Nakanuma Y, Hoso M, Sanzen T, Sasaki M
Second Department of Pathology, Kanazawa University School of Medicine, Japan.
Microsc Res Tech. 1997 Sep 15;38(6):552-70. doi: 10.1002/(SICI)1097-0029(19970915)38:6<552::AID-JEMT2>3.0.CO;2-H.
Microstructure and development of the normal biliary tract and the pathologies of several biliary tract diseases in humans are reviewed. The biliary tract, comprising the bile duct and peribiliary glands, is anatomically divided into the extrahepatic and intrahepatic biliary tree. The intrahepatic biliary tree is further divided into large bile ducts, corresponding to the right and left hepatic ducts and their first to third order branches, and into septal and interlobular bile ducts and bile ductules according to their size and location relative to the hepatic lobules and surrounding structures. The right and left hepatic ducts and the extrahepatic bile ducts are composed of dense fibrous duct walls lined by a layer of columnar biliary epithelium. The peribiliary glands, which may secrete mucinous and serous substances into the bile, are found along the extrahepatic and large intrahepatic bile ducts. They are divided in glands within and outside the duct wall. The former (intramural glands) drain directly into the lumen of the bile duct, while the latter (extramural glands) are composed of several lobules and drain into the ductal lumen via their own conduits. The biliary tract is supplied by a complex vasculature called the peribiliary vascular plexus. Afferent vessels of this plexus derive from hepatic arterial branches, and this plexus drains into the portal venous system or directly hepatic sinusoids. The development of the intrahepatic biliary tract is divided into three stages: the stage of the ductal plate, the stage of biliary cell migration into the mesenchyme, and the stage of bile duct formation in the portal tract. It remains unclear how the extrahepatic and intrahepatic biliary tract integrate. Along with these developmental changes in the biliary tract, the peribiliary glands and the vascular plexus also develop in a step-wise manner and their maturation is completed after birth. Pathologies of various biliary diseases are briefly reviewed noting their relevance to several histologic elements and the microenvironment of the biliary tract and the developmental anomalies of the biliary tract including ductal plate malformation.
本文综述了人类正常胆道的微观结构与发育以及几种胆道疾病的病理学。胆道由胆管和胆管周围腺组成，在解剖学上分为肝外胆道树和肝内胆道树。肝内胆道树进一步分为大胆管，对应于左右肝管及其一级至三级分支，以及根据其相对于肝小叶和周围结构的大小和位置分为间隔胆管、小叶间胆管和胆小管。左右肝管和肝外胆管由一层柱状胆管上皮内衬的致密纤维管壁组成。胆管周围腺可向胆汁中分泌黏液性和浆液性物质，沿肝外和肝内大胆管分布。它们分为管壁内和管壁外腺体。前者（壁内腺）直接排入胆管腔，而后者（壁外腺）由几个小叶组成，并通过自身导管排入管腔。胆道由一个称为胆管周围血管丛的复杂脉管系统供血。该丛的传入血管来自肝动脉分支，该丛排入门静脉系统或直接排入肝血窦。肝内胆道的发育分为三个阶段：导管板阶段、胆管细胞迁移至间充质阶段和门静脉区胆管形成阶段。肝外和肝内胆道如何整合尚不清楚。随着胆道的这些发育变化，胆管周围腺和血管丛也逐步发育，其成熟在出生后完成。简要综述了各种胆道疾病的病理学，指出它们与胆道的几种组织学成分和微环境以及胆道发育异常（包括导管板畸形）的相关性。
