The manufacturing of microstructured devices requires higher performance regarding the increasing development of finer structures and more complex structural shapes, which poses a challenge for existing measurement techniques in terms of anti-scattering, high-precision and high-speed. Accordingly, this study proposes a new technology for surface topography measurement of microstructures based on laser scanning transverse differential confocal (LSTDCM), which inserts a D-shaped aperture into the existing confocal system, and performs split-focal spot detection on the focal plane. This method exhibits improved axial resolution by performing differential phase subtraction of the front- and back-focal signals to obtain a highly sensitive axial response signal. Further normalization of the transverse differential confocal signal eliminates the multiplicative noise of the system, avoids the impact of changes in roughness on the measurement results, and achieves an anti-scattering measurement. The linear region of the axial response signal around the zero-crossing point were used to achieve a “non-axial scanning” height measurement, which was combined with high-speed beam lateral scanning to achieve a high-speed areal topography measurement. Theoretical analysis and experimental results indicate that, for samples with height changes within the linear region of axial response, the method can complete areal topography measurement in 1.7 s with the axial resolution of 1 nm and the measurement range of 128 × 128 μm. A microstructured device processed using a nanoform single-point diamond machine tool and a semiconductor wafer were employed in the application validation experiment. And achieve a wide range stitching measurement of 1 mm × 1 mm under a 100 × objective along with the transverse scanning stage. The measurement efficiency is about three times higher than that of Olympus OLS4100 confocal microscope. The method provides a new and effective technical approach that is not limited by the surface roughness and complex structure of the tested devices, and can achieve high-precision as well as high-speed optical nondestructive measurement without moving the tested device. Thus, this work is expected to has important practical applications in the field of ultra-precision measurement.