Abstract: Objective: To evaluate the clinical application value of calyceal fornix puncture guided by ultrasound in percutaneous nephrostolithotomy(PCNL).Methods: Two hundred and ninty-eight patients treated with primary PCNL were treated with calyceal fornix puncture guided by ultrasound(142 case,RF group) and non-calyceal fornix puncture(156 cases,NRF group).All cases were detected by CTU before operation.The patients with hypertension were treated with antihypertension,reducing blood sugar and antiinfection.The patients with urosepsis complicated with hydronephrosis were treated with renal drainage if the antiinfection effect was poor,and the patients were operated after the complication was improved.The tract number and diameter(average diameter of multi-tract),operation time of PCNL,tract bleeding rate,PCNL time,primary stone free rate,postoperative bleeding time,transfusing blood rate and renal artery embolization rate between two groups were compared.Results: The tract bleeding rate,PCNL time,postoperative bleeding time and transfusing blood rate in RF group were less than those in NRF group(P<0.05 to P<0.01),and the primary stone free rate in RF group was higher than that in NRF group(P<0.05).The differences of tract number and diameter between two groups were not statistically significant(P>0.05).Conclusions: The calyceal fornix puncture guided by ultrasound can decrease the bleeding and shorten operation time of PCNL,increase the primary stone free rate,and has a chance to use large size tract.