有胆石症发生高风险的人群包括:
接受过减重手术以及出现体重快速下降的患者(胆囊在位)[22]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):1090-100.
https://www.cghjournal.org/article/S1542-3565(13)01837-5/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/24321208?tool=bestpractice.com
接受肠外营养的患者
长期使用生长抑素的者。
一级预防从预防胆石症开始,这需要改变生活方式:摄取纤维含量高、饱和脂肪含量低的饮食,维持正常体重,再加上适度体力活动。[23]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
[24]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
然而,关于健康生活方式、饮食、规律体力活动和维持理想体重对胆结石预防作用的证据级别较弱。[25]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.
https://www.journal-of-hepatology.eu/article/S0168-8278(16)30032-0/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/27085810?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,从而使得快速减重的肥胖患者(通过饮食热量限制或减重手术)形成结石的短期风险降低。[22]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):1090-100.
https://www.cghjournal.org/article/S1542-3565(13)01837-5/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/24321208?tool=bestpractice.com
熊去氧胆酸对溶解已成形的胆结石的价值有限。[26]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.
https://aasldpubs.onlinelibrary.wiley.com/doi/10.1002/hep.21182
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个别不适合手术的患者。
应为出现症状性胆结石的患者进行胆囊切除术,以防止进展为急性胆囊炎。