接受过减重手术以及出现体重快速减轻的患者、[41]Stokes CS, Gluud LL, Casper M, et al. Ursodeoxycholic acid and diets higher in fat prevent gallbladder stones during weight loss: a meta-analysis of randomized controlled trials. Clin Gastroenterol Hepatol. 2014 Jul;12(7):1090-1100.e2http://www.cghjournal.org/article/S1542-3565%2813%2901837-5/fulltexthttp://www.ncbi.nlm.nih.gov/pubmed/24321208?tool=bestpractice.com 接受肠外营养的患者以及需要长期使用生长抑素的患者(原位胆囊患者)是胆结石的高风险人群。胆结石形成的初级预防是改变生活方式:摄取纤维含量高、饱和脂肪含量低的饮食,维持正常体重,再加上适度身体活动。[2]Williams CI, Shaffer EA. Gallstone disease: current therapeutic practice. Curr Treat Options Gastroenterol. 2008 Apr;11(2):71-7.http://www.ncbi.nlm.nih.gov/pubmed/18321433?tool=bestpractice.com[42]Aune D, Leitzmann M, Vatten LJ. Physical activity and the risk of gallbladder disease: a systematic review and meta-analysis of cohort studies. J Phys Act Health. 2016 Jul;13(7):788-95.http://www.ncbi.nlm.nih.gov/pubmed/26901710?tool=bestpractice.com预防性药物疗法采用熊去氧胆酸 (ursodeoxycholic acid, UDCA) 降低胆汁中的胆固醇饱和度,从而降低快速减重的肥胖患者(通过饮食热量限制或减重手术)结石形成的短期风险。[41]Stokes CS, Gluud LL, Casper M, et al. Ursodeoxycholic acid and diets higher in fat prevent gallbladder stones during weight loss: a meta-analysis of randomized controlled trials. Clin Gastroenterol Hepatol. 2014 Jul;12(7):1090-1100.e2http://www.cghjournal.org/article/S1542-3565%2813%2901837-5/fulltexthttp://www.ncbi.nlm.nih.gov/pubmed/24321208?tool=bestpractice.com 由于有限的成功率和较高的复发率,UDCA 对于溶解已经形成的胆结石的价值有限。[43]Venneman NG, Besselink MG, Keulemans YC, et al. Ursodeoxycholic acid exerts no beneficial effect in patients with symptomatic gallstones awaiting cholecystectomy. Hepatology. 2006 Jun;43(6):1276-83.http://www.ncbi.nlm.nih.gov/pubmed/16729326?tool=bestpractice.com 此药物最适合存在小胆结石且有真正症状的非手术偶发患者。
健康的生活方式和饮食、规律的体育活动和保持理想体重可能会预防胆固醇性结石和症状性结石的形成,但是这方面的证据不足。[44]European Association for the Study of the Liver (EASL). EASL clinical practice guidelines on the prevention, diagnosis and treatment of gallstones. J Hepatol. 2016 Jul;65(1):146-81.http://www.journal-of-hepatology.eu/article/S0168-8278(16)30032-0/pdfhttp://www.ncbi.nlm.nih.gov/pubmed/27085810?tool=bestpractice.com