ПЕРВЫЕ РЕЗУЛЬТАТЫ РАДИКАЛЬНЫХ И УСЛОВНО РАДИКАЛЬНЫХ РЕЗЕКЦИЙ ПРИ ОПУХОЛИ КЛАЦКИНА

Relevance: Hilar cholangiocarcinoma is the most common malignant tumor of the bile ducts.Aim: analysis of the first experience of radical and conditionally radical operations performed in MCSC during one year.Materials and methods: Extended hepatectomies combined with resection of bile ducts and first segment performed in 18 patients with Klatskin tumor. Right hemihepatectomy performed in 8 patients, resection with caudal lobectomy – in 8 patients. The preoperative percutaneous right-sided selective portal embolisation using Celonova microspheres was performed in 5 patients. One patient with type II tumor according to Bismuth-Corlette classification underwent hemihepatectomy with a left caudal lobectomy and resection of the extrahepatic bile ducts using laparoscopic approach and DaVinci robotic system.Results: The average volume of intraoperative blood loss was 705±616 ml (range 200 to 2000 ml). Postoperative III and IV grade complications according to Clavien-Dindo classification occurred in 13 patients (72%). Two patients (11%) died postoperatively. The cause of death in both observations was severe sepsis. Patients with R1 and R2-resections undergo adjuvant chemotherapy with no objective signs of progression. Patients with R0-resection are under observation with no signs of progression.Conclusion: Late diagnosis, a high risk of postoperative complications requires a multidisciplinary approach at each stage of the treatment of Klatskin tumor.Актуальность. Воротная холангиокарцинома является наиболее частой из злокачественных опухолей желчных протоков.Цель. Анализ первого опыта радикальных и условно радикальных операций, выполненных в МКНЦ в течение года.Материал и методы. Обширные резекции печени в сочетании с резекцией протоков и первого сегмента выполнены 18 пациентам с опухолью Клацкина. Правосторонняя гемигепатэктомия выполнена 8 пациентам, резекция с каудальной лобэктомией  — 8 пациентам. В предоперационном периоде правосторонняя чрескожная селективная портальная эмболизация микросферами Celonova выполнена 5 пациентам. Одному пациенту со II типом опухоли по Bismuth-Corlette левосторонняя гемигепатэктомия с каудальной лобэктомией и резекцией внепеченочных желчных протоков выполнена лапароскопическим доступом с использованием роботизированного комплекса DaVinci.Результаты. Средний объем интраоперационной кровопотери составил 705±616 мл (200–2000 мл). Послеоперационные осложнения III и V типов согласно классификации послеоперационных осложнений Clavien-Dindo имели место у 13 пациентов (72%). На госпитальном этапе умерло 2 пациента (11%). Причиной летального исхода в обоих наблюдениях явился тяжелый сепсис. Пациентам, оперированным в объеме R1 и R2, проводится химиотерапевтическое лечение. Убедительных данных за прогрессирование заболевания нет. Пациенты, оперированные в объеме R0, находятся под наблюдением без признаков прогрессии.Заключение. Поздняя диагностика, высокий риск осложнений хирургического лечения опухоли Клацкина требует мультидисциплинарного подхода на каждом из этапов лечения. Относительно медленное прогрессирование опухоли по сравнению с другими холангиокарциномами оправдывает агрессивную хирургическую тактику и целесообразность адъювантной химиотерапии при R1, R2 резекциях. Лучшие результаты лечения обеспечивает резекция в объеме R0

2-(2-(4-Methoxyphenyl)furo[3,2-<i>h</i>]quinolin-3-yl)acetic Acid

A simple and efficient protocol for the synthesis of the previously unknown 2-(2-(4-methoxyphenyl)furo[3,2-h]quinolin-3-yl)acetic acid was elaborated. The suggested method is based on the telescoped multicomponent reaction of 8-hydroxyquinoline, 4-methylglyoxal, and Meldrum’s acid. The studied process includes the initial interaction of the starting compounds in MeCN followed by intramolecular cyclization to the target product in refluxing acetic acid. The advantage of this approach is the application of readily available starting materials, atom economy, and a simple work-up procedure. The structure of the synthesized furylacetic acid derivative was proven by 1H, 13C, 2D-NMR, IR spectroscopy, and high-resolution mass spectrometry

Multicomponent Approach to the Synthesis of 4-(1<i>H</i>-indol-3-yl)-5-(4-methoxyphenyl)furan-2(5<i>H</i>)-one

A simple one-pot approach was developed for the synthesis of furan-2(5H)-one derivative containing indole fragments. This method includes the telescoped multicomponent reaction of indole, 4-methoxyphenylglyoxal, and Meldrum’s acid. The synthetic utility of the prepared furan-2(5H)-one was demonstrated by condensation with 4-methoxybenzaldehyde. The advantages of this method include the employment of readily accessible starting materials, atom economy, process simplicity, and the easy isolation of the target products. The structure of the synthesized furanones was confirmed by 1H and 13C-NMR spectroscopy and high-resolution mass spectrometry with electrospray ionization (ESI-HRMS)

4a,7a-Dihydroxy-1-(2-hydroxyethyl)-5-methyl-2′,3′,4a,5′,6′,7a-hexahydrospiro[cyclopenta[<i>b</i>]pyridine-4,4′-pyran]-2,7(1<i>H</i>,3<i>H</i>)-dione

An environment-friendly photochemical approach to the synthesis of 4a,7a-dihydroxy-1-(2-hydroxyethyl)-5-methyl-2′,3′,4a,5′,6′,7a-hexahydrospiro[cyclopenta[b]pyridine-4,4′-pyran]-2,7(1H,3H)-dione from 2-(4-(3-hydroxy-6-methyl-4-oxo-4H-pyran-2-yl)tetrahydro-2H-pyran-4-yl)-N-(2-hydroxyethyl)acetamide was elaborated. The suggested method is based on the ESIPT-promoted contraction of 3-hydroxypyran-4-one fragment followed by intramolecular cyclization of generated in situ α-hydroxy-1,2-diketone intermediate. The distinctive feature of the presented protocol is the employment of water as a solvent for the considered photoreaction. The structure of the obtained photoproduct was confirmed by 1H, 13C-NMR, IR spectroscopy and high-resolution mass spectrometry

4a,7a-Dihydroxy-1-(2-hydroxyethyl)-5-methyl-2&prime;,3&prime;,4a,5&prime;,6&prime;,7a-hexahydrospiro[cyclopenta[b]pyridine-4,4&prime;-pyran]-2,7(1H,3H)-dione

An environment-friendly photochemical approach to the synthesis of 4a,7a-dihydroxy-1-(2-hydroxyethyl)-5-methyl-2&prime;,3&prime;,4a,5&prime;,6&prime;,7a-hexahydrospiro[cyclopenta[b]pyridine-4,4&prime;-pyran]-2,7(1H,3H)-dione from 2-(4-(3-hydroxy-6-methyl-4-oxo-4H-pyran-2-yl)tetrahydro-2H-pyran-4-yl)-N-(2-hydroxyethyl)acetamide was elaborated. The suggested method is based on the ESIPT-promoted contraction of 3-hydroxypyran-4-one fragment followed by intramolecular cyclization of generated in situ &alpha;-hydroxy-1,2-diketone intermediate. The distinctive feature of the presented protocol is the employment of water as a solvent for the considered photoreaction. The structure of the obtained photoproduct was confirmed by 1H, 13C-NMR, IR spectroscopy and high-resolution mass spectrometry

2-(2-(4-Methoxyphenyl)-4,9-dimethyl-7-oxo-7<i>H</i>-furo[2,3-<i>f</i>]chromen-3-yl)acetic Acid

For the first time, we describe a new approach towards the synthesis of previously unknown 2-(2-(4-methoxyphenyl)-4,9-dimethyl-7-oxo-7H-furo[2,3-f]chromen-3-yl)acetic acid. The presented method is based on the multicomponent condensation of 5-hydroxy-4,7-dimethyl-2H-chromen-2-one, 4-methoxyphenylglyoxal and Meldrum’s acid. It was shown that the studied reaction proceeds in two steps including the initial interaction of starting materials in MeCN and the final formation of furylacetic acid moiety in acidic media. The structures of the obtained compound were established by 1H, 13C-NMR spectroscopy and high-resolution mass spectrometry

3-Phenyl-10-(2,3,4-trimethoxyphenyl)-9,10-dihydro-4H,8H-pyrano [2,3-f]chromene-4,8-dione

An efficient telescoped method for synthesis of 3-phenyl-10-(2,3,4-trimethoxyphenyl)-9,10-dihydro-4H,8H-pyrano[2,3-f]chromene-4,8-dione was elaborated. The presented protocol includes the one-pot multicomponent reaction of 7-hydroxy-3-phenyl-4H-chromen-4-one, 2,3,4-trimethoxybenzaldehyde and Meldrum&rsquo;s acid. Advantages of this method are the application of readily available starting reagents, atom economy and easy procedure of preparation and purification of the target product. The structure of the synthesized polycyclic compound was proved by 1H, 13C-NMR, IR spectroscopy and high-resolution mass spectrometry with electrospray ionization (ESI-HRMS)

2-(5-Acetyl-7-methoxy-2-(4-methoxyphenyl)benzofuran-3-yl)acetic Acid

We elaborated a convenient one-step approach for the synthesis of previously unknown 2-(5-acetyl-7-methoxy-2-(4-methoxyphenyl)benzofuran-3-yl)acetic acid. The suggested protocol includes the multicomponent reaction of acetovanillone, 4-methoxyphenylglyoxal and Meldrum&rsquo;s acid. We have demonstrated that the considered reaction is a one-pot telescoped process including the preliminary condensation of the components in MeCN followed by acid-catalyzed cyclization. The structure of the synthesized product was confirmed by 1H, 13C-NMR spectroscopy and high-resolution mass-spectrometry

3-Phenyl-10-(2,3,4-trimethoxyphenyl)-9,10-dihydro-4<i>H</i>,8<i>H</i>-pyrano [2,3-<i>f</i>]chromene-4,8-dione

An efficient telescoped method for synthesis of 3-phenyl-10-(2,3,4-trimethoxyphenyl)-9,10-dihydro-4H,8H-pyrano[2,3-f]chromene-4,8-dione was elaborated. The presented protocol includes the one-pot multicomponent reaction of 7-hydroxy-3-phenyl-4H-chromen-4-one, 2,3,4-trimethoxybenzaldehyde and Meldrum’s acid. Advantages of this method are the application of readily available starting reagents, atom economy and easy procedure of preparation and purification of the target product. The structure of the synthesized polycyclic compound was proved by 1H, 13C-NMR, IR spectroscopy and high-resolution mass spectrometry with electrospray ionization (ESI-HRMS)