Objective: The purpose of this study is to evaluate the effect of X-ray guided re-establishment of the channel in percutaneous nephrolithotomy (PCNL). Method: A total of 553 complicated kidney stone cases who received PCNL were collected in our hospital from January 2015 to June 2020. Among them, 500 cases were successfully one-time access under ultrasound positioning. The other 53 cases lost the channels during the operation and the channel was re-established with the help of X-ray guidance. The rate of stone clearance, operation and hospitalization time, postoperative fever, perinephric effusion, postoperative bleeding, interventional embolization, sepsis and other postoperative complications were compared between the two groups.Results: There was no significant difference between the two groups in the rate of stone clearance, postoperative bleeding, interventional embolization, and sepsis ratio (P>0.05). There were statistically significant differences between the two groups in terms of operation and hospitalization time, perrenal effusion, and postoperative fever (P<0.05).Conclusion: In cases of the PCNL channel lost under ultrasound positioning, the use of X-ray positioning can effectively re-establish the channel. The stone removal rate is high and there are no serious surgical complications. It is worthy of clinical promotion.