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排序方式: 共有1583条查询结果,搜索用时 31 毫秒
1.
电视纵隔镜手术在肺癌分期中的应用价值 总被引:1,自引:0,他引:1
背景与目的 随着新辅助治疗方案的提出,以及人们逐渐认识到CT和PET等检查在肺癌分期中的局限性,纵隔镜手术在肺癌分期中的价值日益受到人们的重视。本研究旨在探讨电视纵隔镜手术在肺癌纵隔淋巴结分期中的应用价值。方法 回顾性总结2001年9月至2004年6月60例经电视纵隔镜检查的肺癌患者的临床资料,其中颈部电视纵隔镜手术52例,胸骨旁电视纵隔镜手术2 例,颈部加胸骨旁电视纵隔镜手术6例。术前所有患者胸部CT均发现纵隔淋巴结肿大(直径大于1.0 cm)。结果 本组60 例患者,经电视纵隔镜检查证实纵隔淋巴结转移(阳性)者42例,未见纵隔淋巴结转移(阴性)者18例。纵隔淋巴结阳性者放弃手术,予以化疗;阴性者中转开胸行肺叶切除或肺楔形切除加纵隔淋巴结清扫,术后病理证实17 例纵隔淋巴结未见转移,1例隆凸后淋巴结可见癌转移(电视纵隔镜检查假阴性)。电视纵隔镜手术敏感性、特异性和准确性分别为97.7%、100%和98.3%。本组术中发生无名动脉撕裂1 例,并发症发生率为1.7%(1/60)。无围手术期死亡。结论 电视纵隔镜手术安全、可靠,可作为明确肺癌分期的常规方法。 相似文献
2.
Summary. The increasing spectrum of therapeutic options for tumors of the gastrointestinal tract has resulted in a refinement of the
pretherapeutic diagnostic strategies. The diagnostic approach in surgical institutions that are focused on primary surgical
resection will therefore be much less sophisticated than in institutions who propose a selective therapeutic approach based
on the pretherapeutic tumor stage and prognostic parameters. Pretherapeutic assessment of the depth of tumor infiltration,
i. e. the T-category, is essential because most further diagnostic and therapeutic decisions are based on this information.
This can today be achieved with a high degree of accuracy by endoscopy and endoscopic ultrasonography. Early T-stages (T1–2)
are usually an indication for primary surgical resection and, after exclusion of distant metastases, no further diagnostic
studies are required. In patients with locally advanced esophageal, gastric or rectum tumors (T3–4) multimodal therapeutic
concepts should be considered. This usually requires additional diagnostic studies. None of the available diagnostic imaging
modalities today allows satisfactory pretherapeutic assessment of lymph node metastases. The assumed nodular status should
therefore currently not influence therapeutic decisions. Essential is, however, the assessment of distant metastases, since
the documentation of distant tumor spread will change the therapeutic approach to a palliative situation. Detailed histologic
and molecular-biologic assessment of tumor characteristics is growing in importance. This not only provides therapeutically
relevant information regarding tumor grading, but opens the door towards a modern molecular diagnostic approach. It can be
expected that in the near future a vast amount of relevant prognostic information can be obtained from endoscopic tumor biopsies,
which may soon alter our therapeutic concepts.
相似文献
3.
4.
Clinical stage I seminomas are effectively treated with surgery raising concerns as to when to give adjuvant radiation therapy given the risk of secondary malignancies. A recent randomized trial found tumor size and rete testis invasion to be the strongest predictors of relapse in clinical stage I seminomas. These 2 parameters may be surrogate measures of tumor volume. Intertubular seminoma (ITS) of the testis describes the presence of neoplastic germ cells within the interstitium of the testis. These cells are detected away from the main macroscopic mass. Because ITS can infiltrate in a 3-dimensional fashion, it may also represent a measure of tumor volume not usually noted in standard pathology reporting. The goal of this study was to determine the incidence of ITS in pure seminomas and its association with other prognostic parameters. One hundred twenty consecutive pure seminomas surgically removed between 1998 and 2003 were evaluated. ITS was defined as the presence of an interstitial or intertubular growth pattern of tumor cells, which was noncontiguous with the main tumor and present at least 3 high-power fields away from the tumor mass. The average tumor size was 3.4 cm. Of the entire cohort of patients, which included pathological stages T1 through T3, 11% had invasion through the tunica albuginea, 51% had rete testis invasion, 51% had lymphovascular invasion, 93% had associated intratubular germ-cell neoplasia, and 36% had ITS. ITS was significantly associated with rete testis invasion ( P = .001). Logistic regression analysis looking at ITS, tumor size, patient age, and lymphovascular invasion revealed that only ITS was associated with rete testis invasion (RR, 4.1, P < .0001). ITS is present in a significant proportion of pure seminomas and has a significant association with rete testis invasion. The presence of ITS may therefore be an important prognostic factor, not only because it alters the calculated size of the tumor but also because it has an association with rete testis invasion. 相似文献
5.
Peter N. Brawn Charles F. Johnson III 《Virchows Archiv : an international journal of pathology》1987,411(5):399-402
Summary Consecutive staging lymphadenectomies on 1046 patients with prostate carcinoma identified 275 patients with metastases in a total of 1115 regional lymph nodes. No prostate carcinomas composed entirely of single malignant glands metastasized and no patient had metastases composed entirely of single malignant glands. All prostate carcinomas that metastasized had cribriform and/or undifferentiated histological patterns in the prostate and in the metastases. These findings suggest that identification of cribriform and/or undifferentiated histological patterns, through rebiopsy or further examination of the surgical specimen, should be considered prior to subjecting patients with prostate carcinomas composed entirely of single malignant glands to therapy or procedures directed against the possibility of metastatic disease. 相似文献
6.
Bernd Niederhagen N. Leipner S. Bergé J.-J. von Lindern T. Appel 《Mund-, Kiefer- und Gesichtschirurgie》2000,4(4):217-221
Problem: There is a lack of clear criteria for the use of MR and CT in the diagnosis of head and neck cancer – some of it
is even contradictory. The results of this study should lead to the establishment of more clear criteria. Patients: 165 patients
suffering from head and neck tumors were subjected to a total of 463 CT and 197 MRI examinations. Results: The CT and MRI
staging corresponded in 67% and 60% of the oropharynx tumors, respectively, with the clinical findings. In the case of oral
cavity tumors, the clinical TNM stages were identical with CT and MRI results in 50% and 43% of cases, respectively. In the
case of lymphatic node staging, the frequency of error was slightly higher using MRI, at 27%, compared with the CT rate of
22%. In the evaluation of cervical lymphatic nodes, CT proved to be more sensitive attaining 78% compared to the MRI rate
of 69%. Conclusion: The results provide clear indications as to the MRI and CT examinations. Primary preoperative screening
and post-therapeutic aftercare should be assessed using CT, as should lymphatic node diagnosis in the neck area. In the case
of special problems such as, for example, the relevant bone and periostium infiltration, MR should be considered as a supplementary
examination at a second stage.
相似文献
7.
A. Schauer M. Droese G. Rahlf 《Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie》1977,345(1):39-44
ZusammenfaBung Die Morphologie und das Entartungsrisiko präcanceröser Veränderungen der Brustdrüse (intraduktale atypische Epithelproliferation, papillomatöse Proliferationen, Carcinoma lobulare in situ) werden besprochen. Das jeweils geeignetste therapeutische Vorgehen (kurzfristige Kontrolle, s. c. Mastektomie, einfache Mastektomie) wird mitgeteilt. Ein kombiniertes intraoperatives histologisches und cytologisches staging durch Untersuchung der axillären Lymphknoten wurde entwickelt. Ergibt sich dabei ein Stadium I, so wird lediglich die einfache Mastektomie durchgeführt. Im Stadium II wird nach Rotter-Halsted mit präziser Ausräumung auch der Apex und der interpektoralen Lymphknoten operiert. 相似文献
8.
目的:探讨纵隔镜手术在肺癌纵隔淋巴结分期中的应用价值.方法:回顾性总结1999年11月至2003年7月69例经纵隔镜检查肺癌患者的临床资料,其中颈部纵隔镜手术57例,胸骨旁纵隔镜手术7例,颈部加胸骨旁纵隔镜手术5例.术前所有患者胸部CT均发现纵隔淋巴结肿大(最小直径大于1.0cm).结果:本组69例患者,经纵隔镜检查证实纵隔淋巴结转移(阳性)者50例,未见纵隔淋巴结转移(阴性)者19例.阳性者放弃手术,予以化疗.阴性者中15例中转开胸行肺叶切除或肺楔型切除加纵隔淋巴结清扫,术后病理证实14例纵隔淋巴结未见转移,1例隆突后淋巴结可见癌转移(纵隔镜检查假阴性).纵隔镜手术敏感性、特异性和准确性分别为98.0%、100%和98.5%.全组术后发生声音嘶哑1例,并发症发生率为1.4%(1/69).无围手术期死亡.结论:纵隔镜手术安全、可靠,可作为明确肺癌分期的常规方法. 相似文献
9.
新的肺癌国际分期与预后 总被引:5,自引:0,他引:5
目的 探讨修订后的肺癌国际分期的合理性与预后的关系。方法 回顾性分析中国医学科学院肿瘤医院1961年1月~1988年12月外科手术切除的946例肺癌患者临床资料,选取29个可能对预后有影响的变量输入计算机,用生命表法(Life-table)分别计算修订前后两种P-TNM分期的生存率,Log-Rank统计分析进行显著性检验,Cox模型预后分析来综合评价众多预后因素对生存的影响,从而评价修订后肺癌TN 相似文献
10.
目的 探讨血管内皮生长因子 (VEGF)及其受体 (KDR)与上皮性卵巢癌发展的关系。方法 用免疫组化方法检测 4 5例人上皮性卵巢癌中VEGF及KDR的表达 ,分析VEGF及KDR表达与卵巢癌FIGO分期、淋巴结转移及预后的关系。结果 4 5例上皮性卵巢癌中 ,VEGF、KDR表达阳性率分别为 73.3% (33/ 4 5 )、5 7.8% (2 6 / 4 5 )。Ⅲ~Ⅳ期卵巢癌VEGF表达阳性率 (94 .4 % ,17/ 18)高于Ⅰ~Ⅱ期卵巢癌 (5 9.3% ,16 / 2 7)。淋巴结转移阳性组中VEGF表达阳性率 (10 0 % ,12 / 12 )高于淋巴结转移阴性组 (16 / 2 6 ,6 1.5 % ) ,(P <0 .0 5 )。VEGF表达阴性者生存率高于VEGF表达阳性者 (P =0 .0 4 7)。不同组织学类型上皮性卵巢癌中VEGF表达无明显差异。KDR表达与卵巢癌分期、淋巴转移及预后无关。结论 VEGF与上皮性卵巢癌发展有关。 相似文献