In order to achieve sustainable development and control environmental pollution, this paper proposes sewage sludge (SS) as an auxiliary cementitious material, which is mixed with ordinary Portland cement (OPC), fly ash (FA), and gangue to produce sewage sludge cemented paste backfill (SS-CPB) material. The fluidity and mechanical properties of backfill materials with different SS contents and the heavy metal leaching mechanism of SS-CPB are investigated. The results reveal that (1) with the increase of SS content from 10 to 30%, the slump of fresh SS-CPB mortar decreased from 21.7 to 18.2cm, the initial setting time decreased from 2.83 to 0.58h, and the final setting time decreased from 4.92 to 0.83h. (2) Compared with the control group, the 3-day unconfined compressive strength (UCS) of the SS-CPB mixed with 10% SS increased by 49.5%, and the UCS decreased slightly in the later stage, but it also met the actual needs of coal mines. (3) Scanning electron microscopy (SEM), X-ray diffraction (XRD), and Fourier transform infrared (FTIR) spectroscopy were used to study the SS-CPB samples. It was found that the free Al3+ in SS promoted the formation of ettringite (AFt), provided part of the early UCS, and accelerated the setting time. (4) The leaching rule of heavy metal ions was analyzed in combination with leaching kinetics, and the change of heavy metal ion mass concentration in the rising stage was in line with the contraction core model controlled by diffusion.