(1) 遺体で星状神経節の位置を肉眼解剖学的に検討したところ, 大部分の例で, 第1胸椎の高さで肋骨頸部に位置していた.
(2) 星状神経節節前線維の起始細胞は第1胸髄から第10胸髄まで認められた.
(3) 星状神経節の節後線維が分布する皮膚領域は, C3～T12で, 最も多く分布している領域はC6～T5であった.
(4) 心臓における交感神経支配は, 両側性で, 中頸神経節の関与が最も多く, 星状神経節の遠心性線維は, 主に洞房結節, 心房に終止していた.
洞房結節に至る遠心性線維は, 右の中頸神経節および星状神経節からの方が多く, 右の星状神経節ブロックの方が, 左のブロックよりも心拍数, 心リズムに与える影響が多いと思われた.
(5) 内頸および外頸動脈には, 星状神経節の節後線維は分布しておらず, 主に, 上頸神経節の節後線維が分布していた.
(6) 上腕骨の骨髄には, 星状神経節の節後線維が多数分布していることがわかった.
(7) 星状神経節には感覚神経が投射していることがわかった.
(8) 上頸神経節, 中頸神経節, 星状神経節には, 相互投射があることがわかった.
(9) C6-SGBは, 上頸, 中頸神経節ブロックが適応となる顔面, 頭部の疾患に, C7-SGBは, 上肢の交感神経遮断が必要な疾患に行った方がよいと考えた.

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It is well known that chronic headaches are controled with Stellate Ganglion Block. Effectiveness of stellate ganglion block was examined retrospectively in various chronic headache. The headache classification and the patients number were followed. There were totally 3, 192 chronic headache patients in Kanto Teishin Hospital from 1970 to 1992. 427 were migraine: 514 tension type headache, 120 mixed type, 390 cluster headache, 104 atypical vascular headache, 93 cervical headache, 566 atypical facial pain, 139 temporomandibular dysfunction, 22 facial pain due to neoplasm, 22 psycogenic facial pain, 310 other symptomatic facial pain, 85 other symptomatic headache, 189 others, 182 headache not classifiable. Female patients were 1, 847 and male patients were 1, 345. This study excluded 3, 400 of trigeminal neuralgia that cloud not control with stellate ganglion block and 3, 300 of herpes zoster patients that was general disease.
Patients were treated with stellate ganglion block one to two times a week, and were followed by questionnaire after 6 months of the last treatment. The follow up study showed that 43% of patients enjoyed headache free life without analgesics.

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当科外来患者を対象に, 口腔顔面痛に対するSGBの効果を疾患別に検討した. これに先立って, C6SGBとC7SGBの効果を比較し, 同等の効果が得られることを確認してから, 本研究に入った. 顎関節症では, いずれの症型においても, 疼痛のみならず, 開口障害をも改善した. この効果は, 対照として検討したスプリントのみによる治療群よりも良好であり, また, 治療直後からその効果が得られることから, その有用性が確認された. RSD様疼痛症例においては, 自発痛の改善はみられるものの, allodynia に対する治療効果は高くなかった. 抜歯後痛に対しては, 抜歯創の感染がみられる症例では, 治療成績が悪く, 急性炎症が治まってから疼痛の緩解が得られた. 歯原性疼痛を含めて, SGBは, 歯科領域の急性炎症症状に対しては, 効果的でなく, 消炎処置と並行して施行すべきである.

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頸肩腕痛を呈する疾患を, それらに対する有効な治療法という面からみてみると, それらのすべてに星状神経節ブロック (stellate ganglion block, 以下SGB) がよい適応となるわけではない. 硬膜外ブロック, 頸椎関節ブロック, 神経根ブロックなどにより除痛される例も多いことは知られているが, 今回は, 治療法としてSGBのみに主眼を置き, 頸肩腕痛を主訴とする症例にSGBがどのような効果を現わすかを検討した. 検討した項目は以下のとおりである.
1) 頸肩腕痛を訴えるどのような病態にSGBがよい適応となるのか?
2) どの程度の回数が必要か?
3) SGBの有効例, 無効例の間でSGBにより起こる生体の反応に相違があるのか? の3点である.

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The effect of stellate ganglion block (SGB) on peripheral facial palsy were studied by comparing the results of electroneuronography (ENoG), palsy score (40-point scoring method) and the period from onset to initial block and recovery. The subjects were 114 patients with Bell's palsy and Hunt syndrome who were treated in our department within 14 days after onset.
Of the 114 patients, 102 patients had a response to ENoG of 5% or greater and 97% among these caces revealed complete recovery. On the other hand, 12 patients had a response of 4% or less of normal and 67% of those showed unsatisfactory recovery of function. In addition, 8 patients had mild to moderate sequela.
In conclusion, excellent therapeutic cure rate of facial palsy was obtained by SGB. More earlier treatment of SGB shortened the period of recovery and diminished the drop of ENoG value. From electrophysiological examination, it was suggested that SGB prevented the progress of the nerve degeneration and accelerated the recovery of injured nerve.

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All cases of SHL visited in our hospital have been treated by the SGB since 1989 with the treatment of steroid, vitamins, vasodilatators and oxygenation. The authors investigated the effectiveness of SGB (SGB group: 112 cases in 1989-1993) compared with medical treatment (Control group: 28 cases in 1988-1989), and analyzed the prognostic indicators related to recovery.
According to the recovery criteria decided by the official committee of SHL in Japan, all evaluated data were calculated for the complete recovery rate (cases of cure or complete return to <20dB in all tested frequencies-(1)), the recovery rate ((1) and cases of remarcable return to average pure tone score of >30dB-(2)), the effective rate ((2) and cases of return to average pure tone score of >10dB) and ineffective rate.
The complete recovery rate was 18.7% in SGB group, 10.7% in control group, the recovery rate was 60.7% (SGB), 50.0% (control) and the effective rate was 83.9% (SGB), 64.2% (control). The significant difference was found between two groups in the effective rate (p<0.05).
Poorer prognosis on the recovery rate were found in the groups of high age, downsloping type or profound type of audiogram, delayed initiation of therapies and vertigo.
On the other hand, SGB group had higher effective rate in such poorer prognostic groups and 61% of cases in ineffective group showed the improvement of subjective symptoms.
The conclusion in this study is that SGB is thought to be a useful therapy for SHL, as it may increase the blood supply to the cochlear.

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1984年から1992年までに関東逓信病院ペインクリニック科を受診した鼻アレルギー患者から, 無作為に396名を抽出し葉書によるアンケート調査を行った. SGB治療は60.0%の有効率を示し, この割合は季節性症状の患者では67.3%と通年性患者に比べ有意に高かった. SGB治療有効群と無効群の間に治療回数の差はなかった. また通年性症状のSGB治療有効群で, 治療回数と有効期間の相関は乏しいと考えられた. SGB治療は患者評価の高い治療法であるが, これを受けられる医療施設が少ないことが患者利益を損なっている可能性が示唆された.

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The effects of weekly repeated stellate ganglion block (SGB) on the condition of 11 stable bronchial asthmatics (7 women and 4 men, aged between 40 and 63, mean 53.9) were studied. The 7 parameters adopted for assessment of the effects of SGB were as follows: 1) provisional respiratory function; 2) ventilatory function; 3) ventilatory response to carbon dioxide; 4) serum levels of chemical mediators; 5) state of the autonomic nervous system; 6) number of necessary intravenous injections of aminophylline; 7) patients' subjective assessment of their general condition.
The results of repeated SGB were interpreted as follows: 1) respiratory resistance was decreased; 2) no adverse effects on SpO₂, E_TCO₂, tidal volume, V_1.0%, minute volume and respiration rate were associated with the treatment; 3) ventilatory response to carbon dioxide under the conditions of 59-93% oxygen concentration was not impaired; 4) decreased serum levels of LTB₄, LTC₄ and histamine indicated possible reduction of bronchial hypersensitivity; 5) enhanced regulation of the autonomic nervous system was achieved; 6) occasions requiring aminophylline infusion therapy were reduced; 7) patients' subjective comments.
In conclusion, in terms of the parameters analyzed in the present study, repeated SGB can be recommended as an adjunctive approach to control of bronchial asthma.

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急性期帯状疱疹痛の予後を決定する因子として帯状疱疹の重症度を考慮した報告は少ない. 帯状疱疹の重症度を考慮すると, 高齢者の三叉神経の急性期帯状疱疹痛は, 高齢あるいは三叉神経という因子ではなく, 高齢者および三叉神経領域では重篤な帯状疱疹の症例が多いことから急性期帯状疱疹痛が長期間持続する症例が多いと考えるべきである. 交感神経ブロックは急性期帯状疱疹痛を速やかに軽減させるが, 急性期帯状疱疹痛の消失を得るためにはきわめて集中的な交感神経ブロックが必要である. 三叉神経領域の急性期帯状疱疹痛に対して, 星状神経節ブロックと上胸部硬膜外ブロックによる除痛効果に明らかな違いはなく, 三叉神経領域の激しい急性期帯状疱疹痛に対しては, 星状神経節ブロック単独での治療よりも, 連続的な上胸部硬膜外ブロックを実施し, 症例によって星状神経節ブロックの併用を考えるべきと思われる.

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Is stellate ganglion block (SGB) really useful for the therapy of ocular diseases? In order to answer this question, SGB has been applied to the cases which couldn't be recovered by general methods. As a result, the following five ocular diseases were thought to be good indications for SGB.
1) Prolonged post-operative ocular pain
16 cases were treated by SGB. 6 cases were deafferentation pain. SGB was effective in 4 of 6 cases. 10 cases were non-deafferentation pain. SGB was very effective in all of them.
2) Scleritis
SGB was applied to 6 cases. All of them were recovered by SGB.
3) Central retinal artery occulusion
In 10 of 15 cases, visual acuity improved. The improvement was caused by the decrease of macular edema.
4) Cystoid macular edema after cataract surgery
35 cases were treated by SGB. All of them got improved visual acuity.
5) Central exudative chorioretinopathy
In 34 of 43 cases which were treated by SGB, visual acuity improved. On the other hand, in 22 cases of the non-SGB control group, visual acuity improved in only 6 cases.

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