臺灣博碩士論文加值系統

英國的研究發現,年齡大於 85 歲時,下泌尿道症狀的發生率超過 30%。下泌尿
道症狀包含頻繁解尿,急迫性解尿,夜間解尿,延遲性解尿,間斷性解尿,解尿時
腹部用力,解尿時間過長,排尿時解不乾淨,解尿結束後出現滴尿。攝護腺肥大在
口服藥物治療無效及其他特定狀況出現,手術治療會優先於藥物治療。我們藉由本
研究、運用資料探勘技術來尋找出攝護腺術式選擇的影響因子並建構及選擇出良好
預測效能的模型。
本試驗使用某醫院病歷資訊系統,收集 2012 年 6 月到 2013 年 12 月接受攝護腺
手術治療病患的資料。收案數量共 391 位,接受雷射術式數量為 268 位,接受傳統
電刀術式為 123 位,使用 WEKA 3.8.1 程式進行資料探勘處理及預測模型的建構。
試驗結果中,表現優秀的預測模型為 J48、LWL 及 DecisionTable 這三種。在訓
練組時的 ROC area 項目的優劣排序依次為 J48( 0.8227),DecisionTable
( 0.8111),LWL( 0.761)。在測試組時,ROC area 項目的優劣排序依次為
J48( 0.8565),DecisionTable ( 0.8384),LWL( 0.8133)。本試驗能為這類需要面
臨手術選擇的醫師或病患,提供試驗得知的資訊。J48、LWL 及 DecisionTable 這三
種預測模型在訓練組和測試組的結果都很優秀。

The study from British found that the incidence of lower urinary tract symptoms is more than 30% in people older than 85 years. Lower urinary tract symptoms include frequency, urgency, nocturia, delayed urination, intermittency, abdominal strain, prolonged urination, incomplete bladder empty, and terminal dribbling. If prostate hyperplasia treatment outcome with medicine is poor, surgical intervention should be considered.The purpose of this study is to find out which factor will influence the surgery method by using data mining techniques to construct models with good predictive performance.
We use the medical record information system from a medical center, patients who
received prostate surgery from June 2012 to December 2013 were collected. Total of 391 cases were received, 268 received laser method, and 123 received traditional electrosurgery. The WEKA 3.8.1 program was used for data mining processing and prediction model construction.
The three excellent prediction models are J48, LWL and DecisionTable. The ranking of the ROC area items in the training group was J48 ( 0.8227), DecisionTable ( 0.8111), and LWL ( 0.761). In the test group, the ranking of the ROC area items was J48 ( 0.8565), DecisionTable ( 0.8384), and LWL ( 0.8133).This trial can provide information to physicians and patients who will choose method of surgical intervention. The three prediction models, J48, LWL and DecisionTable, have excellent results in both training and testing groups.

第一章 緒論 ..........................................................................................1
1.1 研究背景 ................................................................................................................. 1
1.2 研究動機 ................................................................................................................. 4
1.3 研究目的 ................................................................................................................. 6
1.4 研究流程 ................................................................................................................. 7
第二章 文獻探討................................................................................................................. 8
2.1 使用抗凝血劑對術式選擇的影響 ......................................................................... 8
2.2 年齡對術式選擇的影響 ....................................................................................... 13
2.3 攝護腺體積對術式選擇的影響 ........................................................................... 14
第三章 研究方法............................................................................................................... 18
3.1 資料來源 ............................................................................................................... 18
3.2 資料前處理 ........................................................................................................... 22
3.3 資料探勘技術 ....................................................................................................... 23
3.3.1 決策樹........................................................................................................ 23
3.3.2 多層感知器................................................................................................ 24
3.3.3 序列最小優化演算法................................................................................ 24
3.3.4 隨機梯度下降( SGD) ................................................................................ 24
3.3.5 Ibk............................................................................................................... 24
3.3.6 LWL............................................................................................................ 25
3.3.7 引導聚集算法( Bagging)........................................................................... 25
3.3.8 貝氏分類器................................................................................................ 26
3.3.9 決策樹樁( DecisionStump)........................................................................ 26
3.3.10 決策表( Decision table) ........................................................................... 26

VII

第四章 資料研究評估結果與分析................................................................................... 27
4.1 資料探勘分析過程 ............................................................................................... 27
4.2 資料探勘結果 ....................................................................................................... 22
4.2.1 J48 設定資料及試驗運作結果.................................................................. 23
4.2.2 MultiplelayerPerceptron 設定資料及試驗運作結果 ................................ 30
4.2.3 SMO 設定資料及試驗運作結果............................................................... 31
4.2.4 NaiveBayes 設定資料及試驗運作結果.................................................... 32
4.2.5 SGD 設定資料及試驗運作結果 ............................................................... 33
4.2.6 IBk 設定資料及試驗運作結果 ................................................................. 34
4.2.7 LWL 設定資料及試驗運作結果............................................................... 35
4.2.8 Bagging 設定資料及試驗運作結果.......................................................... 37
4.2.9 DecisionTable 設定資料及試驗運作結果 ................................................ 38
4.2.10 DecisionStump 設定資料及試驗運作結果............................................. 40
4.3 資料探勘結果分析 ............................................................................................... 41
4.3.1 十種預測模型的結果分析........................................................................ 41
4.3.2 預測效能高於十種預測模型結果平均數值的組別探究........................ 43
4.3.3 預測效能低於十種預測模型結果平均數值的組別探究........................ 44
4.4 J48 權重樹狀圖分析............................................................................................. 44
4.4.1 權重排序.................................................................................................... 44
4.4.2 權重樹狀圖探討........................................................................................ 45

第五章 結論與建議........................................................................................................... 47
5.1 研究結論............................................................................................................... 47
5.2 研究限制 ............................................................................................................... 47
5.3 未來研究方向與建議 ........................................................................................... 48
參考文獻..................................................................................................................... 50

VIII

附錄一 IRB 編號: 11106-L03 .......................................................................................... 56
附錄二 不經過 Resample 處理在訓練組的結果 ............................................................. 57
附錄三 不經過 Resample 處理在測試組的結果............................................................. 58

Abirami, S., & Chitra, P. (2020). Energy-efficient edge based real-time healthcare support
system. In Advances in computers (Vol. 117, pp. 339-368). Elsevier.
Aha, D. W., Kibler, D., & Albert, M. K. ( 1991). Instance-based learning algorithms.
Machine Learning, 6(1), 37-66.
Ahyai, S. A., Gilling, P., Kaplan, S. A., Kuntz, R. M., Madersbacher, S., Montorsi, F., . . .
Stief, C. G. J. E. u. (2010). Meta-analysis of functional outcomes and complications
following transurethral procedures for lower urinary tract symptoms resulting from
benign prostatic enlargement. 58(3), 384-397.
Ahyai, S. A., Lehrich, K., & Kuntz, R. M. J. e. u. (2007). Holmium laser enucleation
versus transurethral resection of the prostate: 3-year follow-up results of a
randomized clinical trial. European urology, 52(5), 1456-1464.
Al-Ansari, A., Younes, N., Sampige, V. P., Al-Rumaihi, K., Ghafouri, A., Gul, T., &
Shokeir, A. A. J. E. u. (2010). GreenLight HPS 120-W laser vaporization versus
transurethral resection of the prostate for treatment of benign prostatic hyperplasia:
a randomized clinical trial with midterm follow-up. European urology, 58(3), 349-
355.
Andersson, K.-E. (2019). Future Considerations in Overactive Bladder Pharmacotherapy.
In Contemporary Pharmacotherapy of Overactive Bladder (pp. 219-229). Springer.
Bach, T., Netsch, C., Haecker, A., Michel, M.-S., Herrmann, T. R., & Gross, A. J. J. W. j. o.
u. (2010). Thulium: YAG laser enucleation (VapoEnucleation) of the prostate:
safety and durability during intermediate-term follow-up. World journal of urology,
28(1), 39-43.
Bachmann, A., Schürch, L., Ruszat, R., Wyler, S. F., Seifert, H.-H., Müller, A., . . . Sulser,
T. J. E. u. (2005). Photoselective vaporization (PVP) versus transurethral resection
of the prostate (TURP): a prospective bi-centre study of perioperative morbidity
and early functional outcome. European urology, 48(6), 965-972.
Becker, B., Knipper, S., Gross, A. J., & Netsch, C. J. J. o. e. (2017). Current management
in transurethral therapy of benign prostatic obstruction in patients on oral
anticoagulation: a worldwide questionnaire. Journal of endourology, 31(2), 163-
168.
Berry, S. J., Coffey, D. S., Walsh, P. C., & Ewing, L. L. J. T. J. o. u. (1984). The
development of human benign prostatic hyperplasia with age. The Journal of
urology, 132(3), 474-479.
Boehme, A. K., Esenwa, C., & Elkind, M. S. J. C. r. (2017). Stroke risk factors, genetics,

51

and prevention. Circulation research, 120(3), 472-495.
Breiman, L. (1996). Bagging predictors. Machine Learning, 24(2), 123-140.
Briganti, A., Naspro, R., Gallina, A., Salonia, A., Vavassori, I., Hurle, R., . . . Montorsi, F.
J. T. J. o. u. (2006). Impact on sexual function of holmium laser enucleation versus
transurethral resection of the prostate: results of a prospective, 2-center,
randomized trial. The Journal of urology, 175(5), 1817-1821.
Cameron, A. P., Lewicky-Gaupp, C., Smith, A. R., Helfand, B. T., Gore, J. L., Clemens, J.
Q., . . . Griffith, J. W. J. T. J. o. u. (2018). Baseline lower urinary tract symptoms in
patients enrolled in LURN: a prospective, observational cohort study. The Journal
of urology, 199(4), 1023-1031.
Capitan, C., Blazquez, C., Martin, M. D., Hernandez, V., de la Pena, E., & Llorente, C. J.
E. u. (2011). GreenLight HPS 120-W laser vaporization versus transurethral
resection of the prostate for the treatment of lower urinary tract symptoms due to
benign prostatic hyperplasia: a randomized clinical trial with 2-year follow-up.
European urology, 60(4), 734-739.
Chang, C.-H., Lin, T.-P., Chang, Y.-H., Huang, W. J., Lin, A. T., & Chen, K.-K. J. B. u.

(2015). Vapoenucleation of the prostate using a high-power thulium laser: a one-
year follow-up study. BMC urology, 15(1), 40.

Chang, Y.-H., Siu, J. J.-Y., Hsiao, P.-J., Chang, C.-H., & Chou, E. C.-L. J. J. o. t. F. M. A.
(2018). Review of underactive bladder. Journal of the Formosan Medical
Association, 117(3), 178-184.
Chapple, C., Castro-Diaz, D., Chuang, Y.-C., Lee, K.-S., Liao, L., Liu, S.-P., . . .
Sumarsono, B. J. A. i. t. (2017). Prevalence of lower urinary tract symptoms in
China, Taiwan, and South Korea: results from a cross-sectional, population-based
study. Advances in therapy, 34(8), 1953-1965.
Chapple, C. R., Wein, A. J., Abrams, P., Dmochowski, R. R., Giuliano, F., Kaplan, S.
A., . . . Roehrborn, C. G. J. E. u. (2008). Lower urinary tract symptoms revisited: a
broader clinical perspective. European urology, 54(3), 563-569.
Chen, Y.-B., Chen, Q., Wang, Z., Peng, Y.-B., Ma, L.-M., Zheng, D.-C., . . . Ma, L.-H. J. T.
J. o. u. (2013). A prospective, randomized clinical trial comparing plasmakinetic
resection of the prostate with holmium laser enucleation of the prostate based on a
2-year followup. The Journal of urology, 189(1), 217-222.
Cui, D., Sun, F., Zhuo, J., Sun, X., Han, B., Zhao, F., . . . Xia, S. J. W. j. o. u. (2014). A
randomized trial comparing thulium laser resection to standard transurethral
resection of the prostate for symptomatic benign prostatic hyperplasia: four-year
follow-up results. World journal of urology, 32(3), 683-689.
Culkin, D. J., Exaire, E. J., Green, D., Soloway, M. S., Gross, A. J., Desai, M. R., . . .
Lightner, D. J. J. T. J. o. u. (2014). Anticoagulation and antiplatelet therapy in
urological practice: ICUD/AUA review paper. The Journal of urology, 192(4),

52

1026-1034.
Daniels, P. R. J. N. R. U. (2005). Therapy Insight: management of urology patients taking
long-term warfarin anticoagulation therapy. Nature Reviews Urology, 2(7), 343.
Descazeaud, A., Robert, G., Lebdai, S., Bougault, A., Azzousi, A. R., Haillot, O., . . .
Barry-Delongchamps, N. J. W. j. o. u. (2011). Impact of oral anticoagulation on
morbidity of transurethral resection of the prostate. World journal of urology, 29(2),
211-216.
Englert, P. (2012). Locally weighted learning. Seminar Class on Autonomous Learning
Systems, 1(1), 1-9.
Enikeev, D., Glybochko, P., Rapoport, L., Okhunov, Z., O’Leary, M., Potoldykova, N., . . .
Taratkin, M. J. B. u. (2018). Impact of endoscopic enucleation of the prostate with
thulium fiber laser on the erectile function. BMC urology, 18(1), 87.
Etheridge, T., Straus, J., Ritter, M. A., Jarrard, D. F., & Huang, W. (2018). Semen AMACR
protein as a novel method for detecting prostate cancer. Urologic Oncology:
Seminars and Original Investigations,
Fayad, A. S., Elsheikh, M. G., Zakaria, T., Elfottoh, H. A., Alsergany, R., Elshenoufy, A., &
Elghamarawy, H. J. U. (2015). Holmium laser enucleation of the prostate versus
bipolar resection of the prostate: a prospective randomized study.“Pros and Cons”.
Urology, 86(5), 1037-1041.
Foster, H. E., Barry, M. J., Dahm, P., Gandhi, M. C., Kaplan, S. A., Kohler, T. S., . . .
Roehrborn, C. G. J. T. J. o. u. (2018). Surgical Management of Lower Urinary Tract
Symptoms Attributed to Benign Prostatic Hyperplasia: AUA Guideline. The
Journal of urology.
Freyer, P. J. L. (1900). A new method of performing prostatectomy. Lancet, 1, 774.
Fuller, E. (1895). Six successful and successive cases of prostatectomy. D. Appleton.
Gill, N., Zouwail, S., & Joshi, H. J. B. (2018). Prostate-Specific Antigen: a Review of
Assay Techniques, Variability and Their Clinical Implications. BioNanoScience,
8(2), 707-712.
Gilling, P. J., Wilson, L. C., King, C. J., Westenberg, A. M., Frampton, C. M., &
Fraundorfer, M. R. J. B. i. (2012). Long‐term results of a randomized trial
comparing holmium laser enucleation of the prostate and transurethral resection of
the prostate: results at 7 years. BJU international, 109(3), 408-411.
Gratzke, C., Bachmann, A., Descazeaud, A., Drake, M. J., Madersbacher, S., Mamoulakis,

C., . . . Gravas, S. J. E. u. (2015). EAU guidelines on the assessment of non-
neurogenic male lower urinary tract symptoms including benign prostatic

obstruction. European urology, 67(6), 1099-1109.
Gravas, S., Bach, T., Bachmann, A., Drake, M., Gacci, M., & Gratzke, C. J. E. A. o. U. G.
(2018). EAU Guidelines on Management of Non-Neurogenic Male Lower Urinary
Tract Symptoms (LUTS), incl. Benign Prostatic Obstruction (BPO). 2017; 22-25.

53
European Association of Urology Guidelines.
Herlemann, A., Wegner, K., Roosen, A., Buchner, A., Weinhold, P., Bachmann, A., . . .
Magistro, G. J. W. j. o. u. (2017). “Finding the needle in a haystack”: oncologic
evaluation of patients treated for LUTS with holmium laser enucleation of the
prostate (HoLEP) versus transurethral resection of the prostate (TURP). World
journal of urology, 35(11), 1777-1782.
Homma, Y., Gotoh, M., Kawauchi, A., Kojima, Y., Masumori, N., Nagai, A., . . . Ukimura,
O. J. I. J. o. U. (2017). Clinical guidelines for male lower urinary tract symptoms
and benign prostatic hyperplasia. International Journal of Urology, 24(10), 716-
729.
Houston, K. A., King, J., Li, J., & Jemal, A. J. T. J. o. u. (2018). Trends in prostate cancer
incidence rates and prevalence of prostate specific antigen screening by
socioeconomic status and regions in the United States, 2004 to 2013. The Journal
of urology, 199(3), 676-682.
Jhanwar, A., Sinha, R. J., Bansal, A., Prakash, G., Singh, K., & Singh, V. J. U. a. (2017).
Outcomes of transurethral resection and holmium laser enucleation in more than 60
g of prostate: A prospective randomized study. Urology annals, 9(1), 45.
Jung, J. H., Kim, J., MacDonald, R., Reddy, B., Kim, M. H., & Dahm, P. J. C. D. o. S. R.
(2017). Silodosin for the treatment of lower urinary tract symptoms in men with
benign prostatic hyperplasia. Cochrane Database of Systematic Reviews, 2017(11).
Kavanagh, L. E., Jack, G. S., & Lawrentschuk, N. J. N. R. U. (2011). Prevention and
management of TURP-related hemorrhage. Nature Reviews Urology, 8(9), 504.
Kolev, M., Georgiev, M., Yanev, K., & Semerdzhiev, Y. J. E. U. S. (2018). Surgical
anatomy of prostate and its value for optimization of functional and oncological
result during robot-assisted radical prostatectomy. European Urology Supplements,
17(11), e2619.
Kuntz, R. M. J. E. u. (2006). Current role of lasers in the treatment of benign prostatic
hyperplasia (BPH). European urology, 49(6), 961-969.
Lomas, D. J., & Krambeck, A. J. E. B. U. (2018). Surgical management of lower urinary
tract symptoms secondary to benign prostatic hypertrophy. Evidence‐Based
Urology, 527-537.
Manchikanti, L., Kaye, A. D., & Falco, F. J. E. (2018). Antithrombotic and Antiplatelet
Therapy. In L. Manchikanti, A. D. Kaye, F. J. E. Falco, & J. A. Hirsch (Eds.),
Essentials of Interventional Techniques in Managing Chronic Pain (pp. 53-59).
Springer International Publishing.
Mayer, E. K., Kroeze, S. G., Chopra, S., Bottle, A., & Patel, A. J. B. i. (2012). Examining
the ‘gold standard’: a comparative critical analysis of three consecutive decades of
monopolar transurethral resection of the prostate (TURP) outcomes. BJU

54
international, 110(11), 1595-1601.
McMeekin, F., & Speakman, M. J. (2014). Diagnostic Techniques in Male LUTS/BPE. In
B. Challacombe & S. Bott (Eds.), Diagnostic Techniques in Urology (pp. 55-63).
Springer London.
Menzies, T., Kocaguneli, E., Turhan, B., Minku, L., & Peters, F. (2015). Sharing data and
models in software engineering. Morgan Kaufmann.
Nabi, N., Nigam, N., Kumar, B., Pranjal, P., & Naikoo, N. N. J. P.-I. J. O. R. (2018).
LOWER URINARY TRACT SYMPTOMS (LUTS): A PUBLIC HEALTH
MENACE-A STUDY ON ASSOCIATION OF RECURRENT URINARY TRACT
INFECTION WITH CHRONIC BACTERIAL PROSTATITIS IN INDIAN MEN.
PARIPEX-INDIAN JOURNAL OF RESEARCH, 7(5).
Omar, M. I., Lam, T. B., Alexander, C. E., Graham, J., Mamoulakis, C., Imamura, M., . . .
N'dow, J. J. B. i. (2014). Systematic review and meta‐analysis of the clinical
effectiveness of bipolar compared with monopolar transurethral resection of the
prostate (TURP). BJU international, 113(1), 24-35.
Peng, B., Wang, G. c., Zheng, J. h., Xia, S. q., Geng, J., Che, J. p., . . . Yang, B. J. B. i.
(2013). A comparative study of thulium laser resection of the prostate and bipolar
transurethral plasmakinetic prostatectomy for treating benign prostatic hyperplasia.
BJU international, 111(4), 633-637.
Quinlan, J. R. (2014). C4. 5: programs for machine learning. Elsevier.
Romo, P. G. B., & Hollingsworth, J. M. J. E. B. U. (2018). Medical management of benign
prostatic hyperplasia. Evidence‐Based Urology, 509-525.
Ronquist, G., & Brody, I. J. B. e. b. a. (1985). The prostasome: its secretion and function in
man. Biochimica et biophysica acta, 822(2), 203-218.
Ruszat, R., Seitz, M., Wyler, S. F., Abe, C., Rieken, M., Reich, O., . . . Bachmann, A. J. e.
u. (2008). GreenLight laser vaporization of the prostate: single-center experience
and long-term results after 500 procedures. European urology, 54(4), 893-901.
Schaal, S., Atkeson, C. G., & Vijayakumar, S. (2002 ). Scalable techniques from
nonparametric statistics for real time robot learning. Applied Intelligence, 17(1),
49-60.
Singh, I., Ansari, A. M., Ali, M. A., & Singh, S. J. R. (2018). Transabdominal and
Transrectal Ultrasound Evaluation of Prostatic Volume and Prostatic Diseases with
Clinical Correlation. Research & Reviews: Journal of Surgery, 7(2), 1-8.
Speakman, M., Kirby, R., Doyle, S., & Ioannou, C. J. B. i. (2015). Burden of male lower
urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH)–
focus on the UK. BJU international, 115(4), 508-519.
Tryba, M. J. A. I. N. S. (1993). Epidural regional anesthesia and low molecular heparin.
Anasthesiol Intensivmed Notfallmed Schmerzther, 28, 179-181.
Tyson, M. D., & Lerner, L. B. J. J. o. e. (2009). Safety of holmium laser enucleation of the

55

prostate in anticoagulated patients. Journal of endourology, 23(8), 1343-1346.
Valentini, F., Marti, B., & Robain, G. J. P. e. U. (2018). Do urodynamics provide a better
understanding of voiding disorders in women over 80? Progrès en Urologie, 28(4),
230-235.
van MELICK, H. H., van VENROOIJ, G. E., & Boon, T. A. J. T. J. o. u. (2003). Laser
prostatectomy in patients on anticoagulant therapy or with bleeding disorders. The
Journal of urology, 170(5), 1851-1855.
Van Rompay, M. I., Curtis Nickel, J., Ranganathan, G., Kantoff, P. W., Solomon, K. R.,
Lund, J. L., & McKinlay, J. B. J. B. i. (2018). Impact of 5α‐reductase inhibitor and
α‐blocker therapy for benign prostatic hyperplasia on prostate cancer incidence and
mortality. BJU international.
Vandermeulen, E. P., Van Aken, H., & Vermylen, J. J. A. (1994). Anticoagulants and
spinal-epidural anesthesia. Anesth Analg, 79(6), 1165-1177.
Wei, H., Shao, Y., Sun, F., Sun, X., Zhuo, J., Zhao, F., . . . Xia, S. J. W. j. o. u. (2014).
Thulium laser resection versus plasmakinetic resection of prostates larger than 80
ml. World journal of urology, 32(4), 1077-1085.
Wilson, L. C., Gilling, P. J., Williams, A., Kennett, K. M., Frampton, C. M., Westenberg,
A. M., & Fraundorfer, M. R. J. B. i. (2006). A randomised trial comparing holmium
laser enucleation versus transurethral resection in the treatment of prostates larger
than 40 grams: results at 2 years. European urology, 50(3), 569-573.
Woo, H. H., & Hossack, T. A. J. U. (2011). Photoselective vaporization of the prostate with
the 120-W lithium triborate laser in men taking coumadin. Urology, 78(1), 142-
145.
Xia, S.-J., Zhuo, J., Sun, X.-W., Han, B.-M., Shao, Y., & Zhang, Y.-N. J. E. u. (2008).
Thulium laser versus standard transurethral resection of the prostate: a randomized
prospective trial. European urology, 53(2), 382-390.
Yang, Z., Liu, T., & Wang, X. J. L. i. m. s. (2016). Comparison of thulium laser enucleation
and plasmakinetic resection of the prostate in a randomized prospective trial with 5-
year follow-up. Lasers in medical science, 31(9), 1797-1802.
Yin, L., Teng, J., Huang, C.-J., Zhang, X., & Xu, D. J. J. o. e. (2013). Holmium laser
enucleation of the prostate versus transurethral resection of the prostate: a
systematic review and meta-analysis of randomized controlled trials. Journal of
endourology, 27(5), 604-611.