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1.
Hiroki Sakamoto Masayuki Kitano Takeshi Nishio Yoshifumi Takeyama Chikao Yasuda Masatoshi Kudo 《Digestive endoscopy》2006,18(3):206-211
Endosonography‐guided celiac plexus neurolysis (EUS‐CPN) safely and effectively relieves pain associated with intra‐abdominal malignancies when the neurolytic is accurately injected. We applied contrast medium to evaluate the ethanol injection sites in patients who received EUS‐CPN due to abdominal pain caused by malignancies. We injected, under the guidance of endoscopic ultrasonography (EUS), ethanol containing 10% contrast medium into the celiac plexus of patients with intra‐abdominal pain due to malignancies. Immediately after the endoscopic therapy, patients underwent computed tomography (CT) to confirm the injection site. Images of distribution of injected solutions were classified into three groups. Injected solution dispersed in unilateral and bilateral anterocrural space was defined as ‘unilateral injection’ or ‘bilateral injection’, respectively. Injected solution located out of the anterocrural space was defined as ‘inappropriate injection’. Pre‐ and postprocedure pain was assessed using a standard analog scale. Before and 2, 4, 8, 12, and 16 weeks after the procedure, pain scores were evaluated. From April 2003 to May 2005, 13 patients were enrolled in this study. Improvement of pain score in the ‘bilateral injection’ and ‘unilateral injection’ groups was significantly superior to the change in the ‘inappropriate injection’ group. Although EUS‐CPN was effective in eight of 13 patients (61.5%), additional EUS‐CPN to the ‘inappropriate injection group’ increased the response rate to 84.6%. Injection of ethanol to the anterocrural space by EUS‐CPN produced adequate pain relief. Immediate examination by CT for confirmation of injection sites after EUS‐CPN would increase the likelihood of induction of pain relief. 相似文献
2.
Key words intractable pain - celiac plexus neurolysis - ultrasonography 相似文献
3.
BACKGROUND: Some patients with endometriosis are candidates for sympathectomy of the superior hypogastric plexus. The objective of this paper is to describe our technique of laparoscopic presacral neurolysis for sympathectomy and to report 1 year results of the first 15 cases. METHODS: To achieve this objective in a prospective observational study of 1 year follow-up; we performed laparoscopic presacral chemical neurolysis with phenol in 15 patients with pelvic pain and minimal-moderate endometriosis. The main outcome measures were: the impact of treatment on pelvic symptom resolution, non-opioid analgesic consumption during menses, sexual performance and observed complications and side effects during 1 year follow-up. RESULTS: We noted a significant reduction in total pelvic symptom score as compared with baseline mean (SD) of 9.04 (1.2). The mean difference [95% confidence interval (CI)] of reduction was 5.7 (4.9-6.5), 5.8 (5.0-6.6) and 5.8 (4.9-6.6) from the baseline at the 3rd, 6th and 12th postoperative month (P < 0.001). We observed a significant improvement in Sabbatberg Sexual Rating Scale as compared with baseline mean (SD) of 30.9 (4.3). The mean difference (95% CI) of increase was 33.4 (30.3-36.4), 33.2 (30.1-36.2) and 33.2 (30.1-36.3) from the baseline at the 3rd, 6th and 12th postoperative month. We observed a significant reduction in analgesic consumption during menses in terms of total naproxen sodium tablets as compared with baseline mean (SD) of 8.9 (1.1). The mean difference (95% CI) of reduction in the total number of naproxen sodium 250 mg tablets was 6.5 (5.5-7.5), 6.7 (5.7-7.7) and 6.6 (5.6-7.6) from the baseline at the 3rd, 6th and 12th postoperative month. The most common side effect was constipation. CONCLUSION: Laparoscopic presacral neurolysis is feasible and simple. More data is needed to support its efficacy and safety. 相似文献
4.
显微外科技术治疗周围神经嵌压症 总被引:2,自引:0,他引:2
目的 :为探讨显微外科技术治疗周围神经嵌压症的疗效。方法 :采用显微外科技术对各部位周围神经嵌压症 2 5例进行神经内外松解术。结果 :2 5例周围神经嵌压症患者术后症状、体征及肌电图检查均较术前明显改善 ,疗效满意。结论 :显微外科技术是治疗周围神经嵌压症的一种有效方法。 相似文献
5.
6.
Guillermo P rez-Aguado Diego Martinez-Acitores de la Mata Carlos Marra-L pez Valenciano Ignacio Fernandez-Urien Sainz 《World journal of gastrointestinal endoscopy》2021,13(10):460-472
Pancreatic cancer produces disabling abdominal pain, and the pain medical management for pancreatic cancer is often challenging because it mainly relies on the use of narcotics(major opioids). However, opioids often provide suboptimal pain relief, and the use of opioids can lead to patient tolerance and several side effects that considerably reduce the quality of life of pancreatic cancer patients. Endosonography-guided celiac plexus neurolysis(EUS-CPN) is an alternative for pain control in patients with nonsurgical pancreatic cancer; EUS-CPN consists of the injection of alcohol and a local anesthetic into the area of the celiac plexus to achieve chemical ablation of the nerve tissue. EUS-CPN via the transgastric approach is a safer and more accessible technique than the percutaneous approach. We have reviewed most of the studies that evaluate the efficacy of EUSCPN and that have compared the different approaches that have been performed by endosonographers. The efficacy of EUS-CPN varies from 50% to 94% in the different studies, and EUS-CPN has a pain relief duration of 4–8 wk. Several factors are involved in its efficacy, such as the onset of pain, previous use of chemotherapy, presence of metastatic disease, EUS-CPN technique, type of needle or neurolytic agent used, etc. According to this review, injection into the ganglia may be the best technique, and a good visualization of the ganglia is the best predictor for a good EUS-CPN response, although more studies are needed. However, any of the 4 different techniques could be used to perform EUS-CPN effectively with no differences in terms of complications between the techniques,but more studies are needed. The effect of EUS-CPN on pain improvement, patient survival and patient quality of life should be evaluated in well-designed randomized clinical trials. Further research also needs to be performed to clarify the best time frame in performing a EUS-CPN. 相似文献
7.
Hirotoshi Ishiwatari Tsuyoshi Hayashi Makoto Yoshida Michihiro Ono Hiroyuki Masuko Tsutomu Sato Koji Miyanishi Yasushi Sato Rishu Takimoto Masayoshi Kobune Atsushi Miyamoto Tomoko Sonoda Junji Kato 《World journal of gastroenterology : WJG》2014,20(30):10512-10517
AIM:To investigate the effectiveness of phenol for the relief of cancer pain by endoscopic ultrasound-guided celiac plexus neurolysis(EUS-CPN).METHODS:Twenty-two patients referred to our hospital with cancer pain from August 2009 to July 2011for EUS-CPN were enrolled in this study.Phenol was used for 6 patients with alcohol intolerance and ethanol was used for 16 patients without alcohol intolerance.The primary endpoint was the positive response rate(pain score decreased to≤3)on postoperative day 7.Secondary endpoints included the time to onset of pain relief,duration of pain relief,and complication rates.RESULTS:There was no significant difference in the positive response rate on day 7.The rates were 83%and 69%in the phenol and ethanol groups,respectively.Regarding the time to onset of pain relief,in the phenol group,the median pre-treatment pain score was 5,whereas the post-treatment scores decreased to 1.5,1.5,and 1.5 at 2,8,and 24 h,respectively(P<0.05).In the ethanol group,the median pre-treatment pain score was 5.5,whereas the post-treatment scores significantly decreased to 2.5,2.5,and 2.5 at 2,8,and24 h,respectively(P<0.01).There was no significant difference in the duration of pain relief between the phenol and ethanol groups.No significant difference was found in the rate of complications between the 2groups;however,burning pain and inebriation occurred only in the ethanol group.CONCLUSION:Phenol had similar pain-relieving effects to ethanol in EUS-CPN.Comparing the incidences of inebriation and burning pain,phenol may be superior to ethanol in EUS-CPN procedures. 相似文献
8.
Denise Wilkes MD PhD ; Natalie Ganceres MD ; Gulshan Doulatram MD ; Daneshvari Solanki MBBS FRCA 《Pain practice》2009,9(2):145-149
Successful pressure ulcer treatment is challenging and is often plagued with prolonged hospitalizations, multiple surgeries, and high recurrence rates. Pressure ulcer secondary to spinal cord injury is further complicated by spasticity, which contributes to both ulcer continuance and healing. This report illustrates the use of neurolytic regional techniques for spasticity control and pressure ulcer healing. Case report: We present our experience with a paraplegic man who suffered from chronic right trochanteric and ischial pressure ulcers that failed to heal despite surgical and conservative treatment. We report the successful treatment of knee and hip flexor spasticity with a femoral and sciatic alcohol neuroablation technique. It was not until the successful control of his lower extremity spasticity that the pressure ulcers showed signs of healing. Neuroablation nay be considered for spasticity control when more conservative approaches fail or are not feasible. 相似文献
9.
目的:明确兔乙醇胫神经阻滞的量效关系。方法:新西兰兔24只,胫神经44条,外周神经电刺激器引导下,行胫神经无水乙醇阻滞。按注射容量分为4组:0.1ml、0.3ml、0.5ml和1.0ml。分别于阻滞前和阻滞后第1、2、4、7天及2、3、4、5、6、7、8周,记录腓肠肌复合肌肉动作电位(CMAP);实验终止时,取胫神经和注射部位肌肉行HE染色,观察组织学损害。结果:小容量0.1ml组CMAP波幅在第1周有所恢复,但第2周作用基本消失(P>0.05),而0.3ml组的作用持续到第8周(P<0.05);大容量组(0.5ml和1.0ml)CMAP波幅降低更明显(P<0.05),但并发症也显著增加。大部分动物(9/15)因并发症死亡,故实验在第4周终止。前4周CMAP波幅降低,除0.3ml与0.5ml组间差异不显著(P>0.05),其他各组间差异显著(P<0.05);组织学示各组出现不同程度神经轴索变性;0.5ml和1.0ml组肌肉局灶性结缔组织增生。结论:兔乙醇胫神经干阻滞的理想有效安全容量是0.3ml/点。 相似文献
10.
《Journal of pain & palliative care pharmacotherapy》2013,27(4):388-390
ABSTRACTA case in which severe neuropathic pain from a chordoma in a 45-year-old Belgian male is presented. Interdisciplinary neurolytic treatment and neuropathic pain pharmacotherapy were initiated and are discussed. Commentaries from pain specialists in Sweden and Italy follow. 相似文献