9% in patients with vaginal erosion and 11% in patient without mesh erosion (p=0.85). There was no occurrence of bladder or urethral erosion and no vaginal or pelvic infection. Isolated vaginal erosion of the mesh did not prove to be problematic. Gynemesh-Soft mesh does not decrease the incidence of vaginal erosion. Age > 70 years is an independent predictive factor of vaginal erosion. We recommend that mesh placement by vaginal route should be avoided by women with moderate cystocele. Where possible, total hysterectomy and vertical incision should also be avoided. Management of vaginal erosion is simple and is associated with a low rate of morbidity. However, patients should be informed that vaginal erosion of the mesh can occur. A multivariate analysis reveals that the incidence of vaginal erosion is not significantly different between Gynemesh and Gynemesh-Soft meshes. Other factors of erosion are analyzed. 相似文献
956.
Joseph M. Novi Catherine S. Bradley Najjia N. Mahmoud Mark A. Morgan Lily A. Arya 《International urogynecology journal》2007,18(10):1163-1169
The objective of the study was to compare preoperative and postoperative sexual function between women undergoing rectocele
repair with porcine dermis graft and women undergoing site-specific repair of rectovaginal fascia. A standardized, validated
questionnaire (Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire [PISQ]) was used to collect preoperative
sexual function data from 100 patients with rectocele pelvic organ prolapse quantification stage 2 or greater. Fifty women
underwent rectocele repair utilizing porcine dermis graft (group 1) and 50 women underwent a site-specific repair of the rectovaginal
fascia (group 2). The same questionnaire was administered to all subjects 6 months after surgery. The two groups were similar
in age, race, parity, prior hysterectomy, and postmenopausal hormone use. Preoperative sexual function scores were similar
in the two groups (group 1 81.4 ± 7.3 and group 2: 83.6 ± 8.2, p = 1.0). Six months after surgery, PISQ scores in group 1 significantly increased (score increase 19.9 ± 2.2, p = 0.01). The mean increase in PISQ scores for group 2 was 6.9 ± 3.1 (p = 0.08). When compared with group 2, subjects undergoing rectocele repair with porcine dermis graft scored significantly
higher on the PISQ 6 months after surgery (group 1 101.3 ± 6.4 and group 2 89.7 ± 7.1, p = 0.01). We conclude that rectocele repair using porcine dermis graft is associated with improved sexual functioning when
compared with site-specific rectovaginal fascia repair. 相似文献
957.
Amy E. Young Paul M. Fine Rebecca McCrery Patricia A. Wren Holly E. Richter Linda Brubaker Morton B. Brown Anne M. Weber for the Pelvic Floor Disorders Network 《International urogynecology journal》2007,18(10):1171-1178
The purpose of the study is to translate existing measures of pelvic symptoms and quality of life from English into Spanish,
facilitating research participation of Hispanic/Latina women. The forward–backward translation protocol was applied then adjudicated
by a concordance committee. The measures included the Pelvic Floor Distress Inventory (PFDI), Pelvic Floor Impact Questionnaire
(PFIQ), Medical, Epidemiological, and Social Aspects of Aging (MESA) Questionnaire, Hunskaar Severity Measure, Fecal Incontinence
Severity Index and modified Manchester Questionnaire, Pelvic Organ Prolapse/Urinary Incontinence Sexual Functioning Questionnaire
(PISQ), and the Life Orientation Test (LOT). English and Spanish versions were administered to 50 Hispanic/Latina women with
pelvic symptoms. Kappa correlations of items and correlation coefficients for scales were computed. Psychometric testing for
translations demonstrated good (0.80–0.89), very good (0.90–0.95), or excellent (>0.95) correlations for primary scales of
the PFDI, PFIQ, MESA, Hunskaar, PISQ, and LOT. Strict translation techniques and testing yielded valid Spanish translations
of instruments assessing pelvic symptoms/functional life impact in women with pelvic floor disorders.
Electronic supplementary material The Spanish translations of the instruments discussed herein are available as Appendixes 1-7 in the form of electronic supplementary
material and can be found at http://dx.doi.org/. 相似文献
958.
Feasibility and patient satisfaction with pelvic organ prolapse and urinary incontinence day surgery
C. H. van der Vaart B. H. C. Lamers A. P. M. Heintz 《International urogynecology journal》2007,18(5):531-536
We performed a prospective cohort study to characterize the feasibility of urinary stress incontinence and pelvic organ prolapse
surgery in day care. Two hundred and one women were prepared for day surgery by a standardised protocol; 132 women underwent
a single Tension-free Vaginal Tape/Tension-free Vaginal Tape–Obturator procedure, and 69 women had additional or only pelvic
organ prolapse surgery. The main outcome measures were complications, satisfaction score and recommendation to others, recorded
after 3 days and 6–10 weeks. We found that it is feasible and safe to perform pelvic organ prolapse and urinary incontinence
surgery in day care. Patients’ satisfaction is high in all aspects of care and the majority would recommend it to others.
In multivariate logistic regression analysis, only dissatisfaction with the care provided by the staff of the surgical ward
was significantly associated with a negative recommendation to others (odds ratio 7.3, 95% confidence interval 1.6–33.5). 相似文献
959.
G. Vanneuville G. Poumarat M. Guillot J. M. Garcier S. Terver F. Duclos J. J. Vacheron 《Surgical and radiologic anatomy : SRA》1997,19(5):341-343
Summary The overall movement of the trunk is made up of two components, namely the movements of the pelvic girdle and the vertebrae. In the frontal plane, the amplitude of the pelvic movements appears to be relatively limited compared to the vertebral column whereas the pelvis makes the major contribution to the total rotational movement in the axial plane.In collaboration with J.P. Barlet, M. Bourges J.L. Irigaray and J.L. Michel 相似文献
960.
OBJECTIVE: For treatment of suspected pelvic abscesses, the use of the trocar technique avoids many of the technical challenges of the Seldinger method. The purpose of this study was to evaluate the effectiveness and safety of sonographically guided transvaginal aspiration or drainage with the trocar technique in suspected pelvic abscesses that were refractory to antibiotic treatment. METHODS: We retrospectively reviewed 22 patients with suspected pelvic abscesses refractory to antibiotic therapy who underwent single-step transvaginal pelvic aspiration or drainage between 1995 and 2000. RESULTS: Transvaginal aspiration or drainage was successful in 19 (86%) of the 22 patients. Of the 3 patients in whom aspiration or drainage failed, all ultimately went on to have surgery despite undergoing repeated drainage procedures. Drainage catheters were placed in 15 (68%) of the 22 patients and left in place an average of 3.7 days. Aspiration alone resulted in a 100% success rate, whereas drainage with catheter placement resulted in an 80% success rate. No complications, including bleeding, bowel perforation, and death, were reported in any of the procedures. CONCLUSIONS: Transvaginal ultrasonographically guided aspiration or catheter placement with the trocar technique is a safe and effective treatment for suspected pelvic abscesses refractory to antibiotic therapy. 相似文献