声带切除术患者声音嘶哑相关语音加工fMRI随访研究

A Follow-up fMRI Study of the Phoneme Processing in Hoarseness Patients with Laser Cordectomy

目的采用朗读任务功能磁共振成像(fMRI)随访喉癌患者激光声带切除术前、术后嗓音嘶哑期、嗓音重建后期患者语言功能脑区激活,研究声音嘶哑、嗓音重建对语言功能脑区的影响。方法 16例早期喉癌患者进行术前、术后1周、术后2～3个月3次检查。刺激任务采用事件相关设计,视觉呈现,受试者朗读汉语名词任务。使用AFNI软件提取各个功能脑区的激活体素。对不同脑区术前、术后第一次、术第二次激活体素进行方差分析,有差异者进行两两比较。结果嗓音明显嘶哑期,患者左侧额下回激活体素多于术前及嗓音重建后期(F值分别为7.916、7.270,P值均<0.01)。嗓音重建后期激活体素多于术前、术后嗓音嘶哑期的脑区为左、右侧中央前回(F值分别为11.665、10.214、7.665、6.482,P值均<0.01)、额中回(F值分别为10.337、10.563、6.458、6.303,P值均<0.01)及辅助运动区(F值分别为14.343、14.095、7.945、7.947,P值均<0.01)。结论激光切除术后患者的声音嘶哑、嗓音调整、重建过程伴随着语言功能网络重塑性改变,左侧额下回前部、双侧额中回、双侧中央前回、双侧辅助运动区在音韵处理过程中功能不同。

Objective To evaluate the activation of language cortex by follow - up reading task fMRI at pre and post la- ser cordectomy, and to study the influence of hoarseness and voice rebuilding state on the language cortex of laryngocarcino- ma patients. Methods 16 patients with laryngocarcinoma of early stage （Tis, T1NOM0 ） underwent MRI examination three times respectively. The first examination was performed before laser cordectomy when the patients had no hoarseness, the other two examinations were performed at 1 week after surgery, at that time the patients had obvious hoarseness, and at 2 -3 month after surgery when the voice rebuilding had been finished. Event related visually presented stimuli were em- ployed. The task was to read visually presented neutral Chinese bi words with high frequency loudly. Activated voxels were obtained by AFNI software package. ANOVA was used to evaluate whether significant difference exist between examina- tions. Results Significantly more activated voxels in left inferior frontal gyrus were detected at husky - voice stage than the other two （ F = 7. 916,7. 270, P 〈 0.01 respectively）. Also significantly more activated voxels were detected in bilater- al preeentral gyrus （F = ll. 66510. 214,7. 665,6. 482, P 〈 0.01 respectively）, middle frontal gyrus （F = 10. 337, 10. 563, 6. 458, 6. 303, P 〈 0.01 respectively） and supplementary motor area （ F = 14. 343,14. 095,7. 945,7. 947, P 〈 0.01 respectively） at voice -recovery course. Conclusion During the voice rebuilding course, the voice function network remodeling was happened at left inferior frontal gyrus, bilateral middle frontal gyrus, bilateral precentral gyrus and bilateral supplementary motor area, which had different role in the phoneme processing.