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| 1 | Chinese medicines for prevention and treatment of human hepatocellular carcinoma: current progress on pharmacological actions and mechanisms显示文摘Hepatocellular carcinoma(HCC) is one of leading causes of death in the world. Although various treatments have been developed, the therapeutic side effects are far from desirable. Chinese medicines(CMs, including plants, animal parts and minerals) have drawn a great deal of attention in recent years for their potential in the treatment of HCC. Most studies have shown that CMs may be able to retard HCC progression with multiple actions, either alone or in combination with other conventional therapies to improve quality of life in HCC patients. Additionally, CMs are used for preventing HCC occurrence. The aim of this study is to review the potential prophylactic and curative effects of CMs on human HCC and the possible mechanisms that underlie these pharmacological actions. Publications were collected and reviewed from Pub Med and China National Knowledge Infrastructure from 2000 to 2014. Keywords for literature searches include 'Chinese medicine', 'Chinese herb', 'traditional Chinese Medicine', 'hepatocellular carcinoma' and 'liver cancer'. CMs in forms of pure compounds, isolated fractions, and composite formulas are included. Combination therapies are also considered. Both in vitro and in vivo efficacies of CMs are being discussed and the translational potential to bedside is to be discussed with clinical cases, which show the actions of CMs on HCC may include tumor growth inhibition, antimetastatic activities, anti-inflammation, anti-liver cancer stem cells, reversal on multi-drug resistance and induction/reduction of oxidative stress. Multiple types of molecules are found to contribute in the above actions. The review paper indicated that CMs might have potential to both prevent HCC occurrence and retard HCC progression with several molecular targets involved. | Xuanbin Wang Ning Wang Fan Cheung Lixing Lao Charlie Li Yibin Feng | 2015 | Journal of Integrative Medicine2015，13，3： | 33 |
| 2 | High-intensity focused ultrasound ablation:An effective bridging therapy for hepatocellular carcinoma patients显示文摘AIM:To analyze whether high-intensity focused ultrasound(HIFU) ablation is an effective bridging therapy for patients with hepatocellular carcinoma(HCC).METHODS:From January 2007 to December 2010,49 consecutive HCC patients were listed for liver transplantation(UCSF criteria).The median waiting time for transplantation was 9.5 mo.Twenty-nine patients received transarterial chemoembolization(TACE) as a bringing therapy and 16 patients received no treatment before transplantation.Five patients received HIFU ablation as a bridging therapy.Another five patients with the same tumor staging(within the UCSF criteria) who received HIFU ablation but not on the transplant list were included for comparison.Patients were comparable in terms of Child-Pugh and model for end-stage liver disease scores,tumor size and number,and cause of cirrhosis.RESULTS:The HIFU group and TACE group showed no difference in terms of tumor size and tumor number.One patient in the HIFU group and no patient in the TACE group had gross ascites.The median hospital stay was 1 d(range,1-21 d) in the TACE group and two days(range,1-9 d) in the HIFU group(P < 0.000).No HIFU-related complication occurred.In the HIFU group,nine patients(90%) had complete response and one patient(10%) had partial response to the treatment.In the TACE group,only one patient(3%) had response to the treatment while 14 patients(48%) had stable disease and 14 patients(48%) had progressive disease(P = 0.00).Seven patients in the TACE group and no patient in the HIFU group dropped out from the transplant waiting list(P = 0.559).CONCLUSION:HIFU ablation is safe and effective in the treatment of HCC for patients with advanced cirrhosis.It may reduce the drop-out rate of liver transplant candidate. | Tan To Cheung Sheung Tat Fan See Ching Chan Kenneth SH Chok Ferdinand SK Chu Caroline R Jenkins Regina CL Lo James YY Fung Albert CY Chan William W Sharr Simon HY Tsang Wing Chiu Dai Ronnie TP Poon Chung Mau Lo | 2013 | World Journal of Gastroenterology2013，19，20： | 23 |
| 3 | Reduced Macular Vascular Density in Myopic Eyes显示文摘 | Hua Fan Hao-Yu Chen Hong-Jie Ma Zheng Chang Hai-Quan Yin Danny Siu-Chun Ng Carol Y Cheung Shan Hu Xiang Xiang Shi-Bo Tang Shuang-Nong Li | 2017 | Chinese Medical Journal2017，，4： | 17 |
| 4 | Combined resection and radiofrequency ablation for multifocal hepatocellular carcinoma: Prognosis and outcomes显示文摘AIM: To analyze the combined treatment of resection and intraoperative radiofrequency ablation (RFA) for multifocal hepatocellular carcinoma in terms of prognosis and surgical outcomes.METHODS: This study was a retrospective case comparison study using prospectively collected data. The study covered the period from April 2001 to December 2006. The data of 200 patients with histologically confirmed hepatocellular carcinoma were reviewed. Nineteen patients (17 men and 2 women) having received resection in combination with RFA were chosen as subjects of the study (the combination group). Fiftyfour patients (43 men and 11 women) having received resection alone were selected for comparison (the resection group). The two groups matched tumor number and tumor size, and all the patients in the two groups displayed no tumor rupture, major vascular involvement and distant metastasis. Their demographics, preoperative assessment, disease recurrence patterns, overall survival and diseasefree survival were compared.RESULTS: In the combination group, the medianage was 65 years (range, 3477 years), the median tumor number was 3 (range, 29), and the median tumor size was 6 cm (range, 1.214 cm). In the resection group, the median age was 51.5 years (range, 2780 years, P = 0.003), the median tumor number was 3 (range, 29, P = 0.574), and the median tumor size was 6 cm (range, 114 cm, P = 0.782). The two groups were similar in characteristics of tumors and comorbidities, and had comparable results in preoperative liver function tests. All patients had ChildPugh class A status. Bilobar involvement occurred in 14 patients (73.6%) in the combination group and 3 patients (5.5%) in the resection group (P = 0.04). Six patients (32%) in the combination group and 35 patients (65%) in the resection group underwent major hepatectomy. Thirteen patients (68%) in the combination group and 19 patients (35%) in the resection group underwent minor hepatectomy (P = 0.012). The combination group had fewer major resections (32% vs 65%, P = 0.012), less blood loss (400 vs 657 mL, P = 0.007), shorter operation time (270 vs 400 min, P = 0.001), and shorter hospital stay (7 vs 8.5 d, P = 0.042). The two groups displayed no major differences in surgical complications (15.8% vs 31.5%, P = 0.24), disease recurrence (63.2% vs 50%, P = 0.673), hospital mortality (5.3% vs 5.6%, P = 1), and overall survival (53 vs 44.5 mo, P = 0.496).CONCLUSION: Safe and effective for selected patients with multifocal hepatocellular carcinoma, the combination of resection and intraoperative RFA widens the applicability of surgical intervention for the disease. | Tan To Cheung Kelvin K Ng Kenneth S Chok See Ching Chan Ronnie T Poon Chung Mau Lo Sheung Tat Fan | 2010 | World Journal of Gastroenterology2010，16，24： | 14 |
| 5 | Mechanism of metastasis by membrane type 1-matrix metalloproteinase in hepatocellular carcinoma显示文摘AIM: To investigate the precise role of membrane type1-matrix metalloproteinase (MT1-MMP) in hepatocellular carcinoma (HCC) metastasis.METHODS: Human HCC cells Hep3B with overexpression of MT1-MMP were established by stable transfection, and compared with control cells carrying the empty vector.Cells were examined in vivo for their differences in the metastatic ability of athymic nude mice, and analyzed in vitro for their differences in invasion ability by invasion chamber coated with Matrigel, adhesion towards collagen I and migration through culture chamber. Cell proliferation and apoptosis in adherent and suspension status were evaluated by MTT and flow cytometry analysis.RESULTS: We found that overexpression of MT1-MMP could increase intrahepatic metastasis in nude mice with orthotopic implantation of HCC cells (incidence of 100%[MT1-MMP transfectants] vs 40% [vector control transfectants], P<0.05). MT1-MMP could also enhance cell invasion through Matrigel (107.7 vs 39.3 cells/field,P<0.001), adhesion towards matrix (0.30 vs 0.12absorbance unit at 540 nm, P<0.001), cell migration(89.3 vs 39.0 cells/field, P<0.001), and cell proliferation(24.3 vs 40.5 h/doubling, P<0.001). We also observed that MT1-MMP supported cell survival (71.4% vs 23.9%,P<0.001) with reduced apoptosis (43.7% vs51.0%, P<0.05)in an attachment-free environment.CONCLUSION: MT1-MMP overexpression could enhance metastasis. In addition to its active role in matrix degradation during tumor invasion, MT1-MMP enhances tumor cell survival upon challenge of detachment, which is important during metastasis when cells enter the circulation. | Ying-Chi Ip Siu-Tim Cheung Ka-Ling Leung Sheung-Tat Fan | 2005 | World Journal of Gastroenterology2005，11，40： | 11 |
| 6 | Pancreaticoduodenectomy with vascular reconstruction for adenocarcinoma of the pancreas with borderline resectability显示文摘AIM:To analyze whether pancreaticoduodenectomy with simultaneous resection of tumor-involved vessels is a safe approach with acceptable patient survival.METHODS:Between January 2001 and March 2012,136 patients received pancreaticoduodenectomy for adenocarcinoma at our hospital.Seventy-eight patients diagnosed with pancreatic head carcinoma were included in this study.Among them,46 patients received standard pancreaticoduodenectomy(group 1)and32 patients received pancreaticoduodenectomy with simultaneous resection of the portal vein or the superior mesenteric vein or artery(group 2)followed by reconstruction.The immediate surgical outcomes and survivals were compared between the groups.Fifty-five patients with unresectable adenocarcinoma of the pancreas without liver metastasis who received only bypassoperations(group 3)were selected for additional survival comparison.RESULTS:The median ages of patients were 67 years(range:37-82 years)in group 1,and 63 years(range:35-86 years)in group 2.All group 2 patients had resection of the portal vein or the superior mesenteric vein and three patients had resection of the superior mesenteric artery.The pancreatic fistula formation rate was21.7%(10/46)in group 1 and 15.6%(5/32)in group2(P=0.662).Two hospital deaths(4.3%)occurred in group 1 and one hospital death(3.1%)occurred in group 2(P=0.641).The one-year,three-year and five-year overall survival rates in group 1 were 71.1%,23.6%and 13.5%,respectively.The corresponding rates in group 2 were 70.6%,33.3%and 22.2%(P=0.815).The one-year survival rate in group 3 was13.8%.Pancreaticoduodenectomy with simultaneous vascular resection was safe for pancreatic head adenocarcinoma.CONCLUSION:The short-term and survival outcomes with simultaneous resection were not compromised when compared with that of standard pancreaticoduodenectomy. | Tan To Cheung Ronnie TP Poon Kenneth SH Chok Albert CY Chan Simon HY Tsang Wing Chiu Dai See Ching Chan Sheung Tat Fan Chung Mau Lo | 2014 | World Journal of Gastroenterology2014，20，46： | 8 |
| 7 | Rapid measurement of indocyanine green retention by pulse spectrophotometry: a validation study in 70 patients with Child-Pugh A cirrhosis before hepatectomy for hepatocellular carcinoma显示文摘BACKGROUND: The indocyanine green (ICG) retention test is the most popular liver function test for selecting patients for major hepatectomy. Traditionally, it is done using spectrophotometry with serial blood sampling. The newly- developed pulse spectrophotometry is a faster alternative, but its accuracy on Child-Pugh A cirrhotic patients undergoing hepatectomy for hepatocellular carcinoma has not been well documented. This study aimed to assess the accuracy of the LiMON , one of the pulse spectrophotometry systems, in measuring preoperative ICG retention in these patients and to devise an easy formula for conversion of the results so that they can be compared with classical literature records where ICG retention was measured by the traditional method. METHODS: We measured the liver function of 70 Child-Pugh A cirrhotic patients before hepatectomy for hepatocellular carcinoma from September 2008 to January 2009. ICG retention at 15 minutes measured by traditional spectrophotometry (ICGR15) was compared with ICG retention at 15 minutes measured by the LiMON (ICGR15(L)). RESULTS: The median ICGR15 was 14.7% (5.6%-32%) and the median ICGR15(L) was 10.4% (1.2%-28%). The mean difference between them was -4.3606. There was a strong correlation between ICGR15 and ICGR15(L) (correlation coefficient, 0.844; 95% confidence interval, 0.762-0.899). The following formula was devised: ICGR15=1.16×ICGR15(L)+2.73.CONCLUSIONS: The LiMON provides a fast and repeatable way to measure ICG retention at 15 minutes, but with constant underestimation of the real value. Therefore, when comparing results obtained by traditional spectrophotometry and the LiMON, adjustment of results from the latter is necessary, and this can be done with a simple mathematical calculation using the above formula. | Tan To Cheung See Ching Chan Kenneth SH Chok Albert CY Chan Wan Ching Yu Ronnie TP Poon Chung Mau Lo Sheung Tat Fan | 2012 | Hepatobiliary & Pancreatic Diseases International2012，11，3： | 8 |
| 8 | Survival outcomes of right-lobe living donor liver transplantation for patients with high Model for End-stage Liver Disease scores显示文摘BACKGROUND: Controversy exists over whether living donor liver transplantation (LDLT) should be offered to patients with high Model for End-stage Liver Disease (MELD) scores. This study tried to determine whether a high MELD score would result in inferior outcomes of right-lobe LDLT. METHODS: Among 411 consecutive patients who received right-lobe LDLT at our center, 143 were included in this study. The patients were divided into two groups according to their MELD scores: a high-score group (MELD score ≥25; n=75) and a low-score group (MELD score <25; n=68). Their demographic data and perioperative conditions were compared. Univariable and multivariable analyses were performed to identify risk factors affecting patient survival. RESULTS: In the high-score group, more patients required preoperative intensive care unit admission (49.3% vs 2.9%; P<0.001), mechanical ventilation (21.3% vs 0%; P<0.001), or hemodialysis (13.3% vs 0%; P=0.005); the waiting time before LDLT was shorter (4 vs 66 days; P<0.001); more blood was transfused during operation (7 vs 2 units; P<0.001); patients stayed longer in the intensive care unit (6 vs 3 days; P<0.001) and hospital (21 vs 15 days; P=0.015) after transplantation;more patients developed early postoperative complications (69.3% vs 50.0%; P=0.018); and values of postoperative peak blood parameters were higher. However, the two groups had comparable hospital mortality. Graft survival and patient overall survival at one year (94.7% vs 95.6%; 95.9% vs 96.9%), three years (91.9% vs 92.6%; 93.2% vs 95.3%), and five years (90.2% vs 90.2%; 93.2% vs 95.3%) were also similar between the groups. CONCLUSIONS: Although the high-score group had signifi-cantly more early postoperative complications, the two groups had comparable hospital mortality and similar satisfactory rates of graft survival and patient overall survival. Therefore, a high MELD score should not be a contraindication to right-lobe LDLT if donor risk and recipient benefit are taken into full account. | Kenneth SH Chok See Ching Chan James YY Fung Tan To Cheung Albert CY Chan Sheung Tat Fan Chung Mau Lo | 2013 | Hepatobiliary & Pancreatic Diseases International2013，12，3： | 6 |
| 9 | Improved anterior hepatic transection for isolated hepatocellular carcinoma in the caudate显示文摘BACKGROUND: One of the best treatments for isolated hepatocellular carcinoma in the caudate lobe is major hepatectomy with caudate lobectomy, but it is not suitable for patients with poor liver function reserve. Isolated caudate lobectomy, which is a very difficult operation, is thus an alternative option.METHODS: Here we report an isolated caudate lobectomy with an anterior approach in the treatment of a large hepatocellular carcinoma with underlying cirrhosis, with focus on the technical aspects.RESULTS: In the operation, both the left and right lobes of the liver were mobilized. Hepatotomy was done along the round ligament where parenchymal transection was minimal. After exposure of the left and middle hepatic veins and the hilar plate the caudate lobe and the tumor were resected en bloc with a5-mm margin.CONCLUSION: Isolated caudate lobectomy can be performed safely with this anterior approach on patients with poor liver function reserve. | TanTo Cheung WaiKey Yuen Ronnie TP Poon SeeChing Chan Sheung Tat Fan Chung Mau Lo | 2014 | Hepatobiliary & Pancreatic Diseases International2014，13，2： | 6 |
| 10 | Modulation of graft vascular inflow guided by flowmetry and manometry in liver transplantation显示文摘BACKGROUND:Survival of the partial graft after living donor liver transplantation owes much to its tremendous regenerative ability.With excellent venous outflow capacity,a graft within a wide range of graft-to-standard-liver-volume ratios can cope with portal hypertension that is common in liver transplant recipients.However,when the ratio range is exceeded,modulation of graft vascular inflow becomes necessary for graft survival.The interplay between graft-to-standard-liver-volume ratio and portal pressure,in the presence of portosystemic shunt or otherwise,requires individualized modulation of graft portal and arterial inflows.Boosting of portal inflow by shunt ligation can be guided by transonic flowmetry,whereas muting of portal inflow by splenic artery ligation can be monitored by portal electronic manometry.METHOD:We describe four cases to illustrate the above.RESULTS:One patient had hepatic artery thrombosis resulting from splenic artery steal syndrome which was the sequela of small-for-size syndrome.Emergency splenic artery ligation and re-anastomosis of the hepatic artery successfully muted the portal inflow and boosted the hepatic arterial inflow.Another patient with portal vein thrombosis underwent thrombendvenectomy.Portal inflow was boosted with ligation of portosystemic shunt,which is often present in these patients with portal hypertension.The coexistence of splenic aneurysm and splenorenal shunt required ligation of both in the third patient.The fourth patient,with portal pressure and flow monitoring,avoided ligation of a coronary vein which became a main portal inflow after portal thrombendvenectomy.CONCLUSION:Management of graft inflow modulation guided selectively by transonic flowmetry or portal manometry was described. | See Ching Chan Chung Mau Lo Kenneth SH Chok William W Sharr Tan To Cheung Simon HY Tsang Albert CY Chan Sheung Tat Fan | 2011 | Hepatobiliary & Pancreatic Diseases International2011，10，6： | 5 |
| 11 | A case of laparoscopic hepatectomy for recurrent hepatocellular carcinoma显示文摘Conventional hepatectomy is an effective way to treat hepatocellular carcinoma.However,it is invasive and stressful.The use of laparoscopy in hepatectomy,while technically demanding,reduces surgical invasiveness and stressfulness but still achieves complete resection with adequate margins.Compared with conventional hepatectomy,laparoscopic hepatectomy provides a better chance and situation for further surgery in the case of recurrence of hepatocellular carcinoma.Even aged patients can successfully endure repeated hepatectomy using laparoscopy,as shown in the present report.This report presents a case of repeated laparoscopic hepatectomy treating hepatocellular carcinoma and its recurrence in an aged patient having cirrhosis,a disease causing extra difficulty for performing laparoscopic hepatectomy.The report also describes techniques of the operation and displays characteristic results of laparoscopic hepatectomy such as smaller wounds,less blood loss,less pain,less scars and adhesion,shorter postoperative hospital stay,and faster recovery. | Tan To Cheung Kelvin Kwok-chai Ng Ronnie Tung-ping Poon See Ching Chan Chung Mau Lo Sheung Tat Fan | 2010 | World Journal of Gastroenterology2010，16，4： | 5 |
| 12 | Surgical Outcomes in Hepatocellular Carcinoma Patients with Portal Vein Tumor Thrombosis显示文摘 | Kenneth S. H. Chok Tan To Cheung See Ching Chan Ronnie T. P. Poon Sheung Tat Fan Chung Mau Lo | 2014 | World Journal of Surgery2014，，2： | 4 |
| 13 | High-intensity focused ultrasound ablation as a bridging therapy for hepatocellular carcinoma patients awaiting liver transplantation显示文摘The scarcity of liver grafts in Asia leads to a significant dropout of patients from liver transplant waiting lists, particularly patients with hepatocellular carcinoma and a low model for end-stage liver disease score. In order to reduce dropping out, different bridging therapies are employed. We report the use of high-intensity focused ultrasound ablation as a bridging therapy for a patient with hepatocellular carcinoma of stage two and an extremely low platelet count (20×10 9 /L). The ablation was successful. Blood tests showed that his liver function was similar before and after the treatment. No adhesion was encountered in the liver transplantation performed six months later. | Tan To Cheung Kenneth SH Chok Regina CL Lo William W Sharr See Ching Chan Ronnie TP Poon Sheung Tat Fan Chung Mau Lo | 2012 | Hepatobiliary & Pancreatic Diseases International2012，11，5： | 3 |
| 14 | Long-Term Survival Analysis of Pure Laparoscopic Versus Open Hepatectomy for Hepatocellular Carcinoma in Patients With Cirrhosis: A Single-Center Experience显示文摘 | Tan To Cheung Ronnie T. P. Poon Wai Key Yuen Kenneth S. H. Chok Caroline R. Jenkins See Ching Chan Sheung Tat Fan Chung Mau Lo | 2013 | Annals of Surgery2013，，3： | 3 |
| 15 | Single-incision versus conventional laparoscopic colectomy for colonic neoplasm: a randomized, controlled trial显示文摘 | Jensen Poon Chi-Wai Cheung Joe Fan Oswen Lo Wai-Lun Law | 2012 | Surgical Endoscopy2012，，10： | 2 |
| 16 | Anterior Approach Versus Conventional Approach Right Hepatic Resection for Large Hepatocellular Carcinoma: A Prospective Randomized Controlled Study显示文摘 | Chi Leung Liu Sheung Tat Fan Siu Tim Cheung Chung Mau Lo Irene O. Ng John Wong | 2006 | Annals of Surgery2006，，2： | 2 |
| 17 | Bile duct anastomotic stricture after adult‐to‐adult right lobe living donor liver transplantation显示文摘 | Kenneth Siu Ho Chok See Ching Chan Tan To Cheung William Wei Sharr Albert Chi Yan Chan Chung Mau Lo Sheung Tat Fan | 2011 | Liver Transpl2011，，1： | 2 |
| 18 | Risk Factors and Prognostic Factors of Local Recurrence after Radiofrequency Ablation of Hepatocellular Carcinoma显示文摘 | Vincent Wai-To Lam Kelvin Kwok-Chai Ng Kenneth Siu-Ho Chok Tan-To Cheung Jimmy Yuen Helen Tung Wai-Kuen Tso Sheung-Tat Fan Ronnie T.P. Poon | 2008 | Journal of the American College of Surgeons2008，，1： | 2 |
| 19 | The impact of family history of hepatocellular carcinoma on its patients' survival显示文摘BACKGROUND:Family history of hepatocellular carcinoma(HCC) has been identified as a risk factor for the development of the disease.The aim of this study is to evaluate the impact of such a history on HCC patients' survival.METHODS:Data of all HCC patients(n=4532) managed at our center from 1989 to 2008 were prospectively collected.The patients were quizzed on their various characteristics including family HCC history.RESULTS:Totally 475(10.48%) patients had a family history of HCC.They presented the disease at a significantly earlier age(median 53 vs 59 years,P<0.0001) and at an earlier stage(the United Network for Organ Sharing staging system).They had significantly better liver function in terms of ChildPugh classification and serum albumin and bilirubin levels.Significantly more of them presented the disease without symptoms(44.0% vs 29.4%,P<0.0001).They also had significantly better overall survival under these specifications:patients in the whole study cohort,patients who had minor hepatectomy,patients with stage I disease,patients with stage II disease,and patients with stage III disease.CONCLUSIONS:Contrary to what is generally believed,we found in this study cohort that patients with a family history of HCC had better overall survival than those without such a history.We believe this was in part due to earlier diagnosis of the disease and better liver function in this group of patients.However,the effects of genetic factors on the risk of HCC cannot be overlooked and are yet to be identified. | Wing Chiu Dai Sheung Tat Fan Tan To Cheung Kenneth SH Chok Albert CY Chan Simon HY Tsang Ronnie TP Poon Chung Mau Lo | 2012 | Hepatobiliary & Pancreatic Diseases International2012，11，2： | 2 |
| 20 | Technical note on complete excision of choledochal cysts显示文摘BACKGROUND: Choledochal cysts are congenital cystic dilatations of the extrahepatic or intrahepatic portion of the biliary tree. Complete excision of choledochal cysts is currently regarded as the gold standard treatment, while less extensive procedures including cystoduodenostomy have become obsolete due to the potential for malignant change in the remnant cyst. For type-1 choledochal cysts, which sometimes extend to the main pancreatic duct closely, some surgeons may adopt a less aggressive approach in order to avoid damage to the main pancreatic duct as such damage can lead to serious consequences. However, incomplete excision of choledocha cysts may also cause problems. METHOD: Here we report on a reoperation treating incomplete excision of a choledochal cyst with focus on the technical aspect. RESULTS: In the reoperation, meticulous dissection of the live hilum which had been previously operated on was performed The hepaticojejunostomy was left intact. With the assistance o intraoperative cholangiography, the residual pancreatic portion of the choledochal cyst was completely excised. The pancreatic opening and the lower end of the common bile duct were reconstructed. Whipple operation was avoided. CONCLUSION: Careful planning with the aid of precise imaging before and during the operation largely enhanced the accuracy of the excision of the choledochal cyst. | Tan To Cheung Sheung Tat Fan | 2013 | Hepatobiliary & Pancreatic Diseases International2013，12，2： | 2 |
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