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肝内胆汁郁积为当前肝脏病领域内最重要与最复杂的问题之一。在临床上有两大难题:1．肝内与肝外胆汁郁积的鉴别诊断有时非常困难。2．肝内胆汁郁积的病因复杂,病变多样,预后各异。关于肝内胆汁郁积的病理机制近年来有一些新的认识。长期以来被认为某些肝内病理过程导致胆小管破坏、堵塞的结果,但是随着电子显微镜的广泛应用,发现不少肝内胆汁郁积病人的胆管分枝与小胆管并无梗阻。因此目前研究方向已从组织形态学转入到功能方面去探索,本文重点讨论这方面的进展,而有关肝内胆管梗阻所引起的胆汁郁积,如原发性胆汁性肝硬化,肝内胆管结石等,不拟在本文内讨论。现将近年来着重讨论的几个问题分述于下:
Intrahepatic cholestasis is one of the most important and complex issues in the current field of liver disease. There are two major clinical problems: 1. Differential diagnosis of intrahepatic and extrahepatic cholestasis is sometimes very difficult. 2. The etiology of intrahepatic cholestasis is complex, diverse lesions, different prognosis. Pathological mechanisms of intrahepatic cholestasis in recent years, there are some new understanding. It has long been considered that some intrahepatic pathological processes lead to the destruction and blockage of the ductules. However, with the widespread use of electron microscopy, many patients with intrahepatic cholestasis have no obstruction of the bile duct branches and small bile ducts. Therefore, the current research direction has been explored from the histopathology into functional aspects, this article focuses on the progress in this regard, and related to intrahepatic bile duct obstruction caused by cholestasis, such as primary biliary cirrhosis, intrahepatic bile duct stones Etc., do not intend to be discussed in this article. Now in recent years, several issues focused on the discussion are described below: