目的观察多西他赛+氟尿嘧啶(5-Fu)静脉滴注全身化疗和腹腔内灌注顺铂局部化疗及热疗治疗晚期胃癌伴腹水的疗效及不良反应。方法 56例晚期胃癌合并癌性腹水患者采用联合静脉滴注多西他赛+持续静脉滴注5-Fu全身化疗和腹腔内灌注顺铂局部化疗并予局部热疗方案治疗;治疗2~6个周期,每2个周期后评价疗效、临床受益及不良反应。结果 56例均可评价疗效,其中完全缓解(CR)12例(21.4%),部分缓解(PR)23例(41.1%),总有效率(RR)为62.5%,肿瘤进展时间(TTP)为8.7个月,中位生存期(OS)为13.4个月。腹水CR 15例(26.7%),PR 28例(50.0%),RR为76.7%。主要不良反应为骨髓抑制、消化道反应和口腔黏膜炎,其中Ⅲ~Ⅳ度白细胞及血小板下降率为19.6%,Ⅲ~Ⅳ度血小板下降率为7.1%,Ⅰ~Ⅱ度恶心呕吐、腹泻腹痛的发生率为58.9%,Ⅲ~Ⅳ度为5.4%。无治疗相关性死亡。结论静脉化疗(多西他赛+5-Fu)和腹腔化疗(顺铂)的改良DCF方案及热疗是治疗晚期胃癌伴腹水的有效手段,不良反应可以耐受,值得临床进一步研究。 Objective To observe the curative effect and adverse reactions of docetaxel + 5-fluorouracil intravenous infusion of systemic chemotherapy and intraperitoneal chemotherapy of cisplatin and hyperthermia in the treatment of advanced gastric cancer with ascites. Methods Fifty-six patients with advanced gastric cancer with cancerous ascites were treated with combined intravenous infusion of docetaxel plus continuous 5-Fu systemic chemotherapy and intraperitoneal chemotherapy with cisplatin and local hyperthermic regimen. The treatment ranged from 2 to 6 Period, every 2 cycles after the evaluation of efficacy, clinical benefit and adverse reactions. Results Fifty-six cases (21.4%) had complete remission (CR), 23 cases (41.1%) had partial remission (PR), the total effective rate was 62.5% and the TTP was At 8.7 months, the median OS was 13.4 months. Ascites CR 15 cases (26.7%), PR 28 cases (50.0%), RR was 76.7%. The main adverse reactions were myelosuppression, digestive tract reaction and oral mucositis. The rates of leukocyte and platelet drop were 19.6%, Ⅲ ~ Ⅳ, and 7.1% respectively. The grade Ⅱ ~ Ⅱ nausea and vomit, diarrhea and abdominal pain The incidence was 58.9%, Ⅲ ~ Ⅳ degree was 5.4%. No treatment-related deaths. CONCLUSION: Modified DCF regimen and hyperthermia with intravenous chemotherapy (docetaxel + 5-Fu) and intraperitoneal chemotherapy (cisplatin) are effective methods for the treatment of advanced gastric cancer with ascites. Adverse reactions are tolerable and worth further clinical study.