Objective: To evaluate the efficacy of ultrasound-guided percutaneous nephrolithotomy for complex renal calculi. Methods: August 2011 -2016 June 98 cases of complex renal calculi surgery in our hospital as the research object, all patients underwent ultrasound guided percutaneous nephrolithotomy, we retrospectively analyzed the clinical data of these patients. Results: the success rate of 98 patients with complicated renal calculi was, the average operation time was 52-119min, the average hospitalization time was 86min, and the average hospitalization time was 11-18d (14.3 ± 3.5) d. The intraoperative complications were as follows: 1 cases were treated with intraoperative hemorrhage, and pleural injury occurred in 1 cases (1%). The postoperative complications were as follows: 5 cases of urinary sepsis (5.1%) were cured after anti infection therapy. Postoperative hemorrhage was found in 3 cases (3.1%). According to the curative effect evaluation, 90 cases were removed completely, a small amount of residual was found in all the patients, and there were significant residual in 3 cases, and the stone clearance rate was about 91.83%. Conclusion: ultrasound guided percutaneous nephrolithotomy has the advantages of accurate positioning, high success rate, real-time monitoring of puncture process, high safety and high stone clearance rate.