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Although ratiometric nanothermometer offers a rapid temperature imaging solution, accurate in vivo signal extraction remains challenging due to the autofluorescence and wavelength\u2010dependent tissue absorption and scattering. Herein, a time\u2010resolved ratiometric fluorescence nanothermometer composed of europium and iridium complex with identical working wavelength but distinguishing lifetimes is reported, whose well\u2010designed structures enable 450\u00a0nm excitation of both complexes with a high quantum yield (57.8%). Based on the nanothermometer, accurate signal extraction is realized in whole blood, beneath a 2 cm tissue phantom and a 5 mm pork slice through a time\u2010resolved ratiometric method. By leveraging the exceptional thermal sensitivity (6.9% K\n                    <jats:sup>\u22121<\/jats:sup>\n                    ), high temperature resolution (0.02 K), and clinically relevant temperature range (30\u201396\u00a0\u00b0C) of the nanothermometer, a fluorescence temperature endoscopy system is further designed with a real\u2010time temperature imaging speed of 10 fps, which is applied to minimally invasive temperature monitoring during microwave ablation of liver tumors in rabbits, realizing precise ablation control through dynamic ablation power adjustment. The real\u2010time and accurate temperature imaging performance of the nanothermometer may offer a new perspective for intraoperative guidance.\n                  <\/jats:p>","DOI":"10.1002\/adma.202503726","type":"journal-article","created":{"date-parts":[[2025,4,21]],"date-time":"2025-04-21T03:42:43Z","timestamp":1745206963000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Time\u2010Resolved Ratiometric Fluorescence Nanothermometer for Real\u2010Time Endoscopic Temperature Guidance during Tumor Ablation"],"prefix":"10.1002","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3718-9268","authenticated-orcid":false,"given":"Lei","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Chemistry &amp; Academy for Engineering and Technology Fudan University  Shanghai 200441 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