Objectives To evaluate the clinical efficacy of percutaneous nephrolithotomy(PCNL)in combination with pneumatic and ultrasonic lithotripsy under the guidance of B-mode ultrasound in the treatment of complex renal calculi.Methods We retrospectively analyzed the records of 356 patients with complex renal calculi who underwent PCNL combined with pneumatic and ultrasonic lithotripsy under the guidance of B-mode ultrasound at our department from October 2008 to March 2012.Results A single tract was used in 319 patients,while two tracts were created in the 37 patients.One-step procedure to remove the stones was achieved in 292 patients,while a second intervention was performed in 64 patients.The mean time of the operations was(75 + 35)min.In this series,the rate of stone clearance was 89.1％(213/239); 62 cases had residual stones,28 of them received ESWL and the stone was removed completely in 26 of the 28 cases,and the other 34 were treated by oral medicines.Conclusions PCNL combined with pneumatic and ultrasonic lithotripsy under the guidance of B-mode ultrasound is effective,safe and little invasion for complex renal calculi.