Much of the 1 078 km long Golmud-Lhasa oil pipeline is located in the permafrost regions at the average elevation above 4 500 m in the interior of the Tibetan Plateau, a region characterized by severe climate and active tectonic activities. There are many ecological and environmental problems, which significantly affect the structural integrity and long-term stability of the pipeline system. Along the pipeline, geohazards and human activities caused significant deformation of the pipeline foundation soils and led to many oil products leaks during the past 30 years. Climate warming and human activities have greatly impacted the permafrost environments along the pipeline route. However, inadequate attention was paid on the cold-region environments and frozen-ground foundations. In the paper, various aspects of the engineering and ecological environments during the past 30 years are reviewed. The mitigative measures for these engineering and environmental problems are proposed. In the end, suggestions are put forward for pipeline construction and the management of cold regions environments along the pipeline route. They include: 1) Timely and practical detecting the internal and external structures of the pipeline; 2) Systematically assessing the risk of pipeline operation and environment; 3) Improving the automation levels of the pipeline monitoring and management; 4) Establishing a long-term monitoring system for the heat-moisture regimes and deformation for pipeline foundation soils; 5) Coordinating the integrated management and protection of the cold regions ecological environments along the Qinghai-Tibet Engineering Corridor (Golmud to Lhasa).