Objective To compare the effects of three kinds digestive tract reconstruction after radical gas-trectomy for gastric cardia carcinoma.Methods The data of 150 patients underwent radical gastrectomy for gastric cardia cancer patients were analyzed.According to the reconstruction of digestive tract,they were divided into group A (55 cases),group B (46 cases),group C(49 cases).Patients in group A underwent jejunal anastomosis.Patients in group B underwent esophageal empty intestine Roux-en-Y anastomosis.Patients in group C underwent esophageal gas-tric wall anastomosis.All were follow-up for 12 months.Results During the follow-up period,the rate of reflux esoph-agitis in group A were significantly lower than that in B group (1.82%vs 19.57%,χ2 =6.966,P=0.008),the rate of reflux esophagitis in B group were significantly lower than that in C group (19.57%vs 38.78%,χ2 =4.212,P=0.042) .12 months after operation,overall health,constipation,diarrhea,nausea and vomiting index score of group A was significantly lower than those of group B and group C (all P<0.05).Conclusion The esophagus jejunum Roux-en-Y anastomosis is suitable for radical total gastrectomy in the treatment of gastric cardia carcinoma.The jeju-nal interposition anastomosis after proximal radical gastrectomy in the treatment of gastric cardia carcinoma shows low incidence of reflux esophagitis and high quality of life.

OBJECTIVE：To systematically evaluate the efficacy an d s afety of apatinib combined with transcatheter arterial chemoembolization（TACE）in the treatment of moderate and advanced liver cancer ，and to provide evidence-based reference for rational drug use in the clinic. METHODS ：Retrieved from Cochrane Library ，Embase，PubMed，Web of Science ，SinoMed， CNKI，Wanfang，VIP database ，RCTs about apatinib combined with TACE （trial group ）versus TACE （control group ）in the treatment of moderate and advanced liver cancer were collected from inception to Sep. 2019. After screening the literature and extracting the data ，the quality of included literatures was evaluated by using bias risk assessment tool recommended by the Cochrane system evaluator manual 5.1.0 and the modified Jadad scale. Meta-analysis was carried out by using Stata 12.0 software. RESULTS：Totally 16 RCTs were included ，involving 1 043 patients. Results of Meta-analysis showed that objective response rate [OR ＝3.10，95％CI（2.38，4.03），P＜0.001]，disease control rate [OR ＝3.56，95％CI（2.62，4.83），P＜0.001] and survival rate [OR ＝2.40，95％ CI（1.86，3.10），P＜0.001]，the incidence of diarrhea [OR ＝2.27，95％ CI（1.21，4.24），P＝0.011]， hypertension [OR ＝6.97，95％ CI（1.21，40.15），P＝0.030]， proteinuria [OR ＝12.44，95％CI（2.51，61.71），P＝0.002] and com hand foot syndrome [OR ＝32.50，95％CI（12.03，87.77），P＝ 0.001] of trial group were significantly higher than those of control group. The serum level of VEGF [SMD ＝－ 3.64， 95％CI（－5.06，－2.22），P＜0.001]，MMP-9 [SMD＝－3.21，95％CI（－4.31，－2.10），P＜0.001]，AFP [SMD ＝－3.54， 95％CI（－7.03，－0.06），P＝0.046] after treatment ，the incidence of myelosuppression [OR ＝0.61，95％CI（0.39，0.97），P＝ 0.035]，fever [OR ＝0.63，95％CI（0.42，0.95），P＝0.027]，nausea and vomiting [OR ＝0.70，95％CI（0.51，0.97），P＝0.030] in trial group were significantly lower than those of control group. There was no statistical significance in the incidence of abdominal pain [OR ＝0.87，95％CI（0.54，1.39），P＝0.547] and skin itching [OR ＝1.63，95％CI（0.36，7.50），P＝0.530] between 2 groups. CONCLUSIONS：Apatinib combined with TACE can significantly improve clinical efficacy ，prolong survival time ，reduce tumor recurrence and metastasis. It can reduce the occurrence of related ADR as diarrhea after TACE ，but increase the occurrence of apatinib-related ADR as myelosuppression.