To investigate the typical disease characteristics of energy transport channels in winter cold regions and guide the design for extending road service life, the causes of diseases such as pavement reflective cracks, continuous potholes on bridge decks, and failures of bridge drainage systems were analyzed based on the 20-year operation data of a 531 km in-service expressway in the coal energy region of northern Shaanxi. The research results indicate that when the asphalt pavement thickness reaches 22 cm, the reflective crack spacing of the expressway operated for 15 years can be controlled to over 50 m. Basically, no base layer water damage caused by cracks occurs, and the pavement service life can be significantly extended. The relatively thin 8 cm thickness of the cement reinforced concrete leveling layer on the bridge deck is the main cause of the continuous potholes on the bridge deck, and the ineffective removal of the laitance layer on the surface of the reinforced concrete is the main cause of the upheaval and slurry pumping diseases in the asphalt layer on the bridge deck. It is recommended to perform precision milling twice to thoroughly eliminate the laitance layer. Under the influence of coal slag and freeze-thaw cycles, conventional bridge drainage systems are highly susceptible to damage and failure. In this special environment, the bridge drainage systems are innovatively optimized. Prefabricated external hanging drainage gutters combined with vertical drainage systems are adopted to perfect the drainage systems of the bridge and the bank slope under the bridge, adapting to the special operating environment of energy transport channels in winter cold regions.