Complications such as liquid pneumothorax, hemopneumothorax and pneumothorax may occur: (1) If symptoms such as obvious chest pain and dyspnea may occur during the operation, the operation should be stopped in time, bedside chest X-ray should be performed, and if moderate to severe liquid pneumothorax is found, closed chest drainage should be performed, and the chest fluid will basically disappear after 3 d of rechecking the chest X-ray. (2) After the removal of nephrostomy tube after surgery, if there is obvious chest pain, dyspnea and other symptoms, bedside chest X-ray should be performed urgently, and if moderate to severe liquid pneumothorax is found, closed drainage of the chest cavity should be performed, and the pleural effusion will basically disappear after 3 d of re-examination of chest X-ray. (3) After removal of the nephrostomy tube after surgery, if symptoms such as obvious chest pain, dyspnea and hemorrhagic shock appear, ultrasonography should be performed urgently, and if it indicates a large amount of blood accumulation in the chest, thoracoscopic clot removal should be performed urgently. Generally, the chest drain is removed after 5 d, and the patient can be discharged from the hospital cured. (4) If postoperative complaints of chest pain without respiratory distress, chest radiography should be performed. If the diagnosis is a small amount of pneumothorax with about 10% lung compression, it can be cured by conservative treatment. Percutaneous nephrolithotomy (PCNL) has a low probability of complicating pleural injury, but the presence of transthoracic access leads to a 0.87% to 5% incidence of fluid pneumothorax complications. munver et al. reported that the incidence of chest complications for the 10th intercostal access was as high as 23.1%, while the incidence of chest complications for the 11th intercostal access and subcostal access was significantly lower at 1.4% and 0.5%. However, the option of 10-ll intercostal puncture is sometimes required for high kidney, partial ureteral stones with failed retrograde ureteroscopic extraction, and multiple kidney stones. Supracostal puncture for PCNL can achieve higher stone removal rates and can be used by physicians with higher intracavitary skills in some patients provided complications related to concurrent pleural injury are still acceptable, but should not be the norm. Pleural injury is closely related to the PCNL puncture approach. In the prone position, because the lumbar bridge is raised to make the crypt of the pleural cavity relatively closed, even if the puncture needle injures the pleura, it is mostly at the place of the edge of the crypt of the crib diaphragm, which is easy to be closed by self-adhesion, so the probability of injuring the pleura by puncture under the 12th rib is low. However, the probability of pleural injury is significantly increased when punctured via the upper 11th rib at the same height. To summarize the reasons for its occurrence: (1) The operation inadvertently lost the percutaneous renal expansion channel, the original channel was not blocked, and when re-punctured, the new channel was perfused with high pressure and the negative pressure attraction of the chest cavity caused the perfusion fluid to enter the chest cavity leading to the occurrence of severe fluid pneumothorax. (2) Due to pleural injury, the working sheath or nephrostomy tube is blocked by debris particles, the intrarenal perfusion pressure is too high, and the perfusate can also leak extravasated through the perirenal space into the thoracic cavity and cause pleural effusion. (3) When the nephrostomy tube placed between two potential pleural layers is removed prematurely, because of the failure to form a stable sinus tract, with the change of breathing and body position, the pleura separates and gas or perirenal fluid can be sucked into the thoracic cavity again, which can lead to hemothorax if combined with channel bleeding. Therefore, high puncture such as the 10th intercostal space should be avoided as much as possible, and when high puncture is really needed, strict attention should be paid to the operation during the operation, and the puncture should be performed after the end-expiratory closure of the needle. Adequately fix the guidewire to prevent slippage of the dilated channel, keep the working sheath unobstructed, and avoid excessive perfusion pressure. In case the percutaneous renal channel is lost, it must not be searched repeatedly, which will only increase the perirenal fluid accumulation and may be aspirated into the chest cavity with serious consequences.