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1.
腹股沟区淋巴静脉分流加硝酸银肾盂灌注治疗乳糜尿的临床疗效 总被引:1,自引:0,他引:1
目的 探讨腹股沟区淋巴静脉分流加硝酸银肾盂灌注治疗乳糜尿的疗效。方法 采用2%硝酸银肾盂灌注加同侧腹股沟区淋巴结与大隐静脉主干吻合方法治疗乳糜尿患者28例。其中男16例,女12例,年龄41~68岁,平均46岁。病史6个月~30年,平均3.6年。乳糜尿来自左肾14例,右肾12例,双肾2例。结果 术后3d内尿乳糜试验转阴者8例,7d转阴者17例,11d转阴者3例。27例随访3~12年,复发3例,复发率11%。结论 腹股沟区淋巴静脉分流加硝酸银肾盂灌注是治疗乳糜尿简单、安全、有效的方法,适宜于基层医院开展。 相似文献
2.
Lia Assumpcao John L. Cameron Christopher L. Wolfgang Barish Edil Michael A. Choti Joseph M. Herman Jean-Francois Geschwind Kelvin Hong Christos Georgiades Richard D. Schulick Timothy M. Pawlik 《Journal of gastrointestinal surgery》2008,12(11):1915-1923
Background
No data on incidence, management, or natural history of chyle leaks following pancreatic resection have been published. We
sought to identify possible risk factors associated with chyle leaks following pancreatic resection, as well as determine
the natural history of this rare complication.
Methods
Between 1993 and 2008, 3,532 patients underwent pancreatic resection at a single institution. Data on demographics, operative
details, primary tumor status, and chyle leak were collected. To identify risk factors associated with chyle leak, a matched
3:1 paired analysis was performed.
Results
Of 3,532 patients undergoing pancreatic resection, 47 (1.3%) developed a chyle leak (n = 34, contained chyle leak versus n = 13, diffuse chylous ascites). Chyle leak was identified at median 5 days following surgery. Median drain triglyceride levels
were 592 ng/dl. After matching on tumor size, disease etiology, and resection type, the number of lymph nodes harvested and
history of concomitant vascular resection predicted higher risk of chyle leak (both P < 0.05). Total parenteral nutrition (TPN) was required in more patients with chylous ascites (92.3%) than those with chyle
leaks (44.1%) (P = 0.003). The median time to resolution was shorter for contained chyle leaks (13 days) versus chylous ascites (36 days)
(P < 0.001). Patients with chylous ascites tended to have shorter overall survival (3-year, 18.8%) versus patients with no chyle
leak (3-year, 46.9%) (P = 0.12). In contrast, patients with a contained chyle leak had a similar survival as patients with no chyle leak (3-year,
53.4% versus 46.9%, respectively) (P = 0.32).
Conclusion
Chyle leak was a rare (1.3%) complication following pancreatic resection that was associated with number of lymph nodes harvested
and concomitant vascular resection. In general, chyle leaks were successfully managed with TPN with no adverse impact on outcome.
Patients with chylous ascites, however, had a more protracted clinical course and tended to have a worse long-term survival.
Presented at the Society for Surgery of the Alimentary Tract, 49th Annual Meeting, San Diego, CA, May 18th, 2008
Support: Dr. Pawlik is supported by Grant Number 1KL2RR025006-01 from the National Center for Research Resources (NCRR), a
component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research. The contents of this publication
are solely the responsibility of the authors and do not necessarily represent the official view of NCRR or NIH. 相似文献
3.
In the seventeenth century, opportunities to discover chyle came about through the revival of vivisection. Gaspare Aselli discovered chyle vessels in a living well-fed dog in 1622. He introduced the term 'lacteals' or milky veins. According to Aselli, the lacteals passed through a mesenteric gland which he called 'pancreas'. The 1627 edition of Aselli's booklet was the start of a 'lymphomania', which led to the dissection and vivisection of hundreds of animals, with the University of Leiden being the clear leader in this field. The prominent researchers in Leiden were Jacobus Sylvius and Johannes Walaeus, who performed diverse experiments to support Harvey's theories on systemic circulation, and to find out the correct anatomy and physiology of lacteals and mesenteric glands. Another centre of excellence was Padua, where Veslingius and Wirsüng introduced the idea of the prominent role of the 'real pancreas', and its duct in the transformation of digested food into clear chyle. The idea of the transport of chyle to the liver was an additional support for Galen's theories regarding the function of the liver. Nevertheless, as time went on, there were fewer and fewer believers in Galenic doctrine. 相似文献
4.
5.
目的探讨乳腺癌术后乳糜漏的诊断及治疗方法,为该病提供有效治疗方法。方法回顾性分析1997年6月至2013年8月收治6例乳腺癌术后并发乳糜漏的诊治经过。结果 1例保守治疗治愈。5例行手术治疗,1例治愈,4例术后仍有乳糜漏,采用碘仿纱填塞漏口加压包扎、负压引流治愈。结论术中熟悉腋窝的解剖关系、彻底结扎淋巴管可以减少乳糜漏发生。禁食营养支持治疗、局部加压包扎、碘仿纱填塞和负压引流是治愈乳腺癌术后乳糜漏的有效方法。 相似文献
6.
R. A. Kroczek 《European journal of pediatrics》1985,144(1):77-79
A severe case of congenital chyloperitoneum was managed over a prolonged period by permanent drainage and replacement of lymphatic loss by fresh frozen plasma, resulting in normal development of the infant. The average daily drainage of 360 ml during a period of a medium-chain-triglyceride (MCT) diet could be reduced to 228 ml (1.58 ml/kg per h) with total parenteral nutrition, representing apparently the basal flow rate of the intestinal lymphatics. Reduction in leakage, however, did not influence the observed lymphocytopenia. Healing of the lesion within the intestinal lymphatic system occurred after a brief period of bacterial peritonitis. The rationale for treatment with an MCT diet and for the application of total parenteral nutrition in infants with chyloperitoneum is discussed.Abbreviation MCT
medium-chain-triglyceride 相似文献
7.
Introduction
Chylous fistula is a known complication in procedures such as neck dissection and aneurysm surgery. However chyle leak that develops after axillary dissection is a rare phenomenon. In this study we have evaluated the incidence, possible cause, and management of chylous fistula that develops after radical breast cancer surgeries.Material and Methods
Chylous fistula developed in 6 of 1863 patients who underwent axillary dissection. Their records were analyzed in terms of clinical profile and management. A review of the literature regarding the thoracic duct anatomy at its termination was carried out and a hypothesis about the possible cause of chylous leak was suggested.Results
All 6 patients had procedures on the left side and had varied clinical stages and profiles. The chyle discharge was detected intraoperatively during the primary surgical procedure in 2 patients. The other 4 patients presented with chyle in their drains postoperatively. One patient did not respond to conservative management and underwent reexploration to seal the leak. Injury to the thoracic duct or its aberrant branches is apparently not the cause of chylous fistula in the axilla. The injury to the left subclavian duct or its tributary, which drains aberrantly into the thoracic duct through a valveless junction has been hypothesized to be the source of chyle in the axilla.Conclusion
Chylous fistula is very unusual after axillary dissection. Most of the chyle leaks in the axilla are manageable through conservative methods; surgical intervention is required rarely in special situations. Injury to the left subclavian duct or its tributary is the possible cause. 相似文献8.
目的 探讨甲状腺癌颈淋巴结清扫术后淋巴管漏和乳糜漏的原因,诊断及处理体会. 方法 回顾分析842例甲状腺癌行颈部淋巴结清扫术及术后发生淋巴管漏或乳糜漏的25例患者的临床病历资料. 结果 术中发现胸导管损伤5例,予结扎处理,术后未发生乳糜漏或淋巴瘘.术后发生淋巴管漏14 例,左侧4 例,右侧10例;发生胸导管漏11例;左侧10例,右侧1例.所有患者都给持续负压引流及局部压迫处理,部分患者给予饮食控制和肠外营养支持治疗.淋巴管漏的14例患者于1周内治愈,胸导管漏的 8例于2周内治愈,其余3例超过1月,最长1例45天治愈. 结论 术中恰当的处理可以有效避免术后淋巴管或胸导管漏的发生,术后一旦发现淋巴管漏或胸导管漏应及时给予持续负压引流,局部加压包扎和合理的饮食控制及及营养支持等保守治疗可获满意疗效. 相似文献
9.
目的回顾性分析中国医学科学院中国协和医科大学肿瘤医院头颈外科1983~1996年底37侧乳糜瘘的临床资料,评价乳糜瘘的治疗效果,以便合理地选择治疗方案。方法37侧乳糜瘘中左30侧,右7侧。26侧采用负压吸引、局部加压及低脂饮食的保守治疗,其中2侧为促进乳糜瘘的愈合,同时给予皮瓣下注入50%葡萄糖;7侧手术缝扎;4侧局部切开填塞碘仿或无菌纱布或纱条。结果86%(32/37)的乳糜瘘发生于手术后前3天。保守治疗的26侧中15侧获得痊愈,平均愈合时间为9.7(4~30)天,11侧失败,经手术治疗而痊愈;手术缝扎的7侧均一期愈合;切开填塞的4侧,均二期愈合,平均愈合时间为8.5(7~10)天。结论乳糜瘘经合理地治疗是可以治愈的,并不延长患者的住院时间。对乳糜量每日少于500ml的早期乳糜瘘可采用保守治疗;对保守治疗短期内无效及乳糜量每日超过500ml的乳糜瘘,应及时采用手术缝扎;对手术后一周及保守治疗超过手术后一周的乳糜瘘,应采用局部切开填塞。 相似文献
10.
Spontaneous chylous peritonitis mimicking acute appendicitis: A case report and review of literature
Acute abdominal pain with signs and symptoms ofperitonitis due to sudden extravasation of chyle intothe peritoneal cavity is a rare condition that is oftenmistaken for other disease processes.The diagnosisis rarely suspected preoperatively.We report a caseof spontaneous chylous peritonitis that presentedwith typical symptoms of acute appendicitis such asintermittent fever and epigastric pain radiating to thelower right abdominal quadrant before admission. 相似文献