To address the core issue of efficiency degradation in concentrator photovoltaics (CPV) caused by high heat flux, microchannel cooling technology has emerged as a critical research direction. Advances in this field were systematically reviewed, with a focus on three mainstream configurations: single-layer, manifold, and jet-impingement structures. The effects of factors such as channel geometry, working fluid, and flow regime on pressure drop, temperature rise, and cooling efficiency were analyzed. Furthermore, the strengths and weaknesses of various flow channel designs, including serpentine, pin-fin, and fractal configurations, were compared. Studies have shown that single-layer straight channels are prone to high pressure drop and temperature non-uniformity. Derived serpentine and fractal channel designs can enhance heat transfer by perturbing the flow. The manifold configuration effectively reduces flow resistance and improves temperature uniformity, often serving as a foundational platform for integrating other cooling technologies. The hybrid jet-impingement and microchannel approach demonstrates potential in addressing localized ultra-high heat flux, though its system complexity and energy consumption still require optimization. Looking ahead, future research on this technology should progressively advance from the millimeter scale to the micro-scale, enabling the development of lightweight and efficient portable concentrator photovoltaic devices. The focus should shift from pursuing “cooling intensity” to emphasizing “intelligent heat transfer architecture,” deeply integrating bionics and artificial intelligence to design adaptive microchannels. Furthermore, the research perspective should transition from optimizing individual components toward a systemic, co-design approach that couples photonic, thermal, electrical, and mechanical multi-physics fields.