Abstract: The thin air, cold and dryness, and strong ultraviolet radiation in the alpine regions lead to low and unstable urban domestic sewage treatment efficiency, which brings challenges to the local urban domestic sewage treatment. It is necessary to summarize the urban domestic sewage treatment technologies to improve the treatment efficiency. This paper summarizes the application status of urban domestic sewage treatment technology in alpine regions of China, and points out that the urban domestic sewage treatment in alpine regions mainly adopts oxidation ditch, sequencing batch reactors (SBR), anaerobic-anoxic-oxic (A²O) systems, and membrane bioreactors (MBR) series processes. The problems of low microbial activity, sludge swelling and decreased microbial abundance in sewage treatment are elucidated. Enhancement measures for urban domestic sewage treatment are proposed, including regulating process parameters, improving processes, setting up thermal insulation measures, adopting combined processes, and carrying out bioaugmentation. To strengthen the efficiency of sewage treatment, three research directions are recommended, including the cultivation of cold-resistant bacteria at low temperature, the use of SBR and MBR series processes, and the development of new processes. To address the problem of low DO, corresponding research directions are recommended, including optimizing the aeration system, increasing the aeration time, and combining anaerobic and aerobic technology. In the future, the research and application of green and low-carbon technologies should provide new solutions for the treatment of urban domestic sewage in alpine regions.