经皮肾镜碎石取石术（PCNL）术后胸腔积液的发生率约为2%~16%，其发生主要与胸膜损伤、灌洗液外渗或吸收综合征有关。危险因素包括：术中肾盂压力>40 cm H₂O、灌洗时间长、结石复杂（多发或较大）、穿刺路径选择（肋上入路，尤其是第11/12肋间）、穿刺点偏内侧或高位，以及肋椎角较小等。预防措施包括：控制灌注压力（建议100~200 mmHg，相当于136~272 cm H₂O）、术中保持通道通畅、选择肋下或更安全的穿刺路径（如肩胛线外侧、低于第10肋）、在呼气末穿刺、术中使用超声引导并结合术前CT评估解剖结构。治疗上，对于少量积液可保守观察，中量积液可行穿刺抽液，而大量积液或伴有明显症状者需行胸腔闭式引流，必要时可辅助人血清白蛋白促进吸收。

The reported incidence of pleural effusion after percutaneous nephrolithotomy (PCNL) ranges from 2% to 16%, primarily attributed to pleural injury, extravasation of irrigation fluid, or absorption syndrome. Identified risk factors include renal pelvic pressure >40 cm H₂O during surgery, prolonged irrigation time, complex stones (multiple or large), supracostal access (particularly via the 11th or 12th intercostal space), medially or cranially located puncture sites, and a narrow costovertebral angle. Preventive strategies include maintaining low irrigation pressure (100-200 mmHg, equivalent to 136-270 cmH₂O), ensuring unobstructed outflow, selecting safer subcostal access routes (e.g., lateral to the scapular line, below the 10th rib), puncturing at end-expiration, intraoperative ultrasound guidance, and preoperative CT-based anatomical assessment. For treatment, conservative observation is appropriate for small effusions, moderate effusions may be managed by thoracentesis, and large or symptomatic effusions require closed thoracic drainage, with adjunctive human albumin administration if necessary to promote absorption.