A reasonable and stable stope structure is the premise of realizing safe mining of underground metal ore. To safely mine the gently inclined medium-thick ore body, stope stability in Bainiuchang Mine was analyzed based on the pillar area bearing theory, and stope stability with regard to nine groups of structural parameters was numerically simulated. The results show that the existing stope structural parameters failed to maintain stability requirements and tended to be exposed to the risk of stope collapse. The middle section of the pillar as well as stope roofs and floors are vulnerable due to tensile stress when mining by open stoping, and the compressive stress concentration is prone to occur at the junction of the pillars, stope side walls, roofs and floors. Shear stress contributes little to pillar failure. The reasonable stope structural parameters of open stoping for the gently inclined medium-thick ore body in Bainiuchang mine are optimized using ANSYS numerical simulation: stope height 4.5 m, pillar diameter 4 m, pillar spacing 7 m and pillar row spacing 8 m. The onsite trial shows that the ore recovery rate reaches 82% under these parameters, which also realizes the equilibrium of safety and economy.